Download - Problem-Based Learning in Health Education
Problem-Based Learning in Health Education
Madeleine Rohlin and Christina LindhMalmö University Malmö, Sweden
Goiania October 2010
SWEDEN in some FIGURES
• Oldest population in the world (aged 80 and over) • Education spending: 7.7% of GDP (Nr 9) (Health spending: 8.7% of GDP Nr 20)
• Teritary education (all levels of post-secondary education) enrolment: 70%
• Highest human development index ~ quality of life after Norway and Iceland. Highest environmental sustainability index after Finland and Norway
The Malmö-model Examples on different levels
Programme
Course
Week
Weekly timetable for course 2 ‘Diagnosis and Treatment of simple Periodontal Disorders’
Monday Tuesday Wednesday Thursday
Friday
am Study-group
Problem
introduction
Clinical setting
Examination of patients with periodontitis
Study-group
Review and
Problem-solving
pm Skills lab
Practice of different skills
Seminar
RELATIONSHIP BETWEEN PROBLEM AND KNOWLEDGE GAINED
Traditional or Case-based Students have to have
education the knowledge required to approach the problem
(situations)
PBL Students’ knowledge arises from work on the problems (situations)
Centre for Oral Health SciencesMalmö University, Sweden
Semester 2Course: Diagnosis and Treatmentof Simple Periodontal Disorders
Scenario: Karin
Karin notices bleeding from the gum in the upper jaw she brushes her teeth.
PROBLEMS (formulated by students)Why is the gingiva red and swollen at one placebut not at another?
HYPOTHESIS (formulated by students)The amount of tissue fluid and blood increases in aregion due to the microorganisms. The bleeding is due tothe increased number of blood vessels with fragile walls.
Weekly timetable for course 2 ” Diagnosis and Treatment of simple Periodontal Disorders”
Monday Tuesday Wednesday Thursday
Friday
am Study-group
Problem
introduction
Clinical setting
Examination of patients with periodontitis
Study-group
Review and
Problem-solving
pm Skills lab
Practice of different skills
Seminar
Examples on questions posed by one cohort after they have studied ’Karin’. The questions are handed to
experts and discussed during a seminar.
•When the tooth surface is covered with a bacterial film do the body defence mechanisms regard the tooth as ’foreign’ and try to remove it
– leading to the breakdown of bone?
• How can H2S produced by micro-organisms cause tissue damage?
• Does pushing the probe into several pockets, without cleaning it in-between, lead to the spread of periodontits?
• Does a deep periodontal pocket which bleeds necessarily mean that periodontits is active?
• Can a pocket be 4-5 mm deep without being classified as diseased?
• Why does platelet-activating factor cause vasodilatation at low and vasoconstriction at high concentration?
LEARNING
Based on students’ own questions and
self-generated discovery
MEANING-MAKING
The Malmö-Model
COURSE LEVEL
Clinical situation SKILLS LABORATORY STUDY GROUP
COURSE 2. Students should be competent to take care of adult patients with simple periodontal disorders
REGISTRATION OF
bleeding
plaquecalculus
pocket depthattachment level
EXAMINATION OFTHE PERIODONTIUM
DIAGNOSIS
TREATMENT
Pain
Local anaesthesiai
Information on diseaseOral hygiene instruction
Health conditionAnamnesis
Inflammatory reactions and their regulation
Virulence of subgingival microfloraCalculus formation
Action of cytokines. Mechanisms forbone resorption
Radiographic image quality. Radiationphysics
Biological effects of radiationSelection criteria for X-ray examination
Healing processes. Blood coagulation and fibrinolytic system
Progression and treatment of periodontitis
Innervation of the oral cavityTopographic anatomy
Nervtransmission and receptors
Pain and pain experience
Pain relief and action of local anaestheticsCommunication. Health perceptionHabits and personality
Respiration and cirkulation
Hemoglobin and oxidative metabolism
Heart failure. Vascular diseases
Scaling
Bitewing
Problems consist of events that are need
of explanations in terms of underlying
processes, principles or mechanisms.
INTERDISCIPLINARY INTEGRATION
Knowledge Domains in Professional Education
Applied Science
Knowledge
Social ScienceHumanitiesKnowledge
BehaviouralScience
Knowledge
BiomedicalScience
Knowledge
The Role of Science Knowledge
Clinical Science Knowledge
Health Promoting Strategies
Diagnosis – novel situations
Prevention Strategies
Treatment Strategies
Social Science and HumanitiesKnowledge
Biomedical ScienceKnowledge
Behavioural ScienceKnowledge
STRUCTURE AT PRESENT
………clinical problems can not be embedded into basic science contexts
BUT
basic science can be embedded within the clinical context
Patel et al. (1990)
Problems consist of events that are need
of explanations in terms of underlying
processes, principles or mechanisms.
INTERDISCIPLINARY INTEGRATION
This has radically restructured the curriculum, quality assessment, the nature of the relationship between staff and students and last, but not least,
the basic vision that underlines Odontology
The MALMÖ-Model - Curricular Level
Holistic View Team-work
Self-directedLearning
Oral Health
LEARNING- Learning is about the process of discovering
knowledge, not just the content (Kolb's circle)
- Intelligence is shaped by experience..(Piaget)
- Any experience that does not violate expectations is NOT worthy of the name experience (Hegel)
What is PBL?• An educational approach (not a method)
• Multiple learning and teaching methods and learning environments
• Organised around problem: small groups, collaborative & independent research, peer learning and teaching, reflection and self-management
CASE1. Define problems
2. Generate hypotheses Elaborate on knowledge
5. Synthesise newlyacquired knowledge
3. Students formulate learning goalsbased on prior knowledge
4. Collect additionalinformation
outside the group
The learning goals are told(what is important to know)
Elaborate on knowledge
CASEApply information
Collect information
PBL
CASE-BASED orPROBLEM-ORIENTED
EDUCATION
The half-life of scientific information in nature sciences is about 5 years.
Thus 50% of what we have taught the students
in a 5-year curriculum will not be up-to-date when they graduate.
Unfortunately we do not know which half!
WHY LEARNING?
EDUCATIONAL RATIONALES
• Learning based on students’ own question and self-generated discovery –
Meaning Making
• Problems consist of events that are in need of explanations in terms of underlying processes, principles or mechanism - Interdisciplinary Integration
• Learning activities referring to real-life situations reinforces what is learned – Relevance
RUBRIK I VERSALER
Clinical situations that a newly qualified graduate should recognise and be able to manage alone
or to refer appropriately.
Oral conditions, which are commonly found in the community and in which oral health care
plays a role.
Note: Care includes both caring for the patient and caring for the condition.
EDUCATIONAL RATIONALES
• Learning based on students’ own question and self-generated discovery – Meaning Making
• Problems consist of events that are in need of explanations in terms of underlying processes, principles or mechanism - Interdisciplinary Integration
• Learning activities referring to real-life situations reinforces what is learned – Relevance
• Learning activities have a degree of complexity adapted to students´ prior knowledge, skills and attitudes - Spiral Curriculum
SPIRAL CURRICULUM
Learning activities have a degree of complexity adapted to
students’ prior knowledge and skills.
’Focusing and ordering are thus the two aspects of direction….
Activity must be centered at a given time in such a way to prepare for what comes next’.
Dewey J. Democracy and education. 1916
Centre for Oral Health SciencesMalmö University, Sweden
Semester 1Course: The Oral Ecosystem
Scenario: Helene
Helene is in her last year at high school and is waiting to give a presentation.As she waits, her mouth feels very dry and she feels that she will not be ableto say anything.
HELENE
EDITH
ALMA
HELENE
Learning Situations and
Situations of Application
• Every learning situation includes the potential for application (of something learned previously)
• Every situation of application implies the potential for learning (something new)