Problem-based Learning in Medicine and Surgery - An Advocacy - A Legacy
Since 1976, when I started my general surgery residency training program in the Philippine General Hospital, I have been using problem-based learning (PBL) in propeling my learning and acquisition of knowledge and skills in medicine and in surgery. I have continued it up to the present time, 2018, when I still continue to practice my surgical profession. Up to now, I believe problem-based learning is how physicians learn and should learn new things fpr their continual professional education. There are new terms that have cropped up recently such as outcome-based learning and situation-based or phenomenon-based learning. They are all derivatives of problem-based learning with new terminologies.
As evidences that I still use PBLin propeling my continual professional education through self-directed learning even after my official retirement in University of the Philippines College of Medicine - Philippine General Hospital and Ospital ng Maynila Medical Center in 2014, I show the following samples of pictures of 2015, 2016 and 2018. I formally used a notebook to jot down my problem-based learning issues (PBLI) derived from patient care in my clinic. At times, I jotted them in a piece of paper.
In the 1990s, when problem-based learning medical curriculum was in vogue, I formally developed a PBL medical curriculum (in 1993 to 1994) for Zamboanga Medical School Foundation Incl (now Ateneo de Zamboanga University College of Medicine). The school still uses this PBL medical curriculum. I had also served as a PBL medical curriculum consultant in Cebu (Southwestern University College of Medicine) and Legazpi City (Bicol Christian College of Medicine) from 1995 to 2005.
I also used PBL as a teaching-learning strategy in the UP College of Medicine and Philippine General Hospital and Department of Surgery of Ospital ng Maynila Medical Center up to time of my official retirement from these two government institutions in 2014. I also used it in teaching surgical interns and residents in Manila Doctors Hospital.
In 1997, I wrote self-instructional programs on Problem-based Learning in Medicine. There were 4 modules, namely:
Problem-based Learning in Medicine
Problem-based Learning Medical Curriculum - How to Design
Problem-based Learning Courses and Modules in Medicine - How to Write
Problem-based Learning Tutorials in Medicine - How to Facilitate
Up to now, I still advocate use of problem-based learning in medicine and surgery because I think it is the way physicians learn and do their self-directed learning. This is a legacy that I will and am leaving behind for medical schools, surgical departments and for medical and surgical education.
What is Problem-based Learning (PBL) in Medicine (in Surgery)?
PBL is the learning that occurs in the process of solving a problem. Experience has shown that this is mainly how human beings learn to live life and it is undeniably the best way of learning especially in terms of retention and recall of knowledge and skills.
The founders of PBL in medicine recalled their sad experiences with the conventional memory-based medical curriculum – hard to recall facts “learned” in the first 2 years and difficulty in integrating the basic and clinical sciences. They theorized that retention and recall of medical knowledge and skills would be enhanced when learned in a context which closely approximates real life, i.e. clinical problems.
Thus, PBL in medicine has been proposed and it is essentially learning the science and art of medicine in the clinical or functional context.
In the practice of medicine, the following events actually or should take place:
1. A physician meets a patient without prior knowledge of what the patient’s problem is.
2. During the encounter, the physician establishes rapport, diagnoses, treats, and gives advices with the goal of resolution of the health problem of the patient.
3. In the process of understanding and resolving the patient’s problem, the physician invariably encounters some insecurities, questions, and gaps in competencies.
4. The physician fills in the gaps in competencies through various means, such as self-study and learning from other people like consultations, referrals, and enrolling in a formal course.
5. The new competencies acquired are used by the physician on the patient on hand and on future patients.
If PBL in medicine is learning the science and art of medicine in the functional context, then the educational activities should consist of the following:
1. The student is presented with a health problem which can be simulated or actual, without the student having prior study on the problem. This means there is no prior teacher’s lecture nor prior assignment to study on the problem.
2. The student tries to understand and to solve the problem.
3. In the process of trying to understand and to solve the problem, the student will invariably encounter questions, uncertainties, and gaps in competencies, which constitute the so-called “learning issues”.
4. The student then decides how to go about settling the “learning issues”.
5. The student implements his plan of study.
6. The student applies what he learned to the problem on hand as well as to future problems or patients.
Problem-based learning is my advocacy in learning medicine and surgery. This is a legacy I leave and will leave behind for the physicians and surgeons, especially those whom I have taught and interacted before.
References:
https://sites.google.com/site/problembasedlearninginmed/
https://pblinsurgery.wordpress.com/category/problem-based-learning-in-medicine-surgery/
https://pblinsurgery.wordpress.com/category/problem-based-learning-in-mdh/
Others:
Just Google "problem-based learning rojoson"
ROJ@18nov13