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MEDICAL EDUCATION
Year : 2023  |  Volume : 21  |  Issue : 1  |  Page : 73-76

Proposing a framework to plan and implement problem based learning sessions for undergraduate medical students


1 Deputy Director – Academics, Sri Balaji Vidyapeeth – Deemed to be University, Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission03-Sep-2022
Date of Decision19-Sep-2022
Date of Acceptance26-Sep-2022
Date of Web Publication17-Jan-2023

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
MD, FAIMER, PGDHHM, DHRM, FCS, ACME, M.Phil. (HPE), Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) . Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_100_22

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  Abstract 

The process of transforming a freshly joined medical student into a competent medical graduate is a complex one. It is an indisputable fact that having good knowledge (cognitive domain) is crucial for better performance in psychomotor and affective domains. In the global vision to improve health-care delivery, it is crucial that medical students are trained in critical thinking, clinical reasoning, and problem-solving skills. Problem-based learning (PBL) is a student-centered teaching–learning strategy, which ensures the active engagement of learners. As students get an opportunity to perform a literature search or explore different learning resources, they attempt to learn through self-directed learning, and in the process understand the need to be a lifelong learner for a successful clinical practice in future. In conclusion, PBL session is an effective way to inculcate complex cognitive skills among medical students, and thus, it is quite essential that medical colleges should initiate and implement PBL in their settings after proper planning and with the support of the Medical Education Unit.

Keywords: Clinical reasoning, critical thinking, medical education, problem-based learning


How to cite this article:
Shrivastava SR, Shrivastava PS. Proposing a framework to plan and implement problem based learning sessions for undergraduate medical students. Curr Med Issues 2023;21:73-6

How to cite this URL:
Shrivastava SR, Shrivastava PS. Proposing a framework to plan and implement problem based learning sessions for undergraduate medical students. Curr Med Issues [serial online] 2023 [cited 2023 Feb 1];21:73-6. Available from: https://www.cmijournal.org/text.asp?2023/21/1/73/367853


  Introduction Top


The process of transforming a freshly joined medical student into a competent medical graduate is a complex one. This is predominantly due to the multiple attributes expected of a medical graduate, which essentially include the acquisition of knowledge, skills, development of the right attitude, and many other noncognitive traits (namely, professionalism, teamwork, leadership skills, etc.).[1],[2],[3] It is an indisputable fact that having good knowledge (cognitive domain) is crucial for better performance in psychomotor and affective domains, as for doing any task (including patient care), medical students should have sound knowledge.[2],[4] Acknowledging the fact that the ultimate aim of medical education is to improve the health-care indices in the community, it is essential that medical students are trained in cognitive domain-related skills.[5],[6] In the global vision to attain this aim, it is crucial that medical students are trained in critical thinking (refers to the ability to analyze available evidence and observations to make a judgment), clinical reasoning (ability to diagnose and decide about the management of patient depending on their clinical presentation), and problem-solving skills.[6],[7],[8]


  Critical Thinking, Clinical Reasoning, and Problem-Solving Skills Top


Critical thinking to the medical students can be taught by giving them analogies with real-life examples through encouraging discussion among students, asking open-ended questions that make students think, the encouragement of reflection, or even through real-life examples.[5] The acquisition of clinical reasoning can be accomplished by exposing medical students to a range of clinical cases, triggering prior knowledge, teaching students to prioritize differential diagnoses, ruling them out through role modeling, etc.[6],[7] The training in problem-solving skills can be delivered by giving practical problems to the students and asking them to resolve them using an evidence-based approach.[8],[9]

These skills are crucial for medical professional as it helps them to practice evidence-based medicine using their clinical acumen to manage patients and not unnecessarily ask for irrelevant laboratory or radiological investigations.[9],[10] However, it is difficult to ask medical teachers to train medical students in these crucial cognitive domain-related skills.[5],[7] We have to accept that the traditional teaching–learning method (namely, didactic lecture) will not be very much effective to ensure competency in these skills. In other words, there is a need to adopt interactive teaching–learning methods to bridge the existing lacunae and thereby train medical students in these specific skills.[11]


  Problem-Based Learning Top


Problem-based learning (PBL) is a student-centered teaching–learning strategy, which ensures the active engagement of learners.[12] As the name itself suggests, in PBL students learn by working in small groups to resolve the identified problems.[12] In fact, the problem, in itself acts as the motivating factor for the students to learn, and in the process acquire critical thinking, clinical reasoning, and problem-solving skills.[12],[13],[14] As the students work in small groups, they also learn teamwork and leadership skills, which are very much crucial for health-care professional. In addition, PBL exercises make the student aware of themselves, as well as the group processes that are involved.[14],[15]

As students get an opportunity to perform a literature search or explore different learning resources, they attempt to learn through self-directed learning, and in the process understand the need to be a lifelong learner for a successful clinical practice in future.[15] This literature search also provides students with a chance to work independently and learn the significance of evidence-based medicine. Eventually, the medical students learn to apply the gained knowledge to real-life examples and be more and more effective.[9],[10],[16]


  Constructivism and Problem-Based Learning Top


Constructivism refers to a process of constructing knowledge by adding new information to past experiences.[12] In PBL, students are given problems in the real world, and they acquire knowledge by designing solutions to the identified problem by adding new information to prior experiences.[16],[17] The goal is to facilitate students to build knowledge based on a wide range of experiences, to ensure that students not only learn how they learn but also even learn the art of evaluating alternate solutions.[16],[17] Further, the knowledge and authority are shared between teachers and students. As the students learn in small groups, they are actively involved in the process of knowledge acquisition (student-centered learning).[14],[16]

In addition, students are given a chance to question, explore, and gain an in-depth understanding of resolving their inquisitiveness. Moreover, it requires reflection and abstraction by the students, so that they become aware of the knowledge-construction process.[17],[18] Owing to the active involvement of students, the learning is joyful, long term (as they understand the concepts), and transferable. Finally, the discussion that happens during PBL sessions becomes a good platform for students to develop social and communication skills by promoting collaboration between students.[13],[16] We must realize that the success of PBL sessions depends on the role of the teacher as a facilitator or guide.[18],[19]


  Designing Problem-Based Learning Sessions for Undergraduate Medical Students Top


To strengthen the process of curriculum delivery and to train medical students in specific cognitive skills, it can be considered a welcome move to introduce PBL sessions, as an additional approach to teaching–learning other than the strategies that are being implemented in the traditional curriculum.[13],[14] The overall objective of such sessions is to ensure the acquisition of critical thinking, clinical reasoning, and problem-solving skills among medical students.[14],[15] These PBL sessions can be planned for students from any of the professional years, and it is very much essential to divide these students into small groups (10–15 students per group). The overall framework/step-by-step guide for designing and implementing a PBL session for the 1st professional year, targeting 150 students can be done as depicted in [Figure 1].[13],[14],[15],[16]
Figure 1: Framework for the plan and the conduct of PBL sessions. PBL: Problem-based learning

Click here to view



  Other Potential Considerations Top


The success and effectiveness of PBL sessions will essentially depend on the quality of communication between the involved departments. In addition, the problem should be designed in such a way that not only contains an adequate number of triggering events but also is in accordance with the level of the students.[14],[16] Moreover, the specific learning objectives should also be framed after through discussion, and it is the responsibility of the teachers to ensure that all the objectives are covered.[13],[14],[15],[16]

Facilitators have a crucial role in the planning, conduct, and evaluation of a PBL session. The facilitators are expected to break the ice between the participating students, design an effective problem with triggering points, define learning outcomes, ensure smooth interaction between team members, give opportunity to every participant to share their opinion, prevent deviation from the topic, prevent deviation from the topic, not start teaching in the session (but only facilitate the discussion between students), provide constructive feedback to the group as a whole, etc.[13],[14],[15],[16] This makes it extremely important that an effective facilitator will be a crucial factor in the planning and conduct of the session. In continuation, it becomes essential that each of the planning departments should have an adequate number of trained facilitators to enable smooth discussion between the group participants. In other words, if the faculty members are in shortage, it is not possible for the departments/institution to conduct an effective PBL session, and thus, the basic prerequisite is to have adequate faculty strength in medical institutions.


  Conclusion Top


The process of producing a competent medical graduate is a complex one. PBL session is an effective way to inculcate complex cognitive skills among medical students, and thus, it is quite essential that medical colleges should initiate and implement PBL in their settings after proper planning and with the support of the Medical Education Unit.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Stubbing EA, Helmich E, Cleland J. Medical student views of and responses to expectations of professionalism. Med Educ 2019;53:1025-36.  Back to cited text no. 1
    
2.
Karakitsiou DE, Markou A, Kyriakou P, Pieri M, Abuaita M, Bourousis E, et al. The good student is more than a listener – The 12+1 roles of the medical student. Med Teach 2012;34:e1-8.  Back to cited text no. 2
    
3.
Matthews JH, Morley GL, Crossley E, Bhanderi S. Teaching leadership: The medical student society model. Clin Teach 2018;15:145-50.  Back to cited text no. 3
    
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Eghosa-Aimufua O. Assessing medical knowledge with open-ended questions: A medical student's perspective. Med Teach 2021;43:119.  Back to cited text no. 4
    
5.
Morrissey B, Heilbrun ME. Teaching critical thinking in graduate medical education: Lessons learned in diagnostic radiology. J Med Educ Curric Dev 2017;4:2382120517696498.  Back to cited text no. 5
    
6.
Min Simpkins AA, Koch B, Spear-Ellinwood K, St John P. A developmental assessment of clinical reasoning in preclinical medical education. Med Educ Online 2019;24:1591257.  Back to cited text no. 6
    
7.
Cooper N, Bartlett M, Gay S, Hammond A, Lillicrap M, Matthan J, et al. Consensus statement on the content of clinical reasoning curricula in undergraduate medical education. Med Teach 2021;43:152-9.  Back to cited text no. 7
    
8.
Custers EJ. Medical education and cognitive continuum theory: An alternative perspective on medical problem solving and clinical reasoning. Acad Med 2013;88:1074-80.  Back to cited text no. 8
    
9.
Çakmakkaya ÖS. Formal evidence-based medicine instruction in Turkish undergraduate medical education: An initial evaluation. BMC Med Educ 2021;21:437.  Back to cited text no. 9
    
10.
Rashid A, Finnikin S, Tackett S. Accreditation drives teaching: Evidence-based medicine and medical education standards. BMJ Evid Based Med 2021;26:216-8.  Back to cited text no. 10
    
11.
Venugopal V, Dongre AR. Effect of interactive lectures and formative assessment on learning of epidemiology by medical undergraduates – A mixed-methods evaluation. Indian J Community Med 2020;45:526-30.  Back to cited text no. 11
  [Full text]  
12.
Ghani AS, Rahim AF, Yusoff MS, Hadie SN. Effective learning behavior in problem-based learning: A scoping review. Med Sci Educ 2021;31:1199-211.  Back to cited text no. 12
    
13.
Burke J, Ditchfield C, Flynn MA, Sneddon S, Stapleton G. Lessons learned from problem-based learning. Clin Teach 2020;17:719-22.  Back to cited text no. 13
    
14.
Seibert SA. Problem-based learning: A strategy to foster generation Z's critical thinking and perseverance. Teach Learn Nurs 2021;16:85-8.  Back to cited text no. 14
    
15.
Chung EY. Facilitating learning of community-based rehabilitation through problem-based learning in higher education. BMC Med Educ 2019;19:433.  Back to cited text no. 15
    
16.
Shrivastava SR, Shrivastava PS, Ramasamy J. Problem-based learning: Constructivism in medical education. Educ Health (Abingdon) 2013;26:197-8.  Back to cited text no. 16
    
17.
Duane BT, Satre ME. Utilizing constructivism learning theory in collaborative testing as a creative strategy to promote essential nursing skills. Nurse Educ Today 2014;34:31-4.  Back to cited text no. 17
    
18.
Taylor DC, Hamdy H. Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Med Teach 2013;35:e1561-72.  Back to cited text no. 18
    
19.
Dennick R. Twelve tips for incorporating educational theory into teaching practices. Med Teach 2012;34:618-24.  Back to cited text no. 19
    


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