Problem Based Learning Implementation Guide
Problem Based Learning Implementation Guide
LEARNING
IMPLEMENTATION GUIDE
PREPARED BY
LALEM MENBER, IFAIMER FELLOW 2020
Contents
Background to Problem Based Learning................................................................................................. 2
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BACKGROUND TO PROBLEM-
BASED LEARNING
Nowadays’ a lot of information is available on the internet, then the real question that
needs to be answered is “should we continue providing all this information in our learning
environment or instead ask students to acquire all this information and discuss it with
themselves in small groups”? The answer should be, the role of the instructor should be
changed from information provider to a facilitator, supporting students to be self-directed
learners.
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to learn biomedical sciences, public health, ethics, and professionalism in a clinically
relevant context and hence improve retention of knowledge. Studies also showed that
PBL graduates had better-perceived learning experiences (Trevena, 2007).
Learning for - The processes of inquiry are more important than the facts
understanding delivered
- Knowledge must be tested by application
- Feedback and Reflection are an integral part of the learning
process
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The Rationale of Developing the Guide
Universities are implementing the new innovative competency-based curriculum where
PBL is used as a major learning strategy. The hybrid PBL curriculum integrates the
advantages of the conventional and the innovative curriculum. PBL is used mainly to teach
biomedical sciences in a relevant clinical context and help students acquire generic skills
such as functioning in a team, communication, professionalism and ethics, synthesis,
critical thinking, problem-solving, and self-directed learning skills, etc. However, problem-
based learning implementation is inconsistent not only across institutions and programs
but also among instructors in terms of case presentation format, case writing format,
frequency, and duration of tutorials, the use of formative and summative assessments,
and the percentage account of PBL tutorials for summative value. Furthermore, PBL
experts have different experiences and understanding, lack consensus about PBL
problems, processes, and practices.
Several factors might have been contributing to the inconsistency in the implementation
of the hybrid PBL curriculum. A survey at Debre Tabor University Midwifery program
revealed that the Lack of institutional or national standard problem-based learning
implementation guide is one of the hindering factors for the effective implementation of
PBL. The teaching and learning process is affected by socio-cultural factors. Having a
standardized PBL implementation guide is critical for the effective implementation of
competency-based curricula. So, Institutions may have their way of implementing PBL
based on the local context. The application of PBL as a unitary concept across different
contexts is being challenged by experts (J. M. Frambach, W. Talaat, S.Wasenitz, & M.A
(Tina). Martimianakis, 2019). Thus, scholars recommend adapting PBL into the local
context. Therefore, we prepared a contextualized guide considering international and
national practices to standardize the PBL implementation. It will help instructors and
students recognize their roles and responsibilities, frequency and duration of tutorials,
case qualities, assessment modalities, etc.
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GUIDELINES FOR
CONSTRUCTING PBL CASES
Well-constructed cases are essential for successful problem-based learning. PBL cases are
generally expected to be ill-structured, realistic scenarios that promote broader thinking
and inspire learning. The case will help to integrate clinical medicine, biomedical science,
behavioral/mental, population, professional attitudes, values, ethical issues, etc. which are
fundamental to medicine.
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- Decide on the flow and key educational issues planned for each part of the case.
New information is provided as the case unfolds requiring students to test and
revise their hypotheses.
- Cases should be on priority health needs of the region/country
- Ensure the case is up-to-date and relevant for the level of students
b) Identify educational objectives of the case
- Derived and linked to module objectives
- 6 -7 objectives per case that can be feasibly addressed in the given period
- Objectives should cover different disciplines and perspectives
› Biological
› Psychosocial and population health issues
› Professionalism and ethical issues
c) Construct a template for cases: The case writing template may vary from disciple
to discipline. Departments/programs may have their case writing format. The case
is constructed to include some or all of the following elements.
› Patient and Visit Information
› Presenting problem/triggers
› History of Present Illness, Past Medical History, and Social History
› Review of Systems
› Ancillary Investigations and Results
› Differential Diagnosis/Hypotheses
› Treatment
› Patient Follow-Up
› Exhibits
› Mini Cases (Vignettes)
d) Think integration, logical flow, and authenticity of the case
› The case provides a focus for integrating a wide variety of learning activities;
Multiple categories of health and risk factors, different mechanisms of disease
› Reflect real practice thereby stimulating a wide range of realistic testable
hypotheses
› ill-structured
› Written from the patient’s perspective: The chief complaint and history are
written in patients’ own words
› Written for students and encourage student-centered learning
› Logical inflow and address objectives
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e) Adjust cases to students’ learning needs and stages of the curriculum
f) Start the case with an engaging trigger
› Addresses key objectives
› Highlights 3-4 key problems
› Encourages broad discussion
› Reflects a realistic scenario
› Provides some background info (age, sex, place of a visit, etc.)
g) Think about students’ engagement with the cases
h) Ensure a deductive approach is applicable
i) Ensure learning objectives are well represented in the case
j) Design images and investigations
k) Mini case: mini cases should be included if the focus of the discussion is more on
clinical and small biomedical sciences. Creating what-if scenarios to help students
apply their knowledge in different contexts. These can be changes in risk factors like
ethnicity, age, sex, lifestyle, etc.
III. Formatting the Case: The format for the case is determined through
consideration of the following questions:
- What information will be provided to students initially?
- How will you provide additional information, if any, to students as they progress
through the case?
- At what point should case exhibits be provided?
- Do you want to include any supplemental activities such as role-plays, videotaped
patient interactions, visiting patients, simulated patients, etc.?
IV. Preparing for use of the Case/ proof reading the case
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CONSTRUCTING TUTOR GUIDE
As most teachers lack experience in facilitating PBL, they are more likely to encounter
difficulties in planning, implementing, and assessing PBL. A tutor guide is an institutional
document that describes all necessary knowledge and skills which an effective tutor is
supposed to have. Each university/institution with a PBL curriculum creates its tutor guide
or tutor handbook based on global experiences and achievements in PBL implementation
and includes some details specific for a particular university.
The tutor guide consists of all the necessary information/ instructions regarding a
specific PBL case. During PBL tutorial a tutor watches, listen, directs, and helps students
with asking the questions, giving them hints (hint questions) if they need to go deeper or
more detailed in their discussion of the learning objectives. That is why each PBL case has
to have a tutor guide with precise instructions, explaining what exactly students are
supposed to know, understand, how deep they should study one or the other learning
objective.
A tutor guide has an explanation per each page of the scenario. So when the students see
a page, the tutor knows what exactly the students should discuss on this page, which
learning objectives they can create here, which new terms students are supposed to
understand.
Knowing from the beginning of the PBL case the final learning outcomes (official learning
objectives), and having precise notes a tutor can easily facilitate the discussion even if
she/he is not an expert in that area. That is the crucial part of a PBL tutor guide – a tutor
does not need and cannot be an expert in all topics of PBL cases. If students do have some
particular questions related to the specific areas, they are supposed to clarify them either
on the lectures (where a lecture is an expert in the exact area) or on the expert forum
(whole group session) which some universities include in PBL curriculum to give their
students opportunity to talk with the professional clinicians. Generally, there are not many
unanswered questions for the students if there are good PBL tutor guides.
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Components of case-specific tutor guide
For facilitators to effectively lead the tutorial process and achieve the objectives, they need
to have the following information about the case before the date of the tutorial:
- A brief abstract of the case
- Location in the course: year, module, week
- The list of objectives (learning goals/ objectives): behavioral, mental health,
biological, population, professional attitudes, values, and ethics
- Overview of tutorials with a brief explanation of what exactly students should
concentrate on in this particular tutorial (Tutorial 1; Tutorial 2).
- Suggestions for facilitating the case (e.g., case progression, recommended
discussion points, prompting questions, what to avoid, etc.):
- Instruction for tutors per each page of the information given to students so that the
tutor knows what students will be discussing when they see a page.
- Information about other integrated educational activities (e.g., lecture, laboratory,
and clinical skills)
- Related and necessary investigations and exhibits, suggestions on how to use them
during the tutorial, and a thumbnail guide to their interpretation and what they add
to the understanding of the case.
- References: Supporting educational materials for the facilitator (e.g.,
articles/information to inform facilitators about the content of the case)
- The list of resources available during tutorials
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FACILITATING PBL TUTORIALS
PBL is a student-centered inquiry where the problems are the starting and ending points
of the PBL tutorial process. The problem creates a realistic context to activate prior
knowledge and experience. Students will be in small groups to learn collaboratively but
that doesn’t mean they are interdependent.
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Day 1 Day 2 Day 3 Day 4
Figure 2: A 3-hour PBL tutorial will be facilitated every week. Every tutorial is divided into
two parts. In the first 2 hours, the case from the previous week will be completed. In the next
1 hour, the next case will be started
PBL tutorials will be conducted once a week that will last for 3 hours. A problem/ case/
scenario will be concluded in two tutorials. The first day of the tutorials will start by
orienting students about the process and opening up a case. Then, the subsequent
tutorials will have two parts; the first part will run for 2 hours and the second part will
continue for the remaining 1 hour. In the first part, the synthesis of the past week's case
will take place in 2 hours and the remaining 1 hour will be used to open the new case and
discuss it till step 5 of the PBL tutorial process.
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Roles and Responsibilities of Tutors and Students
Tutors’ roles
In PBL the role of the teacher is shifted from a “sage on the stage” to a “guide by the
side”(Telang, 2014). Teachers are not expected to provide information, but to guide the
discussion in the tutorial process. A good tutor is like a football coach; he/she actively
listens while students discuss, understands the learning issues to be discussed, and knows
what and when to ask. Hence, instructors who received PBL training can facilitate PBL
tutorials as far as they are provided a well-prepared tutor guide. Tutors should stay in the
same group at least till the end of a module.
Tutors responsibilities
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Students’ roles
A small group of 8-10 students will engage in enquire-based learning. Students will
identify their gaps (need to know) while trying to explain and manage the problem.
Students will assume different roles and responsibilities in PBL tutorials. In the first
meeting, students have to be oriented about the general principles of the PBL tutorial
process (ground rules, roles, and responsibilities of students & tutors).
Roles Responsibilities
Chair - Lead the group discussion in the tutorial process
- Encourage active participation by asking questions
- Help group to order their thoughts by paraphrasing statements
- Maintain group dynamics
- Keep to time
- Encourage scribe to keep recoding of points and share learning issues
Scribe - Record points only upon consensus by the group
- Actively contribute to the group discussion
- Record resources used by the group
Members - Comply with ground rules set
- Select a group leader and a note taker and explain their roles
- Actively participate and contribute to the learning process
- Debate evidence related to the case and avoid personal attack
- Research key learning issues using a variety of resources
- Synthesize what you have learned and be prepared to discuss
- Participate in end-of-session reflection and assessment by giving and
receiving constructive criticism regarding self, tutor, and peers.
- Validate and summarize the key points about the specific case to be
addressed and link back to learning objectives
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ASSESSMENT IN PROBLEM-
BASED LEARNING
In a competency-based curriculum, the assessment drives the learning activities. It is the
motivating factor for students to engage in meaningful learning activities. Thus, in PBL
both the tutorial process and the contents covered are assessed. Student performance
assessment in PBL tutorials should be a continuous process. Assessment rubrics are used
to minimize subjectivity in assessing student performance during the PBL tutorial process
(Sim, Azila, Lian, Tan, & Tan, 2006). The content (knowledge) covered by the tutorial
process will be assessed in block exams like mid-exam and final exams.
Summative Assessment
PBL tutorial assessment should account for 15% of the summative value of the module
assessment. The tutor will do the summative assessment at the end of every second
tutorial (completion of the case). The average value of each assessment score will be
turned out of 15%.
Formative Assessment
The performance of students should be assessed at the end of every PBL tutorial.
Feedback and reflection are an integral part of the PBL tutorial process. Narrative
feedback is more important in the PBL tutorial processes. Students are expected to reflect
on their performance (strengths and gaps to be improved) followed by constructive
feedback from peers and tutors. Student assessment in the PBL tutorial should focus on
the PBL tutorial process (e.g. researching, collaboration, communication, etc.). Peers can
reflect on and assess the performance of other students. Self and peer assessment results
are more generous than teacher evaluation, and hence they should be used for formative
value only. Formative feedback should be assembled, reflected, and documented as a
learning portfolio.
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PBL tutorial assessment rubrics
Module name……………………………. week……………………...tutorial #……………………………
Table 1: PBL tutorial assessment rubrics for assessing student performance during PBL tutorial
Signatures
Name of tutor----------------------------------------
References