Problem Based Learning

Problem based learning in paediatrics

Developed by: 
The Paediatrics teaching team at the School of Physiotherapy (Genevieve Dwyer, Jane Butler, Adrienne Hunt, Vicki Williams and Nia Luxton)
Institution: 
The University of Sydney
Teaching and Learning Strategy: 

The Paediatrics unit of study has sought to provide students with a comprehensive understanding of physiotherapy in relation to paediatrics. The unit was developed within a framework of a problem-based learning (PBL) curriculum model and done so with direct input from paediatric clinical educators. More specifically, the underlying theme of the unit is growth and development from infancy to maturity. In addition, students address issues related to assessment, therapy and training strategies in children with dysfunction in neuromotor, musculoskeletal and cardiopulmonary systems. A PBL education model supports students in contextual learning: so that the students are able to identify and apply relevant theoretical knowledge to clinical practice and also to be able to appreciate outcome measures of clinical interventions.
The theme of the impact of growth and development is embedded within 5 case scenarios that represent either areas of common practice in paediatric physiotherapy, and/or areas in which there are important clinical lessons to be learned. In each of the problem case modules there was integrated use of online web-based support through a dedicated Paediatrics unit website that included unit of study information regarding structure of the unit, learning outcomes for the unit as well as learning for each case scenario. The latter helped to direct and structure the student learning, as did the emphasis on a clinical reasoning approach. In addition resource material was provided on the website such as online learning topics using multimedia (e.g. the impact of prematurity on the respiratory system, motor control in children etc), and links to web-based resources within and outside the university. To help consolidate the learning experience, summaries were posted after completion of the cases.

Tutors were supported by the use of comprehensive case scenario notes and weekly team meetings. This enabled a consistent approach to the students' PBL experience.

Assessments were congruent with a PBL approach and incorporated experiential learning. For example students learned about normal development in infants and children by actively assessing and videoing a subject from a selected age group and then analyzing and comparing the subject's development to theoretical norms. Students presented their work to their peers in a seminar format. At the conclusion of the unit students had an individual viva examination that reflected clinical reasoning approach to learning utilized in the PBL case scenarios.
 

Course Name: 
Bachelor of Applied Science (Physiotherapy): Paediatrics I and II
Year Level: 
Third Year
Expected Outcomes: 

Year Level : (Undergraduate Year 3 students and Graduate Entry Masters Year 2 students.)
 
The aim of this unit of study is to prepare the student as a competent entry-level practitioner in the area of paediatric physiotherapy. In this unit of study it is anticipated that the student will become aware of the changes which occur from infancy through to adulthood in neuromotor, musculoskeletal and cardiopulmonary development and will address issues related to the assessment and training strategies in infants, young children and adolescence with potential dysfunction in these systems.
Paediatrics I and II are closely aligned units of study with common learning outcomes. It is anticipated that students will be able to achieve the following learning outcomes with increasing refinement throughout the year:

  • Solve complex clinical problems accessing appropriate resources and using a process of clinical reasoning.
  • Evaluate their own clinical reasoning ability through self assessment.
  • Demonstrate an understanding of normal growth and development from conception to maturity.
  • Discuss the occurrence of variations in normal development and possible reasons for these.
  • Differentiate between normal and abnormal growth, development and function.
  • Describe the potential impact of abnormal development on the skeletal, respiratory and neurological systems.
  • Identify the potential psychological impact of illness, disease and/or disability on a child, their family and the community.
  • Describe a plan of management for a paediatric problem that recognizes the potential role of other health practitioners.
  • Select physiotherapy intervention based on the best evidence available.
  • Identify how a selected physiotherapy intervention would be managed.
  • Identify how the effectiveness of the intervention would be evaluated.

Example of specific learning outcomes for a problem case module: Cystic Fibrosis:

  • Describe the pathophysiology of cystic fibrosis (CF) and how it impacts upon the growth, development and function of the cardiopulmonary system.
  • Outline the psychosocial issues associated with a chronic, fatal condition.
  • Name other healthcare practitioners involved in the care of a child with CF.
  • Describe the overall health management of a child with CF.
  • Discuss the role of physiotherapy in the management of people with CF.
  • Outline physiotherapy treatment regimens available and the rationale/evidence and limitations for each technique.
  • Design an individualized treatment program for someone with CF justifying the choice of management.
  • Relate knowledge of psychosocial issues of adolescence to optimize the physiotherapy management of someone with CF.
  • Discuss some of the cultural issues that might impact upon the healthcare management of this adolescent with chronic illness.

 

Effective Aspects: 
  • Students are responsible for broad, deep learning with support in terms of being given direction, resources and feedback)
  • Students are responsible for their own learning, thereby allowing integration of prior knowledge and heightening motivation for learning and developing lifelong learning skills.
  • Students bring with them a wide background of prior learning and experience.
  • Learning in small groups enhances understanding, exploration, discussion and debate.
  • Academic staff facilitate the learning process and translate concepts rather than 'teach' or serve solely as information givers.
  • Information used to comprehend and deal with real-life scenarios is integrated from a variety of traditional disciplines.
     
Evaluation: 

The evaluation of this unit of study was undertaken in depth in the first 2 years that the unit was run. The evaluation occurred in two phases and involved two student cohorts, with revisions to the second cohort's learning program and the questionnaire based on findings from the first cohort investigation. In Phase 1 (cohort 1), 154 (82 percent) of the students completed questionnaires evaluating the learning program. Focus groups were conducted ten months later with 18 students by an independent assessor from the University of Sydney Institute for Teaching and Learning. In Phase 2 (cohort 2), 118 (62 percent) of the students completed a revised questionnaire.

Evaluation Outcomes: 

For Phase 1, mean rating agreement for meeting all learning outcomes (listed above) was between 84 percent and 97 percent. Most suggestions from the questionnaires and focus groups concerned unit structure and process. For Phase 2, mean rating agreement for meeting all learning objectives was between 88 percent and 96 percent.

Plans for Changes/Developments in Future: 

The specific changes made from Phase 1 included: conducting a practice case scenario in the introductory tutorial; the entire problem case module learning tasks being made available in the first week of each module; learning tasks being congruent with the criteria of the final oral examination (i.e. emphasising the clinical reasoning process more overtly), a concluding session for each case module with a guided review of learning processes and issues arising from the same, and providing a composite case summary on the Paediatrics website. Other changes included the removal of the peer assessment because of concerns about its lack of validity. Furthermore, there was a change in the respective weighting of the assessment components of the unit. The mark allocation for the group written reports covering the learning tasks and outcomes of each case module was increased to acknowledge student value and effort.
Following Phase 2 (the second cohort evaluation), there were suggestions for further change, the most common of which related to workload and marks, i.e. a reduction in work, allocation of marks according to workload and removal of the self-assessment of clinical reasoning skills. Changes to assessment were: a higher (relative) weighting for each case report, and the removal of mark allocation for the clinical reasoning skills self-assessment.
 
For both cohorts, students' perceptions of their abilities were congruent with the fact that all students passed the unit of study and with the generally high mean level of achievement in the final oral examinations. Although there was no assessment of student ability in the clinical setting, the focus group report indicated that students attributed their enhanced sense of clinical competence in large part to their PBL experience.

For Further Details
Contact Name: 
Genevieve Dwyer
Contact Faculty/School: 
School of Physiotherapy
Contact Institution: 
The University of Sydney
Contact Link: 
http://www.fhs.usyd.edu.au/phy/

Problem based learning for all subjects in order to contextualise and integrate student learning

Developed by: 
Dr Gillian Webb and staff of the School of Physiotherapy
Institution: 
The University of Melbourne
Teaching and Learning Strategy: 

Problem based learning (PBL) was introduced as a key component of the learning and teaching of the school in 1999. PBL is used as the principal framework for student learning, particularly in years 1and 2. Students are allocated into small groups of 10 students. The groups are made up to mix the students for age, gender, local or international student. They are facilitated by a member of the School staff. PBL is used in both the biomedical science systems based subjects as well as the physiotherapy subjects. The PBLs are not used primarily to solve a problem but rather to drive the students' learning and understanding around common clinical problems that they will encounter in their clinical practice. These problems include learning topics in the biomedical and physiotherapy sciences. They also include learning issues in, for example, behavioural science, public health, culture, ethnicity and professional practice. The PBL process requires them to be both collaborative learners and independent learners.
The problems are presented to the students, who must identify the key information given to them, identify the problem(s), and develop broad hypotheses for the problems. Students then must decide what further information they require to be able to prove or refute their hypotheses and then on gaining this information prioritise their hypotheses. For each hypothesis they must develop a mechanism that links the hypothesis with the problem. Throughout students must identify issues that they are unable to understand or explain and list these as learning issues. All students must research each of the learning issues for the second session of the problem and be prepared to share this information with the group. The group must come to an understanding of the mechanisms and develop flow charts to explain these.
 
As part of the process ground rules are made by the group. These enable the proper functioning of the group and include issues such as valuing each other's contributions, making sure everyone does their share of researching topics, not being late and generally ensuring that effective learning takes place.
At the completion of each problem feedback is incorporated. This may be feedback from the group on how they think they have functioned for this problem and also individual feedback. A variety of methods are used for feedback so that students are not threatened by the process but are able to identify their own learning strengths and weaknesses. The social aspect of the group and its contribution to student learning is an important feature of PBL.
 
The assessment includes a percentage weighting for both the students' participation and facilitation of the group and also of their knowledge generation. Questions on exam papers are written using a PBL framework.
Information for students is given in a variety of forms - paper based, videos, web sites, key references, radiological images. Students record their learning issues and flow charts for their own study. The problem is always closed off for the students with an explanation of the clinical management of the person. Key words are given for the students' private revision.

Course Name: 
Principles of Biomedical science, Cardiorespiratory systems, Sensorimotor control systems, Physiotherapy 1 - 4, Musculoskeletal physiotherapy 1
Year Level: 
First Year
Expected Outcomes: 

Year Level : (First to Third)
 
Generic learning outcomes
Students should develop skills in collaborative learning and group work
Students should develop skills in independent learning
Students should learn how to access information and critically evaluate it.
Students should develop skills in clinical reasoning
Students should develop the ability to reflect on their own learning.
 
Specific learning outcomes are dependent on the subject
 

Effective Aspects: 

PBL is a student centred approach to learning which allows the students to use prior knowledge in contributing to understanding a commonly encountered clinical problem. It allows the students to learn about topics in context and considers the person holistically.
The students are introduced into the style of reasoning used in practice and are required to search for evidence to justify their decisions. As part of the learning process students are encouraged to share their understandings of the learning issues, to question and challenge other people's interpretations and to critically analyse information presented. The students are required to work as part of a group and to value other people's contributions.

Evaluation: 

All subjects are evaluated using the standard university quality of teaching survey. As well further internal surveys have been done on PBL separately.
 
Each semester representatives of each PBL group meet with staff to discuss the learning in PBL

Evaluation Outcomes: 

Student feedback on the whole is positive. However there are some concerns. The international students find PBL a difficult form of learning initially as they are required to speak out about their learning and to act as scribes on the board, both of which are difficult when English is not their first language. Students have also expressed concern about the depth and breadth of knowledge that they will be required to have for assessment.
Some of the positives from the students have been the sharing of learning in groups; the opportunity to extend their learning issues as identified by the groups; the contextual nature of the learning that brings everything together with a clinical focus and the social nature of learning.

Plans for Changes/Developments in Future: 

We are constantly reviewing the processes of PBL and the problems.
 
 
 
Students provide feedback on each problem as well as staff. Changes are made where appropriate. The problems are considered in the context of each subject and new problems are written or the problems are modified. Staff development in the role of the facilitator is a continuing process.

For Further Details
Contact Name: 
Gillian Webb
Contact Faculty/School: 
School of Physiotherapy
Contact Institution: 
The University of Melbourne
Contact Link: 
http://www.physioth.unimelb.edu.au/