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Problem-based learning: properly balanced learning?
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In our experience, restructuring of the medical curriculum according to the New Pathway of Harvard Medical School as hybrid courses of PBL, LBL and practical work has met with similar resistance to change and scepticism of faculty members as reported by Michel et al. At Dresden Medical School, the redesigned curriculum of the first clinical year consists of discipline-based block courses (i.e. Pathomechanisms, Basis of Drug Therapy, Infectiology and Emergencies). The pharmacology course ‘Basis of Drug Therapy’ contains daily lectures, three tutorials per week and practical exercises in patient history taking and patient–doctor interaction [5]. One well-accepted strong-hold of PBL learning is its exploitation of good retrieval of knowledge learnt in a clinical context. Indeed, students’ acceptance of the PBL format was strongly associated with the quality and authenticity of the clinical cases. Interestingly, the students’ evaluation of any single case as ‘good’ or ‘bad’ was positively associated with the tutor’s attitude towards PBL. Furthermore, students’ assessment of the complete course also depended on the individual’s acceptance of PBL. Michel et al. emphasize the difficulty in avoiding ‘blind spots’ in pharmacological factual knowledge in PBL classes. From our experience comprehensiveness is not required; in fact, we disagree that anti-microbial drugs for rare infectious diseases should be taught at all. Unless such knowledge is needed for solving a real clinical problem it will soon be forgotten again anyway. In our view, the main learning objective is to obtain competence in the use of common drugs to treat common diseases. Ideally, students should discover how general pharmacological concepts translate into therapeutic options and apply their drug knowledge in individual cases. The student must learn how to find the required information when it is needed. In the future, computers will facilitate access to the necessary pharmacokinetic and pharmocodynamic characteristics of drugs. Finally, PBL enlarges the goal of medical education by including promotion of team work, independent study and handling of data flood, whereas solely traditional learning forms might at present still be equally effective in http://tips.trends.com
TRENDS in Pharmacological Sciences Vol.23 No.4 April 2002
producing factual knowledge but are bound to lead into a dead end in modern medical education. Ursula Ravens* Dobromir Dobrev Institut für Pharmakologie und Toxikologie Cornelie Haag Medizinische Klinik I, Medizinische Fakultät der TU Dresden, Fetscher Straße 74, D-01307 Dresden, Germany. *e-mail: [email protected] References 1 Rangachari, P.K. (2000) ‘Give us good measure’: the basic medical sciences and the overloaded curriculum. Clin. Invest. Med. 23, 39–46 2 Michel, M.C. et al. (2002) Comparison of problemand lecture-based pharmacology teaching. Trends Pharmacol. Sci. 23, 168–170 3 Antepohl, W. et al. (1999) Problem-based learning versus lecture-based learning in a course of basic pharmacology: a controlled, randomized study. Med. Educ. 33, 106–113 4 Jansen, J. et al. (2001) Comparison of problembased and lecture-based pharmacology teaching. Naunyn-Schmiedeberg’s Arch. Pharmacol. 363 (Suppl.), R132 5 Ravens, U. et al. (2001) A pharmacology block course for medical students – a hybrid model of problem-based learning (PBL) and traditional teaching elements. Naunyn-Schmiedeberg’s Arch. Pharmacol. 363 (Suppl.), R115
Problem-based learning: properly balanced learning? Comment from Kwan
I read with great interest the TiPS article by Michel and colleagues [1]. The report on the advantage of using problem-based learning (PBL) as a pedagogic approach in the teaching and learning of pharmacology is typical of what has been reported on the teaching and learning of other basic science disciplines in medicine. Indeed, PBL has been the main instruction for the learning of pharmacology (focusing on student-centered learning rather than teacher-centered teaching) since the inception of PBL at the Faculty of Health Sciences of McMaster University more than three decades ago. Because pharmacological issues are usually embodied within a healthcare problem, along with many other
163
non-pharmacological issues, it can be argued that not all the students are exposed to the science of pharmacology in equal depth and breadth. There is still a constant debate in our faculty as to whether our medical students have acquired all the essential knowledge in pharmacological sciences. For the science students, typically in the Biology/Pharmacology cooperative courses, both student-centered learning and teacher-centered teaching approaches are being used. In this case, the PBL approach is adopted to complement the conventional lectures at the course level. For the medical students, PBL remains the major instruction of learning in a small-group tutorial setting at the curricular level. The PBL curriculum is operating over integrative systems (e.g. cardiovascular, renal and respiratory, among others) across the life-cycle rather than discrete disciplinary areas (e.g. physiology, anatomy, biochemistry and pharmacology, among others). Those students who lack a pharmacology background or wish to enhance pharmacological knowledge are encouraged to take a block elective or horizontal elective in pharmacology, either individually or in groups (using either PBL or reading/discussion formats). Unlike science students, medical students need to sort out pharmacological principles from the overloaded information [2], to integrate them into the clinically relevant situations and to ultimately apply it to the management of patients’ illness. This is most effectively achieved in a studentcentered environment conducive to life-long learning [3]. Adoption of PBL in teaching basic sciences, including pharmacology is now a global trend receiving considerable attention also in the Asia-Pacific regions. A symposium of the 8th Southeast Asia/Western Pacific Regional Meeting of Pharmacologists under the auspice of IUPHAR, held in Taipei, Taiwan in 1999, was devoted to this topic [4]. Although PBL as a pedagogic methodology has only recently been experimented by several medical schools and is presented in various formats in the Asia-Pacific region, reports from medical schools in Japan, Taiwan, Hong Kong and the Philippines clearly indicate that the
0165-6147/02/$ – see front matter © 2002 Elsevier Science Ltd. All rights reserved.
164
News & Comment
pedagogic emphasis is now placed on student-centered learning rather than teacher-centered teaching of pharmacology. David C.Y. Kwan HSC-4N40, Dept of Medicine, Faculty of Health Sciences, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5. e-mail: [email protected] References 1 Michel, M.C. et al. (2002) Comparison of problemand lecture-based pharmacology teaching. Trends Pharmacol. Sci. 23, 168–170 2 Achik, F. and Ogle, C.W. (2000) Information overload in the teaching of pharmacology. J. Clin. Pharmacol. 40, 177–183 3 Des Marchais, J.E. (1999) New pedagogic approaches adapted to the teaching of pharmacology, the activities centered on the student. Therapie 54, 171–181 4 Kwan, C.Y. (2000) Special topics: teaching of pharmacology in medical education in the AsiaPacific region. J. Med. Educ. 4, 71–117
Problem-based learning: the Maastricht experience Comment from Struijker Boudier and Smits
In their contribution to TiPS, Michel et al. [1] provide a stimulating perspective on the various approaches to the teaching of pharmacology in medical schools. In the past three decades problem-based learning (PBL) has been the most intensively explored new teaching method in medical schools. McMaster University in Canada was the first to use PBL systematically in the early 1970s. The method spread rapidly and widely over North America. For those that are familiar with the long academic traditions of American colleges and universities with their strong focus on personal development of students, this spread comes as no surprise. However, the European situation has been different. In Europe, the Maastricht Medical School (The Netherlands) was the first to introduce PBL in 1974. This medical school was founded in that year, with the explicit mission to explore innovative forms of teaching. This was at the time that the ‘student revolt’ of 1968 had just passed. Although the official history of this ‘revolt’ http://tips.trends.com
TRENDS in Pharmacological Sciences Vol.23 No.4 April 2002
has not yet been written, it marked the entry of the post-war baby boom into universities. Up to the late 1960s, European universities were elite organizations, with a dominant role of individual professors in their teaching and research. Within a few years massive increases in student numbers had to be accommodated. In The Netherlands, for example, university student numbers increased by >150% within one decade. The strong government dependence of universities in most European countries led to reforms that can – in hindsight – best be characterized as ‘bureaucratic’. The victim of these reforms – again in hindsight – has been the quality of teaching, which received low priority in these years. Only in the past decade more room has emerged for innovations in teaching. We now observe a spread of PBL-like methods in universities of different European countries. Twenty-five years of PBL experience in the Maastricht medical curriculum have taught us a few things. (1) The system is well suited to present therapeutic aspects of pharmacology. At this university, we present drug-related problems in almost every six-week PBL block of the third and fourth years of our medical curriculum. In these years, students study one of the major pharmacology textbooks that lecturers suggest to them. Thus, our medical students learn about drugs at the same time as they study the diseases for which they are given. (2) PBL is not only suited for clinical cases; on a more basic level – particularly in the first two years of the curriculum – the scientific basis of pharmacology can be introduced using more scientifically oriented problems. In fact, this experience in the past decade has helped to develop a curriculum in biomedical engineering in collaboration with the Technical University Eindhoven. This curriculum trains engineers on the basis of PBL. (3) PBL requires – both for the medical and bioengineering curricula – parallel alternative methods of teaching, including a lecture-based program to introduce the systematics of basic pharmacology and therapeutics. For the medical curriculum we give ~30–40 h of such lectures throughout the first four years of the medical curriculum. In the new medical curriculum, which started in September 2001, the teaching of pharmacology and pharmacotherapeutics has been structured around a personal
formulary that students develop and update in an electronic portfolio under the guidance of pharmacologists from our department. From the first year on, students are required to gather information about drug classes in relation to the subject of the teaching module. Obviously, in the first year such information is mainly related to basic pharmacological and therapeutic principles, but as students progress in their study, they are supposed to develop a detailed list of ‘personal drugs’ that should be usable in practice. We share the view of Michel et al. that PBL is associated with strong motivation on the students’ side without loss of factual knowledge. This latter point was confirmed in a recent study that compared various PBL-based with non-PBL-based curricula [2]. The more central position of students in the learning process is perhaps one of the best university reforms since 1968! Harry A.J. Struijker Boudier* Jos F.M. Smits Dept of Pharmacology and Toxicology, Maastricht University, PO Box 616, Maastricht, 6200MD, The Netherlands. *e-mail: [email protected] References 1 Michel, M.C. et al. (2002) Comparison of problemand lecture-based pharmacology teaching. Trends Pharmacol. Sci. 23, 168–170 2 Verhoeven, B.H. et al. (1998) An analysis of progress test results of PBL and non-PBL students. Medical Teacher 20, 310–316
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0165-6147/02/$ – see front matter © 2002 Elsevier Science Ltd. All rights reserved.
In our experience, restructuring of the medical curriculum according to the New Pathway of Harvard Medical School as hybrid courses of PBL, LBL and practical work has met with similar resistance to change and scepticism of faculty members as reported by Michel et al. At Dresden Medical School, the redesigned curriculum of the first clinical year consists of discipline-based block courses (i.e. Pathomechanisms, Basis of Drug Therapy, Infectiology and Emergencies). The pharmacology course ‘Basis of Drug Therapy’ contains daily lectures, three tutorials per week and practical exercises in patient history taking and patient–doctor interaction [5]. One well-accepted strong-hold of PBL learning is its exploitation of good retrieval of knowledge learnt in a clinical context. Indeed, students’ acceptance of the PBL format was strongly associated with the quality and authenticity of the clinical cases. Interestingly, the students’ evaluation of any single case as ‘good’ or ‘bad’ was positively associated with the tutor’s attitude towards PBL. Furthermore, students’ assessment of the complete course also depended on the individual’s acceptance of PBL. Michel et al. emphasize the difficulty in avoiding ‘blind spots’ in pharmacological factual knowledge in PBL classes. From our experience comprehensiveness is not required; in fact, we disagree that anti-microbial drugs for rare infectious diseases should be taught at all. Unless such knowledge is needed for solving a real clinical problem it will soon be forgotten again anyway. In our view, the main learning objective is to obtain competence in the use of common drugs to treat common diseases. Ideally, students should discover how general pharmacological concepts translate into therapeutic options and apply their drug knowledge in individual cases. The student must learn how to find the required information when it is needed. In the future, computers will facilitate access to the necessary pharmacokinetic and pharmocodynamic characteristics of drugs. Finally, PBL enlarges the goal of medical education by including promotion of team work, independent study and handling of data flood, whereas solely traditional learning forms might at present still be equally effective in http://tips.trends.com
TRENDS in Pharmacological Sciences Vol.23 No.4 April 2002
producing factual knowledge but are bound to lead into a dead end in modern medical education. Ursula Ravens* Dobromir Dobrev Institut für Pharmakologie und Toxikologie Cornelie Haag Medizinische Klinik I, Medizinische Fakultät der TU Dresden, Fetscher Straße 74, D-01307 Dresden, Germany. *e-mail: [email protected] References 1 Rangachari, P.K. (2000) ‘Give us good measure’: the basic medical sciences and the overloaded curriculum. Clin. Invest. Med. 23, 39–46 2 Michel, M.C. et al. (2002) Comparison of problemand lecture-based pharmacology teaching. Trends Pharmacol. Sci. 23, 168–170 3 Antepohl, W. et al. (1999) Problem-based learning versus lecture-based learning in a course of basic pharmacology: a controlled, randomized study. Med. Educ. 33, 106–113 4 Jansen, J. et al. (2001) Comparison of problembased and lecture-based pharmacology teaching. Naunyn-Schmiedeberg’s Arch. Pharmacol. 363 (Suppl.), R132 5 Ravens, U. et al. (2001) A pharmacology block course for medical students – a hybrid model of problem-based learning (PBL) and traditional teaching elements. Naunyn-Schmiedeberg’s Arch. Pharmacol. 363 (Suppl.), R115
Problem-based learning: properly balanced learning? Comment from Kwan
I read with great interest the TiPS article by Michel and colleagues [1]. The report on the advantage of using problem-based learning (PBL) as a pedagogic approach in the teaching and learning of pharmacology is typical of what has been reported on the teaching and learning of other basic science disciplines in medicine. Indeed, PBL has been the main instruction for the learning of pharmacology (focusing on student-centered learning rather than teacher-centered teaching) since the inception of PBL at the Faculty of Health Sciences of McMaster University more than three decades ago. Because pharmacological issues are usually embodied within a healthcare problem, along with many other
163
non-pharmacological issues, it can be argued that not all the students are exposed to the science of pharmacology in equal depth and breadth. There is still a constant debate in our faculty as to whether our medical students have acquired all the essential knowledge in pharmacological sciences. For the science students, typically in the Biology/Pharmacology cooperative courses, both student-centered learning and teacher-centered teaching approaches are being used. In this case, the PBL approach is adopted to complement the conventional lectures at the course level. For the medical students, PBL remains the major instruction of learning in a small-group tutorial setting at the curricular level. The PBL curriculum is operating over integrative systems (e.g. cardiovascular, renal and respiratory, among others) across the life-cycle rather than discrete disciplinary areas (e.g. physiology, anatomy, biochemistry and pharmacology, among others). Those students who lack a pharmacology background or wish to enhance pharmacological knowledge are encouraged to take a block elective or horizontal elective in pharmacology, either individually or in groups (using either PBL or reading/discussion formats). Unlike science students, medical students need to sort out pharmacological principles from the overloaded information [2], to integrate them into the clinically relevant situations and to ultimately apply it to the management of patients’ illness. This is most effectively achieved in a studentcentered environment conducive to life-long learning [3]. Adoption of PBL in teaching basic sciences, including pharmacology is now a global trend receiving considerable attention also in the Asia-Pacific regions. A symposium of the 8th Southeast Asia/Western Pacific Regional Meeting of Pharmacologists under the auspice of IUPHAR, held in Taipei, Taiwan in 1999, was devoted to this topic [4]. Although PBL as a pedagogic methodology has only recently been experimented by several medical schools and is presented in various formats in the Asia-Pacific region, reports from medical schools in Japan, Taiwan, Hong Kong and the Philippines clearly indicate that the
0165-6147/02/$ – see front matter © 2002 Elsevier Science Ltd. All rights reserved.
164
News & Comment
pedagogic emphasis is now placed on student-centered learning rather than teacher-centered teaching of pharmacology. David C.Y. Kwan HSC-4N40, Dept of Medicine, Faculty of Health Sciences, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5. e-mail: [email protected] References 1 Michel, M.C. et al. (2002) Comparison of problemand lecture-based pharmacology teaching. Trends Pharmacol. Sci. 23, 168–170 2 Achik, F. and Ogle, C.W. (2000) Information overload in the teaching of pharmacology. J. Clin. Pharmacol. 40, 177–183 3 Des Marchais, J.E. (1999) New pedagogic approaches adapted to the teaching of pharmacology, the activities centered on the student. Therapie 54, 171–181 4 Kwan, C.Y. (2000) Special topics: teaching of pharmacology in medical education in the AsiaPacific region. J. Med. Educ. 4, 71–117
Problem-based learning: the Maastricht experience Comment from Struijker Boudier and Smits
In their contribution to TiPS, Michel et al. [1] provide a stimulating perspective on the various approaches to the teaching of pharmacology in medical schools. In the past three decades problem-based learning (PBL) has been the most intensively explored new teaching method in medical schools. McMaster University in Canada was the first to use PBL systematically in the early 1970s. The method spread rapidly and widely over North America. For those that are familiar with the long academic traditions of American colleges and universities with their strong focus on personal development of students, this spread comes as no surprise. However, the European situation has been different. In Europe, the Maastricht Medical School (The Netherlands) was the first to introduce PBL in 1974. This medical school was founded in that year, with the explicit mission to explore innovative forms of teaching. This was at the time that the ‘student revolt’ of 1968 had just passed. Although the official history of this ‘revolt’ http://tips.trends.com
TRENDS in Pharmacological Sciences Vol.23 No.4 April 2002
has not yet been written, it marked the entry of the post-war baby boom into universities. Up to the late 1960s, European universities were elite organizations, with a dominant role of individual professors in their teaching and research. Within a few years massive increases in student numbers had to be accommodated. In The Netherlands, for example, university student numbers increased by >150% within one decade. The strong government dependence of universities in most European countries led to reforms that can – in hindsight – best be characterized as ‘bureaucratic’. The victim of these reforms – again in hindsight – has been the quality of teaching, which received low priority in these years. Only in the past decade more room has emerged for innovations in teaching. We now observe a spread of PBL-like methods in universities of different European countries. Twenty-five years of PBL experience in the Maastricht medical curriculum have taught us a few things. (1) The system is well suited to present therapeutic aspects of pharmacology. At this university, we present drug-related problems in almost every six-week PBL block of the third and fourth years of our medical curriculum. In these years, students study one of the major pharmacology textbooks that lecturers suggest to them. Thus, our medical students learn about drugs at the same time as they study the diseases for which they are given. (2) PBL is not only suited for clinical cases; on a more basic level – particularly in the first two years of the curriculum – the scientific basis of pharmacology can be introduced using more scientifically oriented problems. In fact, this experience in the past decade has helped to develop a curriculum in biomedical engineering in collaboration with the Technical University Eindhoven. This curriculum trains engineers on the basis of PBL. (3) PBL requires – both for the medical and bioengineering curricula – parallel alternative methods of teaching, including a lecture-based program to introduce the systematics of basic pharmacology and therapeutics. For the medical curriculum we give ~30–40 h of such lectures throughout the first four years of the medical curriculum. In the new medical curriculum, which started in September 2001, the teaching of pharmacology and pharmacotherapeutics has been structured around a personal
formulary that students develop and update in an electronic portfolio under the guidance of pharmacologists from our department. From the first year on, students are required to gather information about drug classes in relation to the subject of the teaching module. Obviously, in the first year such information is mainly related to basic pharmacological and therapeutic principles, but as students progress in their study, they are supposed to develop a detailed list of ‘personal drugs’ that should be usable in practice. We share the view of Michel et al. that PBL is associated with strong motivation on the students’ side without loss of factual knowledge. This latter point was confirmed in a recent study that compared various PBL-based with non-PBL-based curricula [2]. The more central position of students in the learning process is perhaps one of the best university reforms since 1968! Harry A.J. Struijker Boudier* Jos F.M. Smits Dept of Pharmacology and Toxicology, Maastricht University, PO Box 616, Maastricht, 6200MD, The Netherlands. *e-mail: [email protected] References 1 Michel, M.C. et al. (2002) Comparison of problemand lecture-based pharmacology teaching. Trends Pharmacol. Sci. 23, 168–170 2 Verhoeven, B.H. et al. (1998) An analysis of progress test results of PBL and non-PBL students. Medical Teacher 20, 310–316
New! BioMedNet Magazine The new online-only BioMedNet Magazine contains a range of topical articles currently available in Current Opinion and Trends journals, providing some of the finest material available on BioMedNet that deals with matters of daily importance: careers, funding policies, current controversy and changing regulations in the practice of research. You can elect to receive the BioMedNet Magazine delivered directly to your email address. Don’t miss out! Register now at http://news.bmn.com/magazine
0165-6147/02/$ – see front matter © 2002 Elsevier Science Ltd. All rights reserved.