jim anderson – john evans – t. fraser mustard – …henk+schmidt.pdflife in the judgement of...
TRANSCRIPT
Forty-five years of PBL: Does it deliver on what was promised?
Henk G. Schmidt
Department of Psychology Erasmus University
JIM ANDERSON – JOHN EVANS – T. FRASER MUSTARD – BILL SPAULDING – BILL WALSH
Growth of number of PBL-schools worldwide 1969-2005
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1970 1975 1980 1985 1990 1995 2000 2005
Year
Number of PBL schools
Characteristics of PBL Problem is main stimulus for learning: “The problem
comes first.” Students work in small groups guided by tutor (tutor
does not teach; “facilitates”) Use systematic approach: 7-jump Limited number of lectures; ample time for self-
directed learning Horizontal and vertical integration of subject matter
(in the health sciences) Skills training integrated in PBL-curriculum Serial rather than parallel curriculum Information needed for learning provided online Communication with students online
Gaining weight suddenly: a normal process when you are over forty? A man in his forties comes to your office complaining that he has grown fat in a short time. His abdomen is swollen and he finds it difficult to fasten his belt. His eyelids and the skin around his eyes appear to be swollen too. The percentage of plasma protein in his blood is lower than normal. How would you manage his problem?
Gaining weight suddenly: a normal process when you are over forty? A man in his forties comes to your office complaining that he has grown fat in a short time. His abdomen is swollen and he finds it difficult to fasten his belt. His eyelids and the skin around his eyes appear to be swollen too. The percentage of plasma protein in his blood is lower than normal. What is the matter with this man?
Blood transfusion for a child of Jehovah's witnesses.
A child is admitted to the Emergency ward of a hospital. She has been knocked down by a motorcar and has lost a substantial amount of blood. The only way to save the child's life in the judgement of the attending physician will be transfusion. However, there is a problem, namely that the parents are not likely to give their consent because their religion forbids transmission to their child's body of another person's blood. “She is in God’s hand.” Should transfusion take place in spite of this, the parents will reject the child. What do you think the physician should do?
Procedural
Descriptive
Strategy problem
Declarative
Explanatory
Explanation problem Fact-finding problem
Normative
Knowledge of the world
Public knowledge (e.g., to be found in books)
Personal knowledge
Moral dilemma resolution problem
An example: Love at first sight?
The picture shows the Capilano Bridge in the neighborhood of Vancouver. On this bridge, Dutton and Aron conducted in 1974 a curious experiment. A beautiful research assistant (‘Gloria’) was placed halfway on the bridge. She asked passing males to write, on the spot, a short story about a number of ambiguous pictures shown. In addition, she offered the subjects the opportunity to phone her a few days later to be informed about their score for the story. Exactly the same procedure was carried out at another site, a short bridge that crosses the Capilano River three meters above water level. The stories were scored with regard to the amount of erotic content. In addition, the percentage of participants that called the research assistant was recorded. About 12% of the low-bridge-males called Gloria, whereas almost half of the Capilano bridge participants called. In addition, the stories produced on the Capilano Bridge contained significantly more erotic material.
cell level
tissue level
organ (system) level
person level
family level
population level
“Problems” of pathological functioning
“Problems” of normal functioning
Levels of human functioning
Varieties of written problems
How did PBL change the face of conventional HPE?
Many schools have integrated basic-science with clinical-science teaching: both horizontally and vertically
Greater emphasis on community health needs Earlier introduction into the health care system Behavioral sciences included to larger extent Many schools use patient problems as focus of learning Small-group tutorials have been introduced even in
conventional programs Less lectures and less parallel programming More emphasis on professional skills, communication
and ethics
Do you expect PBL-graduates to be different? If so: in what ways?
What was promised?
According to the early literature, PBL would contribute to renewal of the medical curriculum a more student-centered learning environment students acquiring better clinical reasoning
skills students acquiring better interpersonal and
other relevant professional skills (acquisition and retention of relevant medical
knowledge)
Did PBL act as a enzyme for curriculum renewal?
Generally: Yes Many schools have integrated basic-science with
clinical-science teaching: both horizontally and vertically
Greater emphasis on community health needs Earlier introduction into the health care system Behavioral sciences included to larger extent Many schools use patient problems as focus of learning Small-group tutorials have been introduced even in
conventional programs Less lectures and less parallel programming More emphasis on professional skills, communication
and ethics
Does PBL provide a more student-centered learning environment? According to most studies: Yes Students report less stress, fewer feelings of
being powerless, and less fatalism (Kuhnigk & Schauenburg, 1999)
Students feel more supported by learning environment, and experience more social support (Kiessling, et al., 2004)
In Dutch nationwide surveys among students, problem-based curricula always finish first in their category
Student ratings of Dutch medical curricula 2006
Source: Keuzegids 2006-2007
Student ratings of Dutch psychology curricula 2004
Source: Keuzegids 2004-2005
Does PBL help students acquire clinical reasoning skills? According to few studies available:
Yes Hmelo (1997, 1998a, 1998b): PBL has
strong effects on clinical reasoning and representation skills
Schmidt et al. (1995) Schuwirth et al (1999): PBL improves on
diagnostic competence with 8%
Schuwirth’s (1999) study of diagnostic competence
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Year
Dia
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Maastricht PBL
Groningen
Interlude: Potentially important professional competencies of university graduates Getting much work done
productivity, efficiency, effectiveness Getting work done with the help of others
team work, leadership Getting work done in new innovative ways
creativity, problem-solving Getting work done using science
finding, reviewing, producing, disseminating scientific knowledge
Does PBL help students acquire such professional competencies? All studies point in the same direction:
Yes e.g., Woodward & McAuley (1983) study
using supervisor ratings Van Dalen et al. (2002) Schmidt et al. (2006) using self-ratings
How good are you, compared to colleagues from other universities in: Communication skills?
1 2 3 4 5 Much poorer Much better Equally good
Schmidt’s et al. (2006) comparison of professional skill levels
Comparing performance of about 1400 graduates from two medical schools in the Netherlands
Using self-ratings on five-point scales
Schmidt’s et al. (2006) comparison of professional skill levels
Comparing performance of about 1400 graduates from two medical schools in the Netherlands
Using self-ratings on five-point scales
Maastricht PBL-curriculum
Rotterdam conventional curriculum
Interpersonal competencies e.g., communication skills, leadership skills, and collaboration skills 3.94 3.24
Schmidt’s et al. (2006) comparison of professional skill levels
Comparing performance of about 1400 graduates from two medical schools in the Netherlands
Using self-ratings on five-point scales
Maastricht PBL-curriculum
Rotterdam conventional curriculum
Interpersonal competencies e.g., communication skills, leadership skills, and collaboration skills 3.94 3.24
Medical knowledge level 3.16 3.21
General academic competencies e.g., conducting research, report writing skills, and statistics knowledge level 3.21 3.12
Schmidt’s et al. (2006) comparison of professional skill levels
Comparing performance of about 1400 graduates from two medical schools in the Netherlands
Using self-ratings on five-point scales
Maastricht PBL-curriculum
Rotterdam conventional curriculum
Problem-solving and self-regulation competencies e.g., problem-solving, use of resources, self-directed learning
3.70 3.28
Physical examination skills 3.60 3.19
Task-supporting competencies, e.g., productivity, efficiency 3.58 3.42
Does PBL support acquisition and retention of medical knowledge?
According to most curriculum-level studies: No
Van der Vleuten et al. (2004): Retention of medical knowledge
Assessments of the value of PBL Colliver (2001): “There is no
difference in knowledge acquired with students from conventional schools. So why bother?”
Shanley (2007): “Let’s leave the empty glass of PBL behind.”
Kirschner (2007): “Minimally guided instruction does not work.”
Does PBL support acquisition and retention of medical knowledge?
According to most curriculum-level studies: No
According to micro-level experimental studies: Yes, and with large effects (e.g., De Grave et al., 2001)
A stinging incident Mr Laeven practises a hobby that most of us find rather scary to say the least. At the back of his yard, he has a number of beehives. He always visits his bees first thing in the morning. One morning, when he arrives at the back of the yard, he stumbles and hits a hive. No need of telling what happened. He hardly manages to reach the house and alarms his wife, who calls their family physician. Mr Laeven's sting wounds are seriously aching and after some five minutes he feels faint and gets dizzy. He is in a cold sweat and is getting sick. The family physician arrives after 15 minutes. She sees a conscious looking man with a regular breath. The family physician counts a pulse rate of 88 beats a minute and takes the blood pressure: 120/80 mmHg. After five minutes, she takes the pulse rate, 104 beats/minute, the blood pressure then being 115/80 mmHg. After another five minutes Mr Laeven has a pulse of 120 beats/minute and a blood pressure of 85/55 mmHg. The acra are hot. The family physician injects adrenaline intravenously.
Number of propositions recalled (De Grave, et al, 2001)
Does PBL support acquisition and retention of medical knowledge?
According to most curriculum-level studies: No
According to micro-level experimental studies: Yes, and with large effects (e.g., De Grave et al., 2001)
My interpretation: Serious methodological errors were made in the Colliver and Kirschner curriculum-level reviews
Cohen’s d
Curriculum-comparisons approaches to PBL: Maastricht findings (Schmidt, 2009)
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17.1
6.6
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Conventionalcurriculum
PBL in basic sciences Full PBL -curriculum
Study Group
Per
cen
t
Attrition rates in subsequent Harvard dental curricula
Graduation rates Dutch medical students 1989-1998
70
75
80
85
90
95
Study duration Dutch medical students 1989-1998
6.4
6.6
6.8
7
7.2
7.4
7.6
7.8
Hypothetical effects of two treatments
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1 2 3 4 5 6 7 8 9 10
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6 7 8
6 7 8
6 7 8
6 7 8 9
5 6 7 8 9
4 5 6 7 8 9
4 5 6 7 8 9
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Treatment A Treatment B
MeanA = 6.81 MeanB = 6.31
Hypothetical effects of two treatments (poor performers removed)
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6 7 8
6 7 8
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4 5 6 7 8 9
4 5 6 7 8 9
3 4 5 6 7 8 9
1 2 3 4 5 6 7 8 9 10
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6 7 8
6 7 8
6 7 8
6 7 8 9
5 6 7 8 9
4 5 6 7 8 9
4 5 6 7 8 9
3 4 5 6 7 8 9 10
Treatment A Treatment B
MeanA = 7.38 MeanB = 7.41
Dropout = 19% Dropout = 30%
Summary statistics of the Schmidt (2012) study and the effects of correcting for differences in attrition and study duration