On Wednesday November 5 1994, Bill Galey, Western Regional Director of the Basic Education Special Interest Group of the Group on Educational Affairs convened the annual meeting at the 1993 AAMC Meeting in Washington, DC. The program titled: “Problem-Based Learning: The Role of Basic Scientist in Optimizing Basic Science Learning” was presented by a panel of basic science educators representing problem-based learning efforts at 5 different medical schools. Bill moderated the session and introduced the presentations by Mitchell Halperin from the University Toronto, Jack Strandhoy from the Bowman Gray School of Medicine, Carol Whitfield from Pennsylvania State University College of Medicine, and Howard Zeitz from rush Medical College. The abstracts of each presentation are reproduced below.
BASIC SCIENCE AND MEDICAL EDUCATION: HOW CAN THEY BE INTEGRATED?
A Personal View
Mitchell L. Halperin, M.D., FRCP
Professor of Medicine
St. Michael’s Hospital
38 Shutter Street
TORONTO, ONT M5B 1A6
Ph: (416) 864-5292 Fax: (416) 864-5943
The present crisis in medical education was inevitable because the body of ?essential’ information was growing rapidly and contact hours (read lectures) between highly informed faculty and students were markedly reduced. The solution requires that faculty identify ?need to know’ concepts, and then work as a unit to integrate information and ignore traditional boundaries. Students must assume a greater responsibility for their education. Notwithstanding, the problem is more serious because the tools available are outmoded (read encyclopedia-type textbooks); one attempt to minimize this portion of the problem was the development of a new textbook, Clinical Detective stories, to help support our teaching efforts.
Now to specifics — how should basic science issues be generated from clinical cases, and second, in what depth? I shall provide a synopsis of how this was done in one portion of the curriculum in a generic sense and then provide a concrete example. Four faculty members (3 basic scientists and one tame clinician) integrated several topics (energy metabolism, renal, endocrine and GI physiology) into 4 weeks of year 1 including one PBL week). Given the limited contact hours (8 lectures and 3 small group sessions per week), each contact hour was related to weekly case scenario and driven by the need to distill essential concepts.
An example helps illustrate the major points about case selection and depth of basic science issues.
In our second weeks, the two key topics were metabolic regulation and acid-base physiology. The case scenario began with an effort to attract interest. Students were asked to help Roger Bannister in his efforts to break the four-minute mile by considering how he regenerated so much ATP. This offered an opportunity to develop learning issues in metabolic regulation and fuel selections. During Roger’s finishing kick, an acid-base problem (lactic acidosis) was identified from a blood sample obtained in a practice session. This provided the opportunity to develop learning issues in aspects of renal physiology and reinforce aspects of cardiovascular and pulmonary physiology. At this point, attention was focused on a member of the crowd who had a myocardial infarct. Bloods were drawn from the patient and compared to those from Roger; they had identical value, but Roger survived and the patient died. The students were asked to develop hypotheses and obtain information to back them up for the development in small group sessions. The faculty involved were provided with learning issues, objectives and the like so that they could guide the student to explore issues in greater depth. Hence starting with a clinical case, basic science principles still form a cornerstone of the curriculum, but the quest for this basic information starts with the student rather than the faculty.
PROBLEM-BASED LEARNING: THE ROLE OF THE BASIC SCIENTIEST IN OPTIMIZING NASIC SCIENCE KNOWLEDGE LEARNING.
Incorporating Basic Science Testing Into PBL Examinations
Jack W. Strandhoy, Ph.D.
Department of Physiology & Pharmacology
Bowman gray school of Medicine
Wake Forest University Medical Center
WINSTON-SALEM, NC 27157-1083
PH: (919) 716-4403 FX: (919) 994-2870
Depth and breadth of basic science knowledge is essential to clinical understanding, and is continually stressed in our curriculum. Competence is knowledge which is basic to the study of clinical medicine is evaluated in our PBL students in several ways. Tutor and group evaluations are considered, but in this discussion I will focus on three standardized exams that are used. The first is a Content Examination which is given approximately once every ten weeks. The learning issues from the cases which were studies are listed, and then reassembled into new clinical cases by an exam committee of clinicians and basic scientists. From two or three exam cases, basic science, clinical and psycho-social questions are derived which are answered by the students in essay form. The exam is given over six hours on one day. The answers are graded by faculty expert in the field and the students are provided with written comments and an idealized answer. The scores on this exam have correlated well (r=0.855) with NBME Step 1. A benefit of this exam is that students are tested in the same format in which they studies the information. A second exam format that is used is the individual Process Assessment (IPA) in which the student performs a history and physical on a simulated patient. This phase is graded by clinical faculty, and the student then prepares hypotheses and learning issues, requests laboratory test, and studies basic science concepts over the next two days. At this time, the student meets with a clinician and a basic scientist for two hours. The clinical finding are presented (10-15 min) and relevant basic science issued are discussed (90 min). Feedback is provided to the student on recording and presenting, reasoning processes, knowledge base and depth, and self-assessment. Most of the time in this exam is devoted to presenting basic science information to the faculty. The third exam format that we used follow an eight week intensive Community Experience IICE) for the first year PBL students. While students review patients with their mentor, they note learning issues on a daily patient log They return to the medical Center with a list of 20-30 major learning issues and then meet with a clinician and basic scientist for two hours. The student presents one of the learning issues of his/her choice for 30-40 min. in a grand rounds or seminar format. The topic is expected to be explored in depth from the molecular to the treatment level. The faculty then chose five other topics from the list and the student picks two on which to talk for about 15 min. each, with time allotted for questions and discussion. Evaluation is provided by the faculty of the distribution of learning issued that ere chosen, the depth of basic knowledge, and the presentation of concepts. An important benefit of this exam format is that all of the basic science learning issues are derived individually be each student based solely on the actual patients that he/she observed. The clinical context of learning emphasizes the importance of the basic knowledge. Modifications of these exams could be readily adapted to other curricula.
ENSURING THAT THE PROBLEM-BASED CURRICULUM CONTAINS THE APPROPRIATE BREADTH AND DEPTH OF BASIC SCIENCE OBJECTIVES
Carol F. Whitfield, Ph.D.
Pennsylvania State University
College of medicine
Office of medical Education
HERSHEY, PA 17033
Ph: (707) 531-3877 Fax: (717) 531-3925
Problem-based learning at Penn State University’s College of Medicine was initiated as a track for second-year students, and will be expanded to include the first year in the Fall of 1994. Our emphatic instruction to students is that THE goal of the program is to insure that students understand the basic science mechanisms underlying medical practice. Strategies employed to accomplish the goal are as follows: 1) Directors of the PBL program include a basic scientist and a clinical scientist (M.D., Ph.D.); 2) Cases are carefully designed with basic science objectives in mind; 3) Basic scientists are asked to go over cases and suggest depth of knowledge necessary; clinical faculty also contribute; 4) Students are constantly reminded of the goal of the program; 5) Tutors are instructed to probe student understanding down to the molecular level; 6) Tutorial groups are observed in action to insure that depth of discussion occurs; 7) A tutor guide for each case is provided that indicates the important learning objectives and it will include detail of molecular mechanisms that all tutors would insure are addressed in group; 8) Test questions are designed to emphasize understanding of basic science concepts, down to the molecular level, and students are given sample test questions to write and turn in for unofficial grading so they learn the depth required; 9) attempts are made to get more basic scientists involved in the PL program. These include recruiting them to be oral examiners, enticing them to visit PBL groups in action, enticing them to be tutors, using pairs of tutors—a basic scientist and a clinician, and assigning tutors to shorter time blocks (e.g. 4 weeks) while keeping student groups together for 8 weeks).
THE RUSH MEDICAL SCHOOL EXPERIENCE WITH PROLEM-BASED EDUCATION IN THE BASIC SCIENCES
Howard Zeitz, M.D.
Rush Medical College
CHICAGO, IL 60612
Ph: (312) 942-3189 Fax: (312) 942-2333
Rush Medical College has two tracks for students in the first two years of their undergraduate medical education. The traditional curriculum (TC) was established in 1969. The alternative curriculum (AC), established in 1984, is currently celebrating its tenth anniversary year.
While in the AC, students are expected to learn as much science as possible; develop the skills needed for self-directed learning, problems solving, group dynamics and interpersonal communication; acquire the clinical skills needed for the next phase of their education; and develop the belief that life-long learning is an essential characteristic of a physician.
A. How can we insure that appropriate basic science learning issues are generated from the case?
B. How can we insure that basic science concepts are learned at an appropriate depth of understanding to be useful for the practice of medicine in the future?
In the Rush AC, these questions have been addressed by establishing a policy that the course directors for each discipline and the course directors of the instructional units (quarters) are basic scientists. The course directors establish the core learning objectives (CLOs) for the entire quarter, week by week. The facilitators, who usually are clinical faculty members, will prepare the cases for the quarter based on the CLOs prepared by the basic scientists. The course director must approve the final draft of each case. AC alumni, in their later years of training, assist the faculty in preparing and reviewing the clinical cases. The alumni also assist with the preparation of the basic science exams.
Together, the CLOs for the cases and the basic science content exams determine the breadth and depth of the science concepts.