Friday, July 8, 2011

Web based problem based Learning

Web Based Problem Based Learning
A study conducted by Upacaar at St John’s Medical College
Kishan Kumar & Vivek K.R,
Co Founders, Upacaar
Bangalore, India

 
Abstract:
This article reports the study of Web based – Problem based learning that was conducted for the medical students. In this study we observed the involvement & interaction of student-tutor & student-student. The PBL principles & process were followed during the web based PBL classes.
In this report Web based PBL advantages & disadvantages are identified & data analysed. The analysis has shown great positive results with Web based PBL yielding more output & value than the regular PBL. All the benefits of Electronic format was enjoyed by both the students & tutors such as Easy to store, access & share data, organised data etc and they experienced - reduced complexity, exciting, motivational and innovative. Students assign tasks, watch videos, images & spend time on only discussion and avoid taking notes, enhanced tasks performances by exploring different resources such as online contents, journal and books.
100% students & tutors liked the Web based-PBL and their recommendations extend to support that Web based PBL perfectly fits into the PBL process & 88% recommended conducting Problem solving online. The students enjoyed, satisfied & agreed to do it again. 

 
Introduction:   
Problem-based learning (PBL) is a student-centered pedagogy in which students learn about a subject in the context of complex, multifaceted, and realistic problems. Working in groups, students identify what they already know, what they need to know, and how and where to access new information that may lead to resolution of the problem. The role of the instructor is that of facilitator of learning who provides appropriate scaffolding of that process by (for example), asking probing questions, providing appropriate resources, and leading class discussions, as well as designing student assessments.
In PBL, students are encouraged to take responsibility of their learning and organize and direct the learning process with support from a tutor or instructor. Advocates of PBL claim it can be used to enhance content knowledge while simultaneously fostering the development of communication, problem-solving, and self-directed learning skills.

 

 
Purpose of the Study:
The aims of this study are to look at how students use electronic format to enhance their skills, learn more effectively and perceive the effects of the collaboration in the Web based - PBL approach for undergraduates of Medical colleges. This Web-based PBL learning environment was designed to fit into the St.John’s Medical College PBL process. The findings of this study will provide insight into the Web based student-instructor and student-student collaborative processes in terms of learning effectiveness, interaction, satisfaction and enjoyment in the learning process. It would also provide valuable information and guidelines to conduct PBL classes using Upacaar’s Web based solution.
Web based Environment:
A Web based - PBL environment was designed and developed for conducting PBL classes effectively, interactively and enjoyable. The web link “www.pbl.upacaar.com” is generated exclusively for St John’s medical college where students & tutors can access the application using web browser with authenticated Username & Password. A classroom, few laptops/computers and internet connection were provided.  

 
Introductory Information:
The students and tutors were trained only on the web application & not on the PBL process as PBL is known process to all and since our web based application easily integrated into the existing PBL process without any changes, no process training was further given. Each student was sent an E-mail and SMS to give him/her the login credentials along with ‘URL, user guide’ details.
Sample case was added for both students & tutors to access, practice & get used to application. The students were first required to enter link/URL in web browser to access the site, use the credentials to login into the application and then start using the sample case. The actual problems/cases on which the students were about to work on were added in the system, however only tutors were able to view the cases & not the students, students can view the case only when tutor releases the case information.    

 
Problem design & its presentation:
The Problem/Case was ill-structured and related to real world issues. The ill-structured problem calls forth critical & creative thinking, decision making, and problem solving skills. The problem was cut into 2 parts and each part named as Trigger 1 and Trigger 2. Trigger 1 generally consists of chief complaint, history of patient, physical examination, video & images. Trigger 2 consist further investigations, lab results & reports, and more information to narrow down.  
The real world issues appeal to the students’ desire for resolution, harmony and must be generated in the context of learning which follows,
  • Illustrated that good PBL problems must engage the students’ interest and motivate them to probe for deeper understanding of the concept being introduced
  • They should also be complex enough to require the cooperation of all members in order to work toward a solution & learn new topics
  • Open-ended and contain the content objectives of the course.
  • The problem accessed anytime & anywhere through online sources.
  • The Problems contain beautiful fonts, high resolution colourful Images, Videos and test results, and lot more.     
Web application in Class1:
A small assigned group of 7-8 students were using 2-3 laptops to view the cases/problems. Only 2-3 laptops used per group including tutors’ in order to make sure all the students focus on the discussion, encourage face to face interaction and not on the computer. The Trigger 1 (first set of information on the problem) was released by the tutor using web application, then students were able to view the problem and started to analyse the problem together. Based on their prior knowledge, they determined the information they already know & the information they don’t know and what information they still required to possess and should learn to solve the problem.
One among the group member was made scribe, who noted down the information discussed in the class and added into the web application. During the discussion the group lists the objectives, prioritise, organise the plan of action and assign it to individuals to do further research. Using web application, the scribe adds the discussion points, learning objectives and assigns the objectives to individuals while allowing the tutor to view the entire operation in his/her laptop or computer and here the tutor role is to facilitate, guide & monitor the entire process.    
Research:
Each individual student had his/her own responsibilities to do research on the objectives that were assigned to him/her. In other words he/she had to conduct independent studies after the class and they can utilize all forms of resources such as books, online resources or even interact with physicians etc to find the information on the objectives assigned to him/her. The integration of web application made the students easy to add the online information such as large text, audio & video files, images, picture, lab results/reports and lot more. They can also get information from books, journals & magazines, and can be easily added in the web application. In addition students had to add the references of the resource. Students had to find and evaluate the broad array of resources needed for resolving the learning issues. Such an evaluation provides opportunity for them to develop the critical thinking & decision making in the context of evaluating resources and also students share the entire information they collected and shared to their group members to prompt the ability to view & learn.

 
Class 2:
After the individual students had researched on the assigned objectives, the groups then met to continue the discussion. This time each student discussed on the research that he/she had done, as they identifying the overlapping issues, reviewing information, reviewing the differential diagnosis & treatment plan in accordance to the new information gathered by the each group member. Since all the information collected, including videos, images, reports and lot of other documents are shared to everyone, they were able to view & watch aids along with participating in the discussion.
Once the discussion was over the tutor was informed and based on the information & discussions tutor verify to ensure all the objective of the trigger 1 is covered then the Trigger 2 is released to the students and they started discussions just like they did in the Trigger 1 and objectives are assigned to individuals by the scribe.

 
Research:
The research is carried out by the students similarly as they did for Trigger 1.

 
Class 3:
The discussion is carried out again and this whole process can be repeated in a cycle until the   group members are satisfied that they have addressed the learning issues

 
Solution to the problem:
As the group members are satisfied with learning issues that they have addressed & provided answers to the problem that was initially posed to them. The group collectively plans for the conclusion and scribe updates the information in web application.  
Note: The tutor can view the entire information posted by the students in web application at anytime and anywhere.

 
Logistics of Web based PBL:
There are 4 real-time medical problems that were incorporated in the web application; the objectives & topics covered in those respective problems partly covered the curriculum of the 1st, 2nd & 3rd year subjects of undergraduate medical course. 
 
In 3rd Year UGC there are total 60 students and all the 60 students participated in the Web based PBL class. These students had already done regular PBL classes (not web based PBL) in the previous year, hence the process flow was not a concern. The classes were conducted in the controlled environment where the seating facility, laptop/computer and internet connection were available.
The research was done for 2 batches each batch consisting of 4 groups and each group consisting 7-8 students. The first session was attended by batch 1 and the second session was attended by batch 2 students. Each session had 3 classes conducted once in a week for 2 hrs, each group had dealt with 1 problem using web application where PBL process was followed as described above.

 
After each session feedback was collected from the students & tutors. The feedback form had 10 questions for students and 11 questions for tutors were asked to express about the web applications, advantages, disadvantages and lot more. The results were amazing and interesting.

 

 
Results & suggestions:
The questions asked were both objective and descriptive; Most of the questions were similar to students and tutors.

 
Questions
Students
Tutor
Do you like our product?

 
100% Yes
100% Yes
Do you like the look and feel of product?
98% Yes, 2% No
87.5% Yes, 12.5 No
Please rate your experience using Upacaar product
9 %– Excellent,   
9% – Bad
82%– Good    
100% – Good

 
Does Upacaar fits into your Present PBL process successfully
93% - Yes
7% - No( internet connection)
95% - Yes
Are you aware about Problem Solving?
88% - Yes
12% - No
100% - Yes

 
Do you feel an Online Problem solving tool would be of help to you? 
88% - Yes
12% - No
100% - Yes

 
In the descriptive questions students expressed all the benefits, draw backs and uses of doing web based PBL. Students & tutors clearly stated there were many advantages including but not limited to all the benefits of Electronic format of doing PBL was enjoyed; Easy to add & store information online, They access information from anywhere, anytime & share information to their group members. The data is organised & available at one place, reduced complexity, sorting options to view the interested information; it is exciting, motivational and innovative.
Students can assign tasks to fellow group member or add a reminder for themselves, watch videos, images & spend time on only discuss and avoid taking notes, enhanced tasks performances by exploring different resources such as online contents, journal and books.

 
Some of the drawbacks were also expressed, Few students don’t have laptop/computer to do the research and internet access was not available everywhere to do the research & the internet cafe was over crowded some times, However in the web based PBL class there was no issues.

 
The collaboration of Web based & PBL positively contributed to the enhancement of the communication skills of the students; these students valued the opinion of other students and at the same time debated over complex topics, became confident enough to raise their own ideas. They also realised the importance of collaborating with others in the construction of new knowledge.   

 

 
Even though the results had been analysed through the students’ & tutors’ perceived responses and suggestions; neither an actual task performance analysis nor a relative comparison with other established learning approaches had been carried out, the results provided great degree of indication of the inherent capability of the Web based-PBL in terms of yielding the many positive aspects of the educational outcomes.  The results of research can wary in other colleges based on some degree of uncertainty, for instance the social interaction may have already existed or perhaps been engaged in some kind of group discussions for other courses they had enrolled within the programme and was a part of daily life, however the resulting positive learning outcome was evident as the students participated were both from the medical & nursing back ground.

 
Summary:
The study revealed that Web Based-PBL resulted in many positive aspects of education outcomes. The study also revealed that Web based solution fits appropriately into the PBL process and makes the learning more effective, interactive and importantly enjoyable by the students & tutors. It also gives opportunity to explore problem solving online.
Enabled students to link up different ideas, to share knowledge and induced motivation that contributed to positive learning outcomes.

 
Acknowledgement:
The author acknowledges the contribution and support of the faculty members of St John’s Medical College who facilitated during the PBL assignment. He also extends his thanks to all the students who participated in this study. This research has been conducted with the support from both Upacaar & St John’s Medical college 2011.

 

 
References:

 

 
Web based PBL

 
http://cte.umdnj.edu/active_learning/active_case.cfm Centre for teaching excellence, Problem based learning at UMDNJ

 

 

 

Friday, April 15, 2011

Suprising results of Problem based learning (PBL) class

Hello again,

As I said in my previous blog the PBL is one of the best learning method which I think should be incorporated in medical colleges in India, in abroad the universities like McMaster, MU, Queen’s lot more are experts in it, the results are mind blowing and PBL is part of their curriculum also.
In this world where students want to bunk as many class as possible and doesn’t like boring lectures, gave a very surprising feedback and I will give you some of the facts and figures of its adaption in St John’s and the results are just amazing.

Some of the facts,
1. 80% of students like PBL class, 9% didn’t like the class and remaining were not sure
2. 90% of students continue to attend the PBL class
3. Students quickly understand the problem, learning issues and where to find information.
4. Clearly Critical thinking, decision making and problem solving skills were excellent
5. From first class to last class the communication, networking and team work was increased tremendously.
6. Complex problems are discussed in easy to understand way
7. Students were able to relate the problem and learning into their clinical classes where they are exposed to real patients.
8. They are adapted to the PBL class now and they are willing to attend the regular PBL classes if conducted
9. Happy about the PBL certificates that they get

Student’s suggestions,
1. Access to computer and internet can help them to access huge information, faster & make it more interacting class
2. Access to information tutor along with cases details like objective, reference data can add lot of value
3. More PBL classes as by the time they try to adapt to the PBL class and started liking it, it is over. (recommending for part of curriculum)
4. Less of lecturing(if any) and more of interactions
5. Better organisation of materials that they carry in PBL class & order in which they present
6. Better & more use of Audio/Video aids
7. Team could have met between sessions
8. More enthusiasm & seriousness from team members

Clearly it shows that students, tutors and of course I liked the learning. Some of the students said by the time they started enjoying the PBL class it is over and due to time constrains, not part of syllabus we were not able to continue this method. They were saying it will also help us in our clinical posting & our future professional roles. We spoke to lot of students, doctors, professors, vice principal, principal, dean and some directors, as they agreed it should be part of the curriculum & PBL main success students adaption & it is clearly visible in few Indian students, but larger crowd should try this in India.


Note: Facts & suggestions are taken from St John's students & refered to data collected by Medical education department of St John's medical college (Bangalore) & Dr Nachiket, Anatomy, St John's medical college.
Again feel free to mail me for any question that you may have at kishan.kumar@upacaar.com

Thursday, April 14, 2011

My amazing experience in Problem based learning (PBL) Class


Hello There,

I am so excited to share my experience in Problem based learning class, which I think is way better than traditional teaching methods like class room teaching or lectures. In today’s education system you have so many varieties of teaching & learning methods that are adapted by many schools and colleges, and very few methods are effective & interactive and one of them is Problem based learning or PBL. Personally I have never experienced problem based learning classroom till recently and frankly speaking i wish i had something like this in my college days L
Big thanks to St John’s Medical College (Bangalore, India) for giving me and my friend Vivek permission to attend one of the PBL sessions in their college. We are so glad that we got the opportunity to be part of this class, which was such an effective, enjoyable and self learning class. St John’s College is practicing PBL from past 3 years, they started PBL in the year 2008 & though it is not a mandatory method by MCI(medical council of India), it is still successfully adapted as extracurricular activity.   
I think it’s time for MCI to make this mandatory or atleast make colleges to try this learning and see the results & then probably think about mandating.

Before I narrate my experience I will give you little insight about PBL process and its value:
PBL was pioneered in the health sciences at McMaster University in the late 1960's and subsequently it has been adopted by other medical school programs and also been adapted for undergraduate instruction.
PBL is a student-centered pedagogy in which students learn about a subject in the context of complex, multifaceted, & realistic problems. Working in groups, students identify what they already know, what they need to know, & how & where to access new information that may lead to resolution of the problem. The role of the tutor is that of facilitator of learning who provides appropriate scaffolding of that process by (for Example) asking probing questions, providing appropriate resources & leading class discussions, as well as designing student assessments. (Check the link below)


http://www.youtube.com/watch?v=sNhismExIwU&feature=player_embedded

For more information check this link:

PBL benefits students in enhancing,
  1. Real time exposure to simulated medical cases
  2. Problem solving skills  
  3. Critical & creative thinking
  4. Decision making
  5. Exposure to variety/rare cases   
  6. Collaboratively working among team
  7. Better communication
  8. Longer memory
                and More

How we got there!  Well first we contacted Dr Nachiket & Dr Swarna Rekha Bhatt in St John’s (medical education department) very dynamic people & so passionate about their profession. We got the appointment without any hassle. We met & spoke to them about what we are planning to do (which you can find in my previous blog) and they were really excited when they heard what we wanted to do around PBL. We were also interested to know more about the PBL, its uses and its adaptability in SJ; hence we wanted to attend the PBL class.
Dr Nachiket helped us in getting the permission to attend the PBL class from Dean and after we got the permission we were all set to attend the PBL class in coming days. We were so excited; entry into medical college & back to college feel was just awesome.

Brief about my experience in the class:
1) The First PBL class was a introductory class: All the 4th sem students of medical & some nursing students were present in the introductory class. As we entered the room, we saw they were curious & wondering what is this method and how are they going to do PBL. Dean, Dr Nachiket & other professors gave introduction about the PBL, Especially the Dean gave a very good speech by starting “In life we go through problem based learning as we encounter problem every time, your learning is determined by the problem you encounter”, He also said in abroad the PBL is extensively used by Medical schools, this is very effective learning as he has experienced in the McMaster university in Canada.
Dr Nachiket introduced the PBL, how it is different from problem solving, how a PBL process is & class would look like using ppt and also conducted a Mock PBL class with generic problem. What we saw there is students were not open to discussions, most of them were mum and few gave their input but overall the participation was less however they were able to understand the method.
After the Mock PBL, Dr Nachiket gave the logistics of the class which is 2 hrs/week for 2 months, 7 - 8 members in a group out of which 1 or 2 are nursing students and remaining are medical students. Importantly he mentioned this is not marks based learning, no evaluation, its free class to students to interact and here teacher will be silent listeners. Also students don’t have to be right and can ask lot of questions. He also gave some of the statistics of the previous PBL batch feedback and was shocked as all most all the students liked the PBL sessions, wanted to attend more and their suggestions to make it better was also discussed.
Since it is not part of the curriculum they are doing it for student’s good, to make sure they get the best learning experience and asked them to make best use of it. The group members were decided (smartly by keeping best friends in different groups). Class dispersed for Tea/coffee and for some snacks and would meet in the next PBL class.

2) PBL Class 2: The students and tutor meets in PBL class in the afternoon in a room which has table, chairs placed across the table & all the students were facing each other. I and vivek went to different PBL classes, I met Dr Yashoda the Tutor, very energetic lady, so much interested in education and very friendly to students (ideal). I was there to just observe & take notes in my laptop.
The class had 6 medical students and 1 nursing student. The first trigger “Problem 1, Trigger1” (in paper) is given to all the students. Here a medical Problem/case is cut into 2 parts and these parts are called trigger 1 and trigger 2. Each trigger has information about the patient history & complaint, lab results and physical examination etc. Students have to identify, list the objectives & have to cover these objectives in their discussions, if they miss some objectives, tutor can guide them in the end or middle of the PBL class. The tutor will have the Objectives lists, Areas/topics the problem touching and references, which they do not share with the students however they can guide if the students miss any. Tutor briefed again on the approach to trigger, as the students are new to this method & tutor stated again that students are not here to solve the case but to identify what they know & what they don’t ; learn the new topics & recall the old ones, in the mean time they actually solve the case.
Tutor asks the group to select one scribe (who write the objective) and one chair (who assign the task among the group) In this class the scribe was listing the objectives by discussing with the group. The student’s couldn’t cover all the objectives and that’s where the tutor pitched in and suggested some of the points which made the students to think and finally they listed the all the objective. The discussion was not that intense and everyone was not participating that easily and even the communication was not that effective (which is about to change in the coming class). The Coffee was served in the middle of the class to everyone, they got refreshed and discussion continued (This was given in all the PBL classes though).

Students were little hesitant and most of the time facing towards the tutor to explain her, however the tutor played smart and motivated them to discuss among themselves and told them to forget that she is around. Tutor was hardly interrupting the discussion & was telling me that how slowly they are adapting to this learning. The Chair assigned the objectives to each student at the end of the class and asked the students to do research on those topics and get all possible materials to support their findings. Then they dispersed.

3) PBL Class 3: Students enter the room, one student was absent today and remaining 6 students were energetic. Not all the students were carrying the trigger 1 paper, but they were carrying all the research materials such as, text books, note books etc & pen drive. The students started the discussion as per chair’s direction, here chair only started the discussion, students were liking the talks, however the discussion was between 2 students only the rest of them were just listening.
The speaker’s eye contact was towards only one student and remaining were looking like left out in the scene, however things changed later and speaker was looking at everyone. Then every student started to speak, others were listening, taking notes & discussing. They also used some Audio/Visual aids which was so catchy, brought interest in the students and information grasping was high compared to only lectures which I felt. There are few things in discussions which even the tutor was not aware about, so she also noted few things (learning to the tutor as well). Students were moving from one place to another, having fun & at the same time discussing. Even tutor drops in once in a while and increase the enthusiasm in the students.
The students also spoke about the medical terms & definition, and then finally the tutor asked the students to come to the conclusion of the trigger1, suggestions for patient care at the moment, any tests you would want to suggest etc. Students listed, discussed and it was evident that their critical thinking & decision making skills was clearly visible.
Trigger2’ was handed over to the students, which had EEG report of patient. The students repeated the process at listing the objectives, discussion & assignment. The task assigned to the absentee is taken by one of the student and agreed to research that item/topic before next class and dispersed.

4) PBL class 4: The students gathered in the class, today all the students were present. The discussions started with the Video and audio which sets the mood of the class as the students were so passionately started watching, followed by ‘how to read the EEG report’ PPT and the information presented by student was so easy to understand even by a non medical student like me. Tutor said to me that the ‘EEG report’ one of tough topic to understand by the final year students but these document & video made the job so easy.
Improved communication, active participation, every one speaking, writing and researching data in easy to understand form was evident in this class. It was so nice to see the class like this. Finally the students reached the conclusion of the Trigger 2. The Next problem’s Trigger 1 was suppose to be given in next class but the students wanted insisting to give in this class as they need more time to research. Tutor happily gave the “Problem 2, Trigger1” seeing the student’s enthusiasm. They did the usual thing for this trigger also & dispersed.

5) PBL Class 5: only few students turned up to attend the class & rest didn’t due to some reasons, they discussed about the problem but not in depth though. The students were talking about the smoking - the problem stared with person smoking habits, presents to the OPD with complaints of headache & giddiness for the last 3 months with his physical examination results. The students were moving in the problem solving direction, so the tutor had to jump in and suggested again the PBL intention is to work around the problem & not restricted to Problem solving.
One of the student had got a information on different problems that’s caused by head ache, but it was more like the presentation style & he was trying to present it to teacher, so the teacher asked the students to make a differentiators between the different terminologies, so that we know why not this problem, why this particular problem is related to this and so on. As i always say she handled it really well.
The teacher also sometime pushes the student to think in different terminologies like hypertension which can sometime lead to head ache, so it was good approach from tutor to guide the students in different direction which can make them learn other stuff and also important to restrict not go beyond a relevant points.
Students also spoke about the normal BP, when it goes high like during exercise or in anxiety etc.

6) PBL class 6: In this class all the students turned up and discussions began, students as usual spoke about lot of things, they covered all the objectives, brought some video, audio and PPTs which weres interactive. Not only students even I learnt a lot about the BP, hypertension etc. They also learnt what question to keep in mind when taking history, examining a patient, reading & understanding the physical examination report etc. Looks like the students had covered the objectives & arrived at conclusion, hence “Trigger 2” was given which had ECG report in it. Scribe listed the objective as usual and chair assigned the tasks and class dispersed.

7) PBL class 7: Since next class is a valedictory of PBL session, this is the last day of PBL class. The students & tutor spent about 30 minutes on the Feedback forms which includes 1) tutor to student 2) Student to tutor 3) student’s process evaluation. The Class started after the feedback, One of the students started speaking about smoking as he encountered many patients in his routine clinical class where they are suppose to take history from the live patients and he asked the patient about their smoking habits, frequency, type of medium they use for smoking like cigarette, bidi(local made), cigar, the kind of questions & probable causes that he learnt in his PBL classes last week. They were saying PBL class & real time patient experience gives a lot of learning & understanding to the group as they say gives them good understanding of the approach to the problem & depth of the problem and be able to do history taking, critical thinking, examining, decision making and problem solving much better.  They also continue to say this gives them the feel of professional Doctor.
Then the discussion was on ECG reports, how the electrical pulses work, so on and again they presented it so simple, that a non professional can understand very easily. One of the girls was so involved she got her ECG done and brought it to class to explain.
Finally they all understood the how practically it is important to experience and apply all your knowledge to solve a problem and find information in variety of resources for things that you don’t know.
They all agreed this is far better than just reading the text books & some lectures.

8) PBL Valedictory: The valedictory was fun Dr Nachiket and other professors & vice principal spoke about the PBL process and how St John’s is trying to teach its students all the best possible teaching and learning method to help students to become good Doctors, so on. There was interactive session between the students and professors where they shared their likes and dislikes about the PBL etc. (The feedback of the PBL class & statistics I have posted in next blog, please click: http://upacaar.blogspot.com/2011/04/suprising-results-of-problem-based.html ). Dr announced PBL certificates will be given in their respective classes
Happy students moved to have tea/coffee and some snacks, so did we had some :) Discussions & suggestions continued after the valedictory class also and in the end all happy faces.

If you would like have PBL training or workshop please let me know, I shall make an arrangement for you or your institute.

Thanks for reading my Blog, please let me know you have any questions at kishan.kumar@upacaar.com or info@upacaar.com  and also check the our website upacaar.com          

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