Problemistics and

Problem-Centred Health Professional Education

Prof KR Sethuraman. MD, PGDHE

Email: krs@sbvu.ac.in

Overview• What is Problem Centred Learning (PCL)• Why PCL? • Types of PCL: PBL versus PSE• Challenges of implementing PBL• Problem-Knowledge coupling (PKC) for finding

holistic solutions to patient problems• Problemistics – the science of Problem dealing• Spectrum of PBL / PSE

POME 3

T: “Tell me 10 causes of Anemia”S: “I know 50 Sir!

Shall I tell all of them?”

Memorize and Recite!

POME 4

T: How will you treat a pregnant woman with anemia for Rs.30 per month?S: Hmm…Errr…

Bowled by a simple Problem!

5

COGNITIVE

“Tomorrow’s Doctors” 1993 & 2009 - http://www.gmc-uk.org/education/undergraduate/tomorrows_doctors_2009.asp

Hybrid CurriculaHybrid CurriculaThe The S P I C E S S P I C E S modelmodel

SStudent-centred ..……………...…….Teacher-centredtudent-centred ..……………...…….Teacher-centred

PProblem-based ……………...……Passive acquisitionroblem-based ……………...……Passive acquisition

IIntegrated ………...…………...……Discipline-basedntegrated ………...…………...……Discipline-based

CCommunity……..……………...……..Hospital-basedommunity……..……………...……..Hospital-based

EElectives ……………...………...…….Standardizedlectives ……………...………...…….Standardized

SSystematic...……………….....……….Opportunisticystematic...……………….....……….Opportunistic

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HardenHarden

| | = Where We Are

What is Problem-Centred Learning?• Essential principles of PCL The problem, – activates prior learning – resembles real life cases – facilitates transfer of learning to other problems

• Solving the problem involves – elaboration of knowledge via group-discussion and – reflection to consolidate learning experiences.

• Includes problem-solving exercise (PSE) and problem-based learning (PBL)

Why Problem-Centred Learning?

• Solving authentic problems matches 21st Century skills

• What are 21st C Skills?

21st Century Education• Learning ‘to be’

– not ‘learn about’• Learn by doing

– not just listening• Learning how to learn

– Generation Y (web-2.0 gen) is – participatory – cooperative & adapted for – constructivist learning

Goals for Problem-Centred Learning

• Structure knowledge for practice

• Develop clinical reasoning

• Develop self-directed learning

• Increase motivation

• Problem-centred learning predates 21st century skills but is more relevant now

PCL Types: PSE & PBLPCL Types: PSE & PBL- - Different but RelatedDifferent but Related - -

Problem-solvingProblem-solving - arriving at - arriving at solutions based on solutions based on prior prior knowledge and reasoningknowledge and reasoning

Problem-based learningProblem-based learning - the - the process of acquiring process of acquiring newnew knowledge based on knowledge based on recognition of a need to learnrecognition of a need to learn

POME 12

T: How will you treat a pregnant woman with anemia for Rs.30 per month?

Teach & Solve = PSE

Learn by Solving = PBL

PBL & PCL begin with a problem

–Group analysis of what needs to be known

– Individual research

– Developing a solution

– Reflection on process & learning

Characteristics of PBL1. Starting point is a problem

2. Authentic for professionals

3. Knowledge organised around problems

4. Students have responsibility for learning

5. Most learning in small groups, not lectures

6. Andragogy (adult learning) - Not pedagogy

The Relative Proportion of PSE toThe Relative Proportion of PSE to PBL PBL Changes with Curriculum ProgressChanges with Curriculum Progress

Time in the curriculum Time in the curriculum

Problem Problem solvingsolving

Problem-based Problem-based learninglearning

Mostly

Known !

Mostly New !

How “pure” must PBL be?

– Barrows proposed a taxonomy

– Spectrum of methods Achieving objectives by degrees

PBL PCL

Six methods in the spectrum

Barrows’ taxonomy of PBL methodsSCC CRP SDL MOT

Lecture-based cases 1 1 0 1

Case-based lectures 2 2 0 2

Case method 3 3 3 4

Modified case-based 4 3 3 5

Problem-based 4 4 4 5

Closed-loop problem-based 5 5 5 5

Complete case or case vignette

Partial problem simulation

Full problem simulation (free inquiry)

Teacher-directed learning

Student-directed learning

Partially student & teacher directed

Abbreviations:CRP - Clinical Reasoning ProcessSCC - Student Centered CurriculumSDL – Self Directed LearningMOT – Motivation to Learn

Fidelity in PBL - i

• Presentation format: – simulated patient (high fidelity) to – "case write up"(low fidelity).

• Manifestation: – ill structured with a range of possibilities (high

fidelity) to – a "text-book case" (low fidelity & 'bookish').

Fidelity in PBL - ii• Signal-Noise Ratio

– “noise” (associated problems) overlaying the “signal” (main problem) = high fidelity

– pure filtered one-dimensional problem = low fidelity

• Context: – permit real-life situations, eg., talk with family

members of the patient (high fidelity)– more contrived (low fidelity).

Fidelity in PBL - iii• Objectives:

– patient-centred and integrated across disciplines (high fidelity)

– only disease-focussed, discrete and piece-meal (low fidelity and artificial)

• Low-fidelity problems borrowed from textbooks are counterproductive in terms of the Goals of PBL. – Jayawickramarajah. Problems for Problem-Based Learning: a

comparative study of documents. Medical Education, 1996;30:272-282

Effectiveness of PBL Curricula:Research and Theory

• “No convincing evidence that PBL improves knowledge base and clinical performance, – at least not of the magnitude that

would be expected given the resources required for a PBL curriculum.”

• Jerry A. Colliver, Acad. Med. 2000;75:259–266.

POME 23

Individualising Solutions

"Give me ‘standard patients’ and I'll practice standard medicine." --James S. Todd, MD. AMA Executive Vice President, 1990-1996

POME 24

Problem Knowledge Coupling

POME 25

What is Problemistics ?

• It is the science of dealing with problems

• It is an activity aimed at - – the resolution of a Problem &

– the development of Well-Being

POME 26

Problemistics – contd…

• It is concerned with -

Problem Framing – Context Problem Finding – Holistic approachProblem Solving – Appropriate

resolutionProblem Acting - Systematic action

*

POME 27

Spheres of Problem Experience • Bio-sphere - nature and

environment (e.g., infections)

• Socio-sphere - individuals & groups (e.g., phobic neurosis)

• Techno-sphere - tools and artifacts (e.g., implant malfunction iatrogenesis etc)

POME 28

Problem Dealer (Professional in Making) • Cultivate following characteristics –

– Dimensions - cognition, emotion & volition

– Qualities - thrill, skill, will • Thrill - emotive ( enthusiastic )• Skill - cognitive ( mindful & critical *)

• Will - volitional ( proactive )

Range of Problem-Centred Education

DURATION = DURATION = SEMESTER(S)SEMESTER(S)

Example -Example -

FULL TIME P B L orFULL TIME P B L or

HYBRID CURRICULUMHYBRID CURRICULUM

DURATION = DURATION =

Hours to DaysHours to Days

Example -Example -

Integrated Modules Integrated Modules

Orientation WorkshopsOrientation Workshops

DURATION = DURATION =

1 – 3 hours1 – 3 hours

Example -Example -

Problem Solving Problem Solving ExercisesExercises

Simulation GamesSimulation Games

DURATION = DURATION =

3 to 10 minutes3 to 10 minutes

Example -Example -

Buzz SessionBuzz Session

Simulated Initial Simulated Initial ManagementManagement

We must make our Graduates

• Think critically and be able to solve complex, real-world problems

• Find, evaluate, and use appropriate learning resources

• Work cooperatively in teams and small groups• Demonstrate versatile and effective communication

skills, both verbal and written • Become life-long learners to update their

knowledge and skills acquired at the university

Can We Do it ?

We can !If we have the self belief and motivation like this modeler, who shapes “mere Clay” in to “Desirable objects”

POME 36

THANK YOU All !

(visit www.problemistics.org andwww.pkc.org for more information)

The Handout has more details on PKC & Problemistics