A student-centred,problem-based curriculum: 5 years' experience.

In 1987, the University of Sherbrooke''s school of medicine implemented a student-centred, problem-based learning (PBL) curriculum. The experience of the first 5 years is reviewed; program goals, the schedule of learning activities, the instructional format and assessment of student learning are described. The new program is more demanding of teachers and requires better faculty training in pedagogy. No new financial resources have been available. The preclinical reform has led to revision of the clerkship, where sessions on clinical reasoning are now based on the PBL philosophy. Student reactions to the program are reported. The Sherbrooke experience has demonstrated that it is both possible and feasible to shift from a traditional to a problem-based curriculum.     

Toward meaningful learning in undergraduate medical education using concept maps in a PBL pathophysiology course

Problem-based learning (PBL) is now an established method in undergraduate medical education that aims to develop reasoning skills based on clinical problems. More recently, the use of concept mapping in medical education aims to improve meaningful learning. At the New University of Lisbon, we have been using PBL as a major educational method in a pathophysiology course. In 2003-2004, we started to use Inspiration, a computer-based concept mapping tool, with a single tutorial PBL group. A total of 36 maps were constructed related to short cases, already used in the PBL course, in which a certain number of key nodes were hidden to allow the students to fill in the gaps. The results obtained appear to indicate that the use of concept maps stimulated meaningful learning within a PBL course.     

Endocrine PBL in the year 2000

The Southern Illinois University School of Medicine (SIU-SOM) has utilized problem-based learning (PBL) in its curriculum since 1981, when Dr. Howard Barrows joined the faculty. From 1989 to 2000, SIU-SOM implemented two parallel curricula for the basic science years (years I and II), one curriculum being a problem-based learning curriculum (PBLC). An executive decision to design and implement a single curriculum, to begin in Fall 2000, fostered a review of existing pedagogy upon which to base this new curriculum: C2000. The results of this review, which considered formal outcome measures as well as internal review in consideration of the institutional mission, led to PBL becoming the predominant pedagogy for C2000, albeit with some modifications from its PBLC predecessor. C2000, then, represents the third iteration of PBL in use at SIU-SOM, and its design and rationale offer insight for the teaching of Endocrine Physiology in a PBLC.     

Preparing faculty to teach in a problem-based learning curriculum: the Sherbrooke experience.

Over the last 6 years Sherbrooke Medical School has undertaken a major reform of its undergraduate curriculum. A new student-centred, community-oriented curriculum was implemented in September 1987. Problem-based learning (PBL) is now the main educational method. To adequately prepare teachers for the curriculum a series of faculty development programs in pedagogy were offered: first, a 2-day introductory workshop to initiate teachers into educational principles and their application in the new program; second, a 1-year basic training program in medical pedagogy; third, a 1-day workshop on PBL; and fourth, a comprehensive 3-day training program in PBL tutoring. Over 60% of all full-time teachers attended the introductory program and 80% the tutor training program. The 1-year basic training program was completed by 33% of the faculty members. The implementation of these programs, coupled with a high participation rate, resulted in a more student-centred educational philosophy and a greater interest in medical education. This had a significant impact when the new curriculum was instituted. Lessons learned from the experience are discussed.     

Impact of problem-based learning in a large classroom setting: student perception and problem-solving skills

Problem-based learning (PBL) can be described as a learning environment where the problem drives the learning. This technique usually involves learning in small groups, which are supervised by tutors. It is becoming evident that PBL in a small-group setting has a robust positive effect on student learning and skills, including better problem-solving skills and an increase in overall motivation. However, very little research has been done on the educational benefits of PBL in a large classroom setting. Here, we describe a PBL approach (using tutorless groups) that was introduced as a supplement to standard didactic lectures in University of British Columbia Okanagan undergraduate biochemistry classes consisting of 45-85 students. PBL was chosen as an effective method to assist students in learning biochemical and physiological processes. By monitoring student attendance and using informal and formal surveys, we demonstrated that PBL has a significant positive impact on student motivation to attend and participate in the course work. Student responses indicated that PBL is superior to traditional lecture format with regard to the understanding of course content and retention of information. We also demonstrated that student problem-solving skills are significantly improved, but additional controlled studies are needed to determine how much PBL exercises contribute to this improvement. These preliminary data indicated several positive outcomes of using PBL in a large classroom setting, although further studies aimed at assessing student learning are needed to further justify implementation of this technique in courses delivered to large undergraduate classes.     

PBL教学模式在八年制《医学导论》教学中的应用

《医学导论》课对于八年制临床医学专业学员的学习非常重要,将PBL教学模式应用到《医学导论》教学中,从课程设计、问题筛选、团队精神培养等环节进行实施,有利于培养学员自主学习和解决实际问题的能力,圆满完成了《医学导论》的教学任务。     

PBL 教学模式在八年制《医学导论》教学中的应用

《医学导论》课对于八年制临床医学专业学员的学习非常重要,将PBL教学模式应用到《医学导论》教学中,从课程设计、问题筛选、团队精神培养等环节进行实施,有利于培养学员自主学习和解决实际问题的能力,圆满完成了《医学导论》的教学任务。     

Combination of didactic lecture with problem-based learning sessions in physiology teaching in a developing medical college in Nepal

Physiology teaching as an essential part of medical education faces tremendous criticism regarding curriculum design, methods of implementation, and application of knowledge in clinical practice. In the traditional method of medical education, physiology is taught in the first year and involves little interdisciplinary interaction. The Manipal College of Medical Sciences, Pokhara, Nepal (affiliated with the Kathmandu Univ.) started in 1994 and adopted an integrated curriculum drawn along the lines of the student-centered, problem-based, integrated, community-based, elective-oriented, and systematic (SPICES) medical curriculum. Here, physiology is taught for the first 2 yr of the 4.5-yr Bachelor of Medicine, Bachelor of Surgery course. Methodology adopted is as follows. For a particular topic, objectives are clearly defined and priority content areas are identified. An overview is given in a didactic lecture class to the entire batch of 100 students. Tutorial classes are conducted thereafter with smaller groups of students (25/batch) divided further into five subgroups of five students each. In these sessions, a problem is presented to the students as a focus for learning or as an example of what has just been taught. Each problem was accompanied with relevant questions to streamline the students' thought processes. A tutor is present throughout the session not as an instructor but as a facilitator of the learning process. A questionnaire sought students' opinion on the usefulness of this approach, relevance of the combination of problem-based learning (PBL) sessions and didactic lectures in understanding a particular topic and relating clinical conditions to basic mechanisms, and improvement of performance on the university final examination. The majority of the students opined that the combination of didactic lectures and PBL sessions was definitely beneficial regarding all the above-mentioned aspects of learning. The university results corroborated their opinion. Thus it may be considered that a judicious mixture of didactic lectures and PBL sessions is beneficial as a teaching module of physiology in medical schools.     

Biological and Health Science courses in New Zealand technical institutes

Argumentation in science is the process of coordinating theory and evidence to justify conclusions. This practice is at the heart of scientific journal writing and communication, but little is known regarding the argument quality of college science majors, the future scientists. Studies on written arguments at the college level have focused primarily on non-majors and upper-level students. To investigate and describe these skills throughout the biology curriculum, majors (n = 243) in four levels of undergraduate biology courses at a public university were assessed using a short, written argument instrument based on a hypothetical data set and scenario. Using Toulmin’s argumentation pattern to assess the instruments for argument aspects and quality, very few differences were found in the scores across course levels. Students were able to generate simple arguments consisting of claim, evidence and reasoning. The ability to provide scientific principles as reasoning to connect evidence and claims was positively correlated with course level. However, advanced argumentation skills, such as creating alternative explanations and rebuttals, were lacking across all course levels. These findings imply the need for explicit attention to argument construction throughout the undergraduate biology curriculum.     

Public access for teaching genomics,proteomics, and bioinformatics

When the human genome project was conceived, its leaders wanted all researchers to have equal access to the data and associated research tools. Their vision of equal access provides an unprecedented teaching opportunity. Teachers and students have free access to the same databases that researchers are using. Furthermore, the recent movement to deliver scientific publications freely has presented a second source of current information for teaching. I have developed a genomics course that incorporates many of the public-domain databases, research tools, and peer-reviewed journals. These online resources provide students with exciting entree into the new fields of genomics, proteomics, and bioinformatics. In this essay, I outline how these fields are especially well suited for inclusion in the undergraduate curriculum. Assessment data indicate that my students were able to utilize online information to achieve the educational goals of the course and that the experience positively influenced their perceptions of how they might contribute to biology.     

浅谈免疫学与病原生物学整合课PBL教学模式

以问题为导向的PBL教学方法,将问题作为学习的起点,有助于提高学生解决问题的能力。免疫学与病原生物学整合课使用了PBL式教学。本教研室在扎实掌握重点知识的前提下,运用这种教学法,调动了学生自主学习的积极性,提高了学生的团队意识。学生的创新精神和能力有所提高。这种教学方法与传统教学方法有较大不同,而客观条件仍存在着一些不足,需要不断完善。     

Problem-based learning and the medical school: another case of the emperor's new clothes?

For almost four decades, problem-based learning (PBL) has been the stated cornerstone of learning in many medical schools. Proponents of PBL cite the open nature of the learning experience where students are free to study in depth, unencumbered by the burdens of broad courses based on the memorization of facts; detractors, on the other hand, cite the lack of breadth and factual knowledge required for professional qualification. Both points of view have merit. Professional schools have a different set of needs and requirements, and it is these that drive the curriculum and learning philosophies. The constraints of the professional school are so different from those of the purely academic environment that PBL, while admirably suited to the latter, is just problem solving in the former.     

PBL+LBL教学模式在留学生医学微生物学教学中的实践

由于留学生的特殊性导致他们对传统教学模式的不适应,医学微生物学的课程特点使留学生学习掌握相关知识较困难,有必要探索好的教学方法,提高教学质量。我国传统的LBL教学模式和国际上流行的PBL教学模式各有优缺点,我们融合PBL和LBL的优点,互补其缺点,对留学生医学微生物学课程采取PBL+LBL教学模式,既发挥PBL教学法打破学科界限,容易调动学生学习积极性,注重培养学生自主学习和团结协作能力的特点,又结合LBL教学法传授知识系统、完整,培养学生基础理论扎实等优势。教学实践证明,PBL+LBL教学法运用于留学生医学微生物学教学,能激发留学生学习兴趣,在增强留学生对医学微生物学基础理论和基本技能掌握的同时,培养留学生知识整合的能力及创新思维的医学综合能力,提高教学质量。     

Learning approaches of undergraduate medical students to physiology in a non-PBL- and partially PBL-oriented curriculum

Melaka Manipal Medical College (Manipal Campus; Manipal, Karnataka, India) conducts the Bachelor of Medicine and Bachelor of Surgery program, for which the admission intakes are during the months of March and September. The present study was undertaken to study the differences in learning approaches to physiology of undergraduate medical students in a partially problem-based learning (PBL)- and non-PBL-oriented curriculum. PBL was introduced as a curricular reform for the September 2006 batch of students (partially PBL group), whereas it was not incorporated for the March 2006 batch of students (non-PBL group). Learning approaches to physiology of both groups of students were compared using the short inventory of approaches to learning. Mean scores for deep and strategic approaches were found to be significantly higher for the partially PBL group compared with the non-PBL group. The results of the present study support the earlier observation that PBL promotes a deep approach to learning.     

组织学与胚胎学PBL教学对学生创新能力的培养

中国医科大学组织学与胚胎学教研室承担了CMB03-#793项目,连续五年在临床医学七年制日文班实施了PBL（problem based learning）的教学模式,根据其教学特点确立了组织学与胚胎学（组胚）PBL教程,编写了＂组织学与胚胎学PBL病例集＂并制作了多媒体课件。学生在PBL中受到启发,激发了主动学习积级性,也制作了多媒体课件。同学课下查阅文献,准备资料。讨论病例分组进行,同学主持。大家踊跃发言,举证说明,用学得的知识,联系组胚理论去解释生命现象并和疾病相联系。我们对实施过PBL教学的几个年级的学生257人进行了追踪问卷调查,结果看出得到明显提高的依次是学生的主动学习的能力,独立查阅资料的能力、拓宽知识面、对相关领域感兴趣、分析解决问题的能力及对知识的理解能力。提高的相关指标就是创新思维的基础和前提。学生拓宽了知识面、开阔了视野,自然就会产生兴趣迸发出学习的生机去主动思维,也就有了分析解决问题的能力。由此产生不同以往的看法和想法,有了新的认识、新的观点和新的所为,丰富的想像力就会迸发出创造力,这些就是创新的萌芽。这是PBL教学带给学生的新的理念。刷新理念将会产生更多的创新。     

以执业医师考试为导向的基础医学教学模式探索与实践

以社会需求为导向,加强基础医学课程教学模式探索,不断深化医学人才培养改革,已成为基础医学教育创新改革的目标需求。本文就近年来以执业医师考试为导向的基础医学课程教学模式探索与改革实践进行了分析和总结,着重从优化整合医学课程体系,实施基于病例和问题的PBL教学方法改革,加强辅导答疑重点培养学员综合素质与能力,加强师资队伍建设,加强针对性练习强度及合理设置考试方式,加强信息化教学手段等方面进行了讨论,以期为进一步深化基础医学教育改革和不断提高基础医学教学质量提供思路。     

Portal branch ligation induces a hepatic arterial buffer response, microvascular remodeling, normoxygenation, and cell proliferation in portal blood-deprived liver tissue

Portal branch ligation (PBL) may prevent liver failure after extended hepatic resection. However, clinical studies indicate that tumors within the ligated lobe develop accelerated growth. Although it is well known that tumor growth depends on the host's microvascularization, there is no information about how PBL affects the hepatic microcirculation. Our aims were to determine hepatic artery response, liver microcirculation, tissue oxygenation, and cell proliferation after PBL. Therefore, we used intravital multifluorescence microscopy, laser-Doppler flowmetry, immunohistochemistry, and biochemical techniques to examine microcirculatory responses, microvascular remodeling, and cellular consequences after left lateral PBL in BALB/c mice. During the first 7 days, PBL induced a reduction of left hilar blood flow by approximately 50%. This resulted in 80% sinusoidal perfusion failure, significant parenchymal hypoxia, and liver atrophy. After 14 days, however, left hilar blood flow was found to be restored. However, remodeling of the microvasculature included a rarefaction of the sinusoidal network, however, without substantial perfusion failure, compensated by a hepatic arterial buffer response and significant sinusoidal dilatation. This resulted in normalization of tissue oxygenation, indicating arterialization of the ligated lobe. Interestingly, late microvascular remodeling was associated with increased endothelial nitric oxide synthase expression, significant hepatocellular proliferation, and weight gain of the ligated lobe. Thus PBL induces only an initial microcirculatory failure with liver atrophy, followed by a hepatic arterial buffer response, microvascular remodeling, normoxygenation, and hepatocellular proliferation. This may explain the accelerated tumor progression occasionally observed in patients after PBL.     

关于在神经外科实习教学中采用Web-CPBL教学模式的探讨

在医学生临床实习带教过程中,神经外科实习教学由于其教学内容具有专业性强、信息量大、知识更新快的特点,与其它专业相比更具难度,教学效果往往难达到预期水平。Web-CPBL教学模式,是将传统的PBL教学理念与网络信息技术有机融合,延伸和发展出的一种新型教学模式。在神经外科实习教学中,巧妙得当的借力于网络资源平台,有助于打破临床师资缺乏、实操场地不足的局限,能更充分的发挥PBL教学的优势。此模式在培养和锻炼医学生临床思维能力的同时,也帮助他们尽早养成主动学习、善于协作、乐于共享的良好学习习惯,提高其医学人文素养。     

PBL教学模式在病原生物学、免疫学及感染病学课程整合改革中的探索与实践

探讨问题导向教学(PBL)方法在病原生物学、免疫学及感染病学课程整合改革中的教学效果及意义。以中国医科大学2009级七年制临床系学生240人为研究对象,随机分为实验组和对照组各120人。实验组采用PBL教学方法,教学内容采用病原生物学、免疫学及感染病学整合,对照组采用传统教学方法,教学内容为传统病原生物学课程,2组由相同教师授课,采用期末考试和教学效果自评调查问卷的方式评价教学效果。实验组与对照组相比,期末考试成绩无统计学差异(P>0.05),但病例分析题成绩有统计学差异(P<0.01)。2种学生的自评调查问卷中,实验组的自学能力、团队协作能力及发现问题解决问题的能力均显著高于对照组(P均<0.01)。PBL教学模式能有效提高教学质量,具有一定的示范及推广价值。     

Ethics,jurisprudence, and economics in the medical school curriculum.

Medical ethics, medical jurisprudence, and medical economics are recognized as important components of a medical school curriculum. These subjects were introduced through a course given at the University of California, Davis, School of Medicine. Four aspects of the format and content of the course were instrumental to its success. Teaching principles of medical ethics within the context of jurisprudence and economics permitted the students to gain an understanding of the institutions and processes that act as positive and negative constraints on physicians'' clinical and professional behavior. The course was offered during the fourth year following required clinical rotations so that all aspects of the course could be based on the clinical experiences of the students. It was presented in a continuing medical education format away from the normal teaching environment of first- and second-year classrooms and third-year clerkships. Finally, the course was designed by a multidisciplinary, multidepartmental planning group that included students.