Problem based learning has been proved to be a very good way of of learning as it is based on a practical approach. Although our university doesn't much include this approach in syllabus, the potential outcome is tremendous which is evident in day to day activities. Assessment of learning outcome can also be done on the basis of day to day work like for example testing the knowledge of technical terms, testing skills regularly required, quiz sessions, small games , crosswords etc

We are utilizing PBL as the central vehicle for the learning process in the Core Curriculum on Childhood Trauma, which is now in over 40 clinical training programs across the country (primarily in social work thus far, but now expanding into other disciplines). Please see Layne, Ghosh-Ippen, et al. (2011) for an in-depth discussion; we have several other papers describing its use and evaluation now in press or under review.

Christopher M. Layne

Director of Education in Evidence-Based Practice

UCLA National Center for Child Traumatic Stress/NCTSN

My doctorate research in education was about PBL in medical education at the faculty of medicine of university of Montreal (Canada). Indeed PBL approach as a great potential as active learning and student-centered method. But it needs firstly a great comitment of students to perform a deep information research. It needs also tutor's skills as a guide, helping students to learn by themselves. By the kind of his interventions the tutor can lead students to deepen teir discussions and learning. This tutor should be able to detect student's misconception, and help them to correct them.

Problem based learning is an alternative teaching method which prepares students to be independent and critical thinkers .It helps in eliminating irrelevant subject matter in the curriculum, encourages integration of subjects between disciplines and helps to bridge the gap between theory and practice. The role of a Teacher/Tutor in PBL is to facilitate the learning process and steer the group process in the right direction. Student assessments can be in form of test, quiz, written assignments. clinical skills can be evaluated using OSCE, Vivas/orals, practicals etc.

I am not a formal educator however have particpated in facilitating an interdisciplinary course for a number of years. That course used case scenarios and the teams worked together to solve - provide care. We also with some of the scenarios used standardized patients, making the problems more real. The course used TOSCEs to evaluate learning, which is a modification of the OSCEs (i may have spelled the acronym incorrectly so will check). McMaster University in Hamilton Ontario uses PBL and has for a long time.

http://en.wikipedia.org/wiki/Objective_structured_clinical_examination

This link describes the OSCE.

According to Dr. Woods from McMaster University, PBL is any environment where the problem drives the learning and the student then takes the initiative for learning.

It is necessary means for nurse students who have responsibilities to solve patient problems with problem-solving (nursing process) approach and relevant to their works after graduation.

We have used varying styles of problem based learning. These range for table top exercises with small groups in our Recognise and Respond programs for post graduate nurses. The groups are given case scenarios and as they work through each stage- they are given more information about the patient i.e. such as changes in vital signs. The groups refer to the resources that they had built on from the program to reference against. We also facilitate simulation events which start with what would you do if this happened? This is particulaly good for the remote area clinics staff we visit- the staff are generally experienced and have completed a number of courses- these sessons provide with them with opportunity to address/review/practice for problems they face. Another example of PBL is "build a case" the beginnings of a case scenario is placed on a wall in the team room of a clinical area- over the week the staff build their own case study based on the information that is added. This encourages a IPL activity.

Gill O'Connor

Nurse Education Consultant

Clinical Learning

Alice Springs

On the epistemological perspective Medicine is changed. Medical Education and Clinical teaching has been completely revolutioned by Person Centered Medicine we teach from 1995 in our University.

If you want know "how" download my paper : Person Centered Medicine Theory, Teaching, Research

Prof. Giuseppe R.Brera

Director of Milan School of Medicine and Person Centered Medicine International Academy

http://www.unambro.it/html/smistamentoISPCM.html

According Person Centered Medicine, Problem Centered Clinical Teaching ,to date ,is a true deep epistemological and methodological error in Medical Education, with the exception of emergency Medicine at the firts time when there are survival problems but excluding Emergency in Psychiatry (if there is relational space) It is necessary to prepare clinical teachers and investigators in medical Education able to teach Person Centered Medicine that is " Person's resource centered", coherent with the deep epistemological change in Medical Science. Problem centered clinical teaching is to date wrong.

Hier in College of Nursing, Qassim University, KSA, we use the Problem Based Learning approach and I tested the outcomes of PBL in term of critical thinking and self directed learning. This research now in print in Journal of Nursing education and practice, the results reveald that the PBL significantly improved the student's self directed learning and critical thinking.

I work in an institution with a curriculum based in PBL, in the Faculty of Medicine, and I can say that is an excellent teaching method, as Catherine said, it prepares students to be more critical thinkers, it allows knowledge to be integrative, and the students understand the usefulness of theory when they see how they can apply that knowledge to practice. In our institution, the tutor not only facilitates the learning process, but is also a mediator in interpersonal relationships and helps the group to develop leadership skills. I think we find a little resistance in people who was formed in classical ways, because they think its the best way to learn medicine. It is difficult to break paradigms.

We have bee using PBL now PSIL (problem solving integrated learning) a very useful tool for teaching undergraduate medical students. Several components are necessary for its success including training of facilitators ad committed faculty who are willing not only to conduct the sessions but also contribute to scenarios. If facilitators are not trained sometimes the true essence of the session is lost and it becomes a "teacher centered learning" which this is not. Similarly use of the same scenarios for several batches leads to stagnation and students then just rely on the "diagnosis /key learning points" as discussed with their seniors and the true problem solving and critical thinking skill is disintegrated.

I like to use the Kirkpatrick Levels for measuring learning. http://kirkpatrickpartners.com/

(Disclosure: I have no affiliation nor hold any certifications from this group).

I think using casestudies as problem based learning is very useful in teaching any subject in nursing education.

Problem based learning givea an opprtunity to learn the students to combine the basic subjects knowledge with the clinical subjects. It also give san opprotunity to the students to learn in detail of the particular topic and also helps in getting more points from the group discussion. It will definately be a strong point in addition to the clincal cases they get to see during thier learing curve

Gina, at the onset I would like to clarify whether your question is particularly related to clinical education, which means in the clinical rotation or anything related to clinical practice learning.

We at our college have not yeat started using PBL formally in nursing curricula though all of us are trained to some extent in PBL facilitation.

The clinical practice in a hospital is always full of live situations which can be easily adapted and an instructor need not make a special case. PBL is just extending the actual clinical scenario at the bedside and discussing care to be provided at the bedside, on discharge, and cover the family and society like Michael says. It may be too time consuming and hence some part of the pathophysiology, pharmacology could be discussed by the student after clinical hours.Of course the student should have prepared those aspects by themselves. Gill has already mentioned PBL and simulation which are very popular methods of enhancing clinical self learning.

The facilitator/instructor has to direct the student to draw from subjects such as microbiology, nutrition, pharmacology, biochemistry etc. It requires the instructor to visualise comphrehensive care in their head, to help the students. Please let me know whether this answer made sense to you.

Shreedevi - Thank you for your response; your answer makes sense. I am asking mostly about embedding problem-based learning into clinical content courses.

Our students also have clinical practicum where they may have a chance to implement and apply clinical knowledge, but not everyone has the opportunity to see patients that cross a range of impairments during these practicums.

In addition to variable opportunities to work with actual patients, the challenge seems to be delivery/mastery of content regarding impairments with sufficient opportunities to integrate and apply that knowledge in a systematic way. In my teaching, I am trying to shift more of the onus of acquiring the clinical knowledge to the student outside of class time (via pre-recorded lectures, readings, and online tests) so that in-class time can be focused more on application.

Most of the responses--thank you everyone---seem to endorse the use of PBL with a few caveats.

Hi Gina, my understanding is that the evidence for PBL is stronger outside the area of medicine, perhaps because medical students tend to be deeper learners more so than other students and perhaps don't gain quite as much out of this approach. From a policing perspective, it has had a degree of success, however, it has had to contend with a culture that tends to prioritise control in the classroom. It is also important to implement PBL the correct way into the curriculum to favor its strength in integrating aspects of subject content in authentic situations and contextual problem solving. Finally, without effective and ongoing teaching development, any PBL program will suffer. In terms of evaluation, I would suggest my organisation has done poorly in that regard. It has tended to overly rely upon student feedback at face value, which tends to emphasis student comfort over effective learning. There needs to be a broader focus on quality learning outcomes and staff feedback to bolster this process.

Students on my problem based learning module 'Psychology of Patient safety' tell me that they really appreciate the opportunity to learn in this way and apply the knowledge they have of theory and methods to interesting and 'real' issues in healthcare. They also tell me that they learn new and useful skills including team-working, prioritisation, presentation skills, negotiation etc. Students find the course challenging, particularly the less able ones, but they benefit hugely from it.

The teaching and learning in medical education has evolved over years. We started with bedside teaching, didactic lectures and symposiums. However, what matters is the ability to bring relevant knowledge and learning to the fore while managing a patient in real life situation. This is where the class room teaching has not succeeded, these are the times where 'Problem based learning' has proved superior. In fact problem based learning and learning on simulators are the major thrust areas and likely to improve medical practice in a great way and should be encouraged.

I've used PBL for the past 5 years in a midwifery course. It was a new concept to me and we aren't actually using "problem-based" learning in it's purest sense but "situation" or "case-based" learning. We use scenarios that have multiple layers so that as the students apply SOAP or another systematic analysis tool to go through each layer they are presented with another layer that allows them to address the client/patient again as time progresses. This simulates real-life situations and asks them to build upon previous knowledge and history. At each layer they are asked for their initial impressions, their assessment, their differential diagnosis, what they anticipate might happen, identify areas that they are unfamiliar with and will need to do more critical research on, and then asks them to critique the plan of care provided in the scenario. There are no "wrong" or "right" answers at times. There are different priorities based upon whether the setting is urban or rural, social determinants of health, the culture and desires of the patient in a patient-centred model of care. However they are able to explore ethical dilemmas, interprofessional issues, communication issues etc. I believe it provides an opportunity for more in depth critical thinking, however the danger is that they students unless facilitated by the instructor will miss key learning objectives that are designed to be addressed in that scenario. The temptation I have is to be content driven and so I've had to find a balance of providing "the best practices" at the end of each of our 3 hour tutorials, jogging their memories with key words and phrases. With my group I have those who tend to pathologize normal birth and others who tend to normalize pathology, as each student approaches the scenario from their own world view and personal philosophies. This is an adult learning situation where each student must take responsibility for their own learning and come prepared. Also, we use a distance education curriculum that uses webconferencing platform (e.g., Collaborate, Adobe connect are some of the programs available) since our students are in clinical placements over a wide geographic area. PBL that was developed at McMaster University, Hamilton, Ontario Canada has several workshops and pointers. They've used it for med students, midwifery students and other healthcare professionals for tutorials. The grading not only looks at the quality of the discussions but the group dynamics and the ability of each participant to promote the success of the group, rather than their own individual success (and so this avoids one participant taking the podium and lecturing to the others). You are right that the evidence is equivocal. It should not be the sole method of evaluation since it so subjective. We also use protocols, clinical issues papers and examinations for evaluation. Because interprofessional collaboration is so inportant in healthcare though, PBL is an excellent way of modeling this interprofessional communication and power brokerage in a safe environment. I've enjoyed the multidisciplinary PBL exercises I've participated in. Outcomes are measured by the success of the group. There are various group evaluation tools available. Self reflection is not something that can be evaluated however the ability to be involved in "peer" evaluation can be measured. That is one of the outcomes and goals of the PBL format. I'll try to look up one of the group evaluation tools to provide for you. Also consider: 1. McCourt, C.,Thomas,B.G.,2001.Evaluationofaproblem-basedcurriculumin

midwifery. Midwifery17,323–331. 2. Barret, T.,2001.Philosophicalprinciplesforproblem-basedlearning:Freire’s

concepts ofpersonaldevelopmentandsocialempowerment.In:Little,P.,

Kandlbinder, P.(Eds.),ThePowerofProblem-basedLearningExperience,

Empowerment, Evidence.PROBLARC,Newcastle. 3. Norman, G. (2008). Problem-based learning makes a difference. But why? CMAJ, 178(1),

61-62.

I hope that this is helpful.

Karline Wilson-Mitchell

I am speaking from the perspective of a Nurse (BSN) and a teacher (Adult Education) MS. We need to use different strategies to educate our students for example technology, collaborative learning groups,  the FLIP method. These strategies engage students , develop critical thinking, and give them the chance to have misconceptions cleared. For example I used the FLIP model to educate my nursing aid, high school students about their first day of clinicals. The students were aware of prioritized duties like Introduction, vital signs, ADL's this method ,FLIP helped to guide students in outcomes and expectations.

PBL is an obsolete and to date wrong model of Medical Education, valid only in emergency, when vital functions are at risk. Medical Education  should be epistemologically oriented by the progress of medical science that changed the Medicine paradigm and call for  Person Centered Medicine and  the Person Centered Medicine Clinical Method.

Medical teachers should be prepared to teach Person Centered Medicine and its epistemology.

https://www.healthparadigmchange.it

PBL is an active learning method, very interesting but the problem is misconceptions and sometimes superficial learning. My PhD thesis at Université de Montréal was about PBL at he Faculty of medicine. While I was observing students I noticed their enthusiasm but all students didn't participate in the same way. Before a PBL course each participant has a naive representation of concepts and through discussion, research and collaboration, this representation must change to become a scientific concept. But this is a building,not always easy but necesssary. So I've found the model of Montréal Faculty of medicine very interseting combining PBL and Profesor' teaching to overcome misconceptions and give all the students the same basis of knowledge.