structuring problem-based learning - mine, ours and yours

Structuring Problem-based Learning –Mine, Ours, Yours

Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

Annual Conference of Tripartite Training Institution in Manila

March 27, 2015


Problem-based learning (PBL)

- the learning that is triggered and acquired as a result of attempts to resolve a problem

encountered


PBL

• most effective way of learning by any human being with sound mind in terms of retention and recall of knowledge and skills

• most effective educational method that should be used by learning organizations regardless of type of profession


PBL

• promotes self-directed learning which is required by all human beings as they continue to live in this world and by all practicing professionals

• above statement is based on the fact that nobody will ever know everything in one’s life time and one has to keep on learning up to the last moment of life


In the practice of medicine, surgery included, even after graduation from medical school, residency and fellowship training programs,

• nobody should say that learning has been completed.

Self-directed learning still continues as there are still infinite things to learn.


How do practicing physicians continue learning after graduation from the formal training courses mentioned above?

It is through problem-based learning.


In the practice of medicine, the following events actually or should take place:

1. A physician meets a patient without prior knowledge of what the patient’s problem is.

2. During the encounter, the physician establishes rapport, diagnoses, treats, and gives advices with the goal of resolution of the health problem of the patient.



3. In the process of understanding and resolving the patient’s problem, the physician invariably encounters some insecurities, questions, and gaps in competencies.



4. The physician fills in the gaps in competencies through various means, such as self-study and learning from other people like consultations, referrals, and enrolling in a formal course.

5. The new competencies acquired are used by the physician on the patient on hand and on future patients.


The abovementioned 5 events or steps constitute the lifetime learning method of certified physicians after graduation from formal training courses.

The 5 steps constitute the PBL method during practice of medicine.


If PBL is the method practicing physicians will use after certification and for life for self-directed learning,

• it is but logical to advocate, if not insist,

• that all medical learning and training institutions should inculcate this learning method among their students or learners

• who will one day be practicing physicians and

• who will and have to use PBL for their continuing professional education.


I started being an advocate of PBL when I helped establish the Ateneo de Zamboanga University School of Medicine in 1994.

I helped in the formulation of the curriculum which carries this label: competency-based, problem-based, and community-based medical curriculum.


In the University of the Philippines College of Medicine Department of Surgery, I have been advocating PBL for the medical students and surgical residents who have been assigned to me for coaching.


In Manila Doctors Hospital Department of Surgery, I have been advocating PBL for the medical students and surgical residents who have been assigned to me for coaching.


In the Ospital ng Maynila Medical Center Department of Surgery, I have been advocating PBL since 2001 when I became its chairperson.


All of us

to a certain extent

are using PBL in our field of specialty (surgery).

Some are structured but most are not.

Some have maximized its usage but most have not.


Sharing

Mine

Ours – OMMC Surgery

Yours


Sharing

Mine

Structuring PBL – Mine (ROJ)

In my clinic, in operating room, in inpatient rooms, in medical conferences, anywhere and whenever I interact with patients, students, and colleagues -

• in the process of understanding and resolving a patient’s problem,

• I invariably encounter some insecurities, questions, and gaps in competencies.


What I do is to jot down these insecurities, questions, and gaps in competencies as PBL Issues (PBLI) in a sheet of paper or in a notebook.


Then, as soon as I can, and as much as I can, I use the Internet mostly and ask people in the know to fill in the gaps in my competencies.

I put the learnings that I got in my computer files or in my websites.


I share my learnings with other people – my patients, my students, and my colleagues.

It goes without saying that I put my learnings to use in my current and future patients.


Sharing


The PBL framework of problem trigger – learning

issues – independent study – information

reporting – knowledge reinforcement – learning

outcome evaluation was utilized and continually

developed.

The weekly postoperative and preoperative

conference, weekly case presentation and

discussion, and discussion topic for the

month were the main sources of problem trigger.

The learning issues consisted primarily of

patient management insecurities in clinical

diagnosis, paraclinical diagnostic process,

and treatment process, the resolution of

which, were all geared towards

incorporation into the department’s clinical practice guidelines.

PBLI: Hirschsprung’s DiseaseQuestion: In patients with documented HD, what is the percentage of collapsed / distended bowel but contain

ganglion cells?

The independent study utilized mainly

Internet search for information. The venue

for information reporting was either in the

Tuesday and Thursday conference hours or in the department’s group email. In subsequent years,

reporting is also done

in FB group.

The independent study utilized mainly

Internet search for information. The venue

for information reporting was either in the

Tuesday and Thursday conference hours or in the department’s group email. In subsequent years,

resident-intern

partnership was created

for the PBL activity.

Application to subsequent patient

management, debates and action

researches were main methods of knowledge reinforcement.

Outcome evaluation consisted mainly of

continuous observation for positive changes in study habit and patient care.

With systematization, the surgical residents

acquired a clearer concept of PBL,

appreciated the self-directed learning effect

of PBL, and developed an efficient way of PBL which they could use after graduation.

Challenges: problems in fulfilling the requirements of the independent study by the residents: absence of accomplishment, tardiness, and no follow-through.

Discipline and perseverance are the recommended strategies.


Sharing


Current Status:

Up to now, under Chairperson, Dr. Hazel Turingan,

OMMC Surgery is still promoting problem-based

learning habit among the residents and medical

students.


Sharing

Mine


How about YOURS?

structuring problem-based learning - mine, ours and yours

Healthcare

selfdirected learning

medical learning

learning organizations

patients problem

effective way of learning

health problem

practice of medicine

pbl method