Problem-based Learning in Medicine and Surgery

Problem-based Learning in Medicine and Surgery

ROJoson’s Pioneering Efforts and Advocacy

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 propelling my learning and acquisition of knowledge and skills in medicine and in surgery.

After I finished my general surgical residency in 1981 and started teaching in the Philippine General Hospital, I have been using problem-based learning in teaching medical students and surgical residents as early as 1982.

In 1993, I formalized my advocacy in using problem-based learning as the most effective way of teaching medical students in medical schools when I designed a problem-based, competency-based and community-based medical curriculum. This was formally adopted by the Zamboanga Medical School Foundation (ZMSF) now Ateneo de Zamboanga University School of Medicine (ADZU-SOM) in 1994. ADZU-SOM is still using this medical curriculum as of November 2019. The problem-based, competency-based and community-based medical curriculum which I designed was also adopted by Bicol Christian College of Medicine from 1995 to 2003 and by the Southwestern University College of Medicine from 1995 to 2000.

I have been using problem-based learning in the Departments of Surgery of the University of the Philippines College of Medicine; Philippine General Hospital; Ospital ng Maynila Medical Center; Manila Doctors Hospital and Zamboanga City Medical Center.

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

https://sites.google.com/site/problembasedlearninginmed/home

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.

My concepts of problem-based learning in medicine consist of the following:

PBL in Medicine

– learning the science and art of medicine in the functional or clinical context.

Format of PBL in Medicine in Small Group

Session I (2 hours)

1. Facilitator presents a problem (simulated or actual).

2. Students attempt to understand and solve the problem through brainstorming, discussion, and consensus. They learn from each other as well as discover learning issues (later converted to students’ learning objectives).

3. Students decide on a learning plan with or without the help of the facilitator. The learning plan contain the following:

Learning objectives

How to attain the learning objectives

Methods

Reading – what and which books, journals

Asking – who, where, when

Doing – what, where, when

Individual work or division of labor

How to assess attainment of learning objectives

Timetable

Independent Study (based on timetable in the learning plan)

Students implement learning plan.

Session II (2 hours)

1. Students report and discuss the learning gained during the independent study in trying to understand and solve the initial problem.

2. Student may be given another problem to apply what they have just learned for reinforcement purposes.

3. Students are asked to assess their individual and group performance in the learning process.

4. Facilitator gives feedback on the individual and group learning process. He may also give comments on the content of the learning objectives as well as on the problem(s).

Practice and Learning of Medicine – The Process

1. An MD meets a patient without prior knowledge of what the patient’s problem is.

2. During the encounter, the MD 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 MD invariably encounters some insecurities, questions, and gaps in competences.

4. The MD fills in the gaps in competences through various means, such as self-study and learning from other people like consultations, referrals, and enrolling in a formal course.

5. The new competences acquired are used by the MD on the patient on hand and on future patients.

PBL in Medicine – The Process

1. The student is presented with a health problem which can be simulated or actual, without the student having prior study on the problem. 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 competences, 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 action.

6. The student applies what he learned to the problem on hand as well as to future problems or patients.

References of activities that I have been done in advocating and pioneering problem-based learning in medicine and surgery:

I am an Advocate of Problem-based Learning in Medicine and Surgery

https://pblinsurgery.wordpress.com/2018/05/25/i-am-an-advocate-of-problem-based-learning-in-medicine-and-surgery/

Local Experience in PBL in Medicine – ROJoson (1999)

https://rojosonnotesonpblinmedsurg.wordpress.com/2013/03/23/local-experience-in-pbl-in-medicine-rojoson-1999/

Problem-based Learning in Medicine – A Primer by ROJoson

https://rojosonnotesonpblinmedsurg.wordpress.com/2013/03/23/problem-based-learning-in-medicine-a-primer-by-rojoson/

Problem-based Learning in Patient Management – Models

https://rojosonnotesonpblinmedsurg.wordpress.com/2013/03/26/problem-based-learning-in-patient-management-models/