Flipping Dental Education

Beyond PBL:

Flipping Dental Education

The 9th International Conference on Problem-Based Learning in Dentistry

June 25-26, 2016

JIHYUN LEE

Seoul National University

[email protected]

CONTENTS

1. PBL

3.

Future Directions to Dental Education

2. Flipped Learning

4.

Finding Proper Mix

CONTENTS

1. PBL

3.


2. Flipped Learning

4.

Finding Proper Mix

CONTENTS

1. PBL

3.


2. Flipped Learning

4.

Finding Proper Mix

CONTENTS

1. PBL

3.


2. Flipped Learning

4.

Finding Proper Mix

FLPBL Future DirectionMix

Problem-based Learning:

History

What is it?

Features

Educational Paradigm Behind PBL

Effectiveness

Issues


Historical Review on Problem-based Learning

1969 Initially developed and applied in a medical education McMaster University in Canada.

Dissatisfaction with medical education (Barrows, 1996)

• Large numbers of lectures from the front of a lecture theatre with limited student interaction

• Passive bored students (contrast: students during residency)




A lecture at the University of Bologna in

Italy in the mid-14C.

The lecturer reads from a text on the

lectern while students in the back sleep.





• Large numbers of lectures from the front of a lecture theatre with limited student interaction

• Passive bored students (contrast: students during residency)

• Minimal integration between basic sciences and clinical subjects

• Little chance for applying knowledge in relevant situations and for developing clinical reasoning ability




1984 The dental school at Malmö in Sweden was closed.

1990 The dental school at Malmö was reopened with revised curriculum employing PBL.

2007 All of Australian dental schools had adopted PBL (Winning & Townsend, 2007)

2009 Almost half of US. and Canadian schools had adopted PBL (Bassir et al., 2013)



the assumption that learning is an active, integrated, and constructive

process influenced by social and contextual factors (Barrows, 1996)

� a student-centered learning with

� specific problems (ill-structured real-world clinical, community or scientific problems)

� in small groups with facilitating tutors

� whilst identifying and evaluating information sources, acquiring knowledge, and seeking solutions

� in an active, integrated, and constructive process

PBL is both a method and a philosophy.



Process

Describe Problem

Interpret Problem

Brainstorm Hypothesis/Ideas

Identify Learning Issues/Learning Needs

Research – Learn

Define what we know,

what we don’t know, and

what we don’t know that we don’t know it

Develop Diverse Perspectives

Identify Facts Provided

Devise Solutions

Evaluate Solutions and Reflect



(Fincham & Shuler, 2001)

Six core features of PBL (Barrows, 1969)

(1) Learning is student-centered;

(2) Learning occurs in small peer-groups;

(3) Teachers act as facilitators;

(4) Problems provide the organizing focus and stimulus for learning;

(5) Problems are the vehicle for the development of problem- solving skills;

(6) New information is acquired through self-directed learning.



� Problem solving skills

� Reasoning, Critical thinking skills

� Self-assessment skills

� Self-directed learning skills

� Intrinsic interest in the subject matter

� Communication, teamwork, leadership

� Increased retention of knowledge

� Enhanced integration of basic scientific concepts

Benefits of PBL



Classical cognitive theories supporting PBL

Tulving & Thomson, 1973



(Rich, Keim, & Shuler, 2005)



Classical cognitive theories supporting PBL

Conditionalized Knowledge

(Simon, 1980; Glaser, 1992)



Research Evidences on the PBL Effectiveness

Medical Education Literature

� Overall outcome: NSD

� Acquisition of factual knowledge: negative effect

� Self-directed learning: NSD



Research Evidences on the PBL Effectiveness

Dental Education LiteratureSystematic review on the effectiveness of PBL in Dental Education from 1997-2012

� Factual knowledge: Significantly superior performance

� Knowledge application to clinical situation: Significantly superior performance

� Clinical hand skills: NSD

� Perceived career preparedness: Significantly superior performance



Issues

Variability affects the effectiveness of PBL.

� Mode and degree of the implementation

� Role of faculty, faculty training, time-poor faculty

� Relevant students assessment

� Relevant problems

� Relevant timing

� Program evaluation

� Cost and effort – class size, group size, maintenance, staffs

Is PBL still worth the cost and effort?



Paradigm Continuum

both a method and a philosophy based on a certain paradigm



Paradigm Continuum


Views on Objectivism Constructivism

Knowledge Absolute objective knowledge exists

independently of or experiences

The true meaning of knowledge is constructed by

individual learner’s mind

Learning Transmitting the absolute objective

knowledge into learners’ mind

Active construction of meaning based on

learner’s experiences

Conditions

of Learning

Absolute knowledge can be taught regardless

of context.

Rich real-world context should be provided

where knowledge can be interpreted and applied.

Outcome

of Learning

Same understanding and memory across

individual learners

Diverse meaning-making by individual

Teaching Delivery of knowledge Supporting learners to construct his/her own

meaning

Role of teacher Efficient and effective deliverer of knowledge Facilitator, mentor, supporter

Major method Lecture PBL, Discussion, Inquiry Learning



Paradigm Continuum











Conditions

of Learning


of context.



Outcome

of Learning


individual learners



meaning





Paradigm Continuum











Conditions

of Learning


of context.



Outcome

of Learning


individual learners



meaning





Paradigm Continuum











Conditions

of Learning


of context.



Outcome

of Learning


individual learners



meaning





Paradigm Continuum











Conditions

of Learning


of context.



Outcome

of Learning


individual learners



meaning





Paradigm Continuum











Conditions

of Learning


of context.



Outcome

of Learning


individual learners



meaning





Paradigm Continuum











Conditions

of Learning


of context.



Outcome

of Learning


individual learners



meaning





Paradigm Continuum











Conditions

of Learning


of context.



Outcome

of Learning


individual learners



meaning





Paradigm Continuum


Objectivism Constructivism

Lecture PBLFlipped Learning

Flipped Classroom / Flipped Learning

“what is traditionally done in class

what is traditionally done as homework

is now done at home and

is now completed in class”

(Bergman & Sams, 2012, p.13)

PBL FL Future DirectionMix



OnlineOffline +Existing way of Blended Learning



Online Offline+New way of Blended Learning


Which one is better

for students’ learning?


Media Theories

Cost↑, Richness ↑, Synchronicity ↑

Media richness theory

Cost of communication theory

Media synchronicity theory

More significant task should be done using media with

Flipped Learning


Face to face class phase

Online learning phase

Knowledge transmission

Knowledge application, assimilation, practice

More significant task should be done using media with Cost↑, Richness ↑, Synchronicity ↑

Flipped Learning



Teacher’s role Learner’s roleActivities

Flipped Learning

1. Pre-class: Online lecture produced in studio, Voice-over ppt, publicly available resources, reading materials


OROR

OR

PBL Mix Future DirectionFL

Flipped Learning

Team-based Learning (Michaelson, Knight, & Fink, 2002)



OCW

Open Courseware

MOOCs

Massive Open Online Courses



PBL Future DirectionMixFL
















2. Quiz


To ensure that the students had learned the pre-class materials prior to class

To evaluate students’ readiness for classroom phase (To see if mini-lecture is necessary)

To facilitate classroom learning activities


F2F Group Activities


- Educationally purposeful interactive classroom activities consisting of a variety of interesting group

projects, scenarios, cases, and games allowed the instructor to make synchronous formative assessments

and address misconceptions in student learning

- Much more demanding because it is the core element of FL.

Flipped Learning at SNU


Topics Assignment Learning Activities

Week

1

Significance of dental infection control

Learning with clips (2 documentaries, 1 news clipon the Oklahoma incident)

Quiz─ Mini lecture─ Small group activities(Difference between the case of 2006 and 2006, USand Korea)

Week

2

The routes of cross-infection(Various pathogens): Immunological understanding

Learning with lecture clips (week 1 clip, week 2clip)

Quiz─ Mini lecture─ Small group activities(Analyzing routes of cross infection Hepatitis B andC Virus)

Week

3

Scientific understanding of standard precautions

Learning with reading material (CDC Summaryup to p.18) and with lecture clips (week 3 clip)

Quiz─ Mini lecture─ Small group activities(Discussing the clip “If saliva were red”)

Week

4Cross-infection cases in dental clinics Learning with reading material (Rha, 2015) Quiz─ Lecture

Week

5

Diverse possibilities of dental infection control

Devise an infection control solution regardingissues provided and send your ideas by email.

Idea presentation, Q & A on infection control indental clinics

Week

6

Current status of infection control in dental hospitals

Prepare your questions on infection control indental hospitals.

Special invited lecture by nurse and dental hygienistin SNUDH

Week

7

Levels of infection control, Related issues, Protocol development

Learning with a news report provided.Submit your own protocol by email.

Discussion on recent issues on the news report.Protocol presentation

Flipped Learning (SNU Case)


Flipped Learning at SNU


Course Evaluation Items (N=76)Strongly

AgreeAgree Neutral Disagree

Strongly

Disagree

This course gave me opportunities to participate during class. 21.1% 34.2% 25.0% 15.8% 3.9%

I can discuss my ideas with my peers and professor in this course. 21.1% 48.7% 15.8% 7.9% 6.6%

My professor responded to my questions immediately in this

course.36.8% 42.1% 13.2% 5.3% 2.6%

I got to know how basic bio-dental science learned in this course

can be applied to clinical situations.10.5 % 39.5% 32.9% 10.5% 6.6%

I think that what I learned in this course will be helpful in clinical

situations.26.3% 47.4% 19.7% 5.3% 1.3%

I am overall satisfied with this course. 5.3% 26.3% 35.5% 26.3% 6.6%



• the possibility for students to appropriate content at their own learning pace;

• the possibility of self-assessment for students and lecturers, through the introduction of small

tasks and quizzes into the process;

• the possibility to receive direct feedback;

• the possibility to interact with the lecturer;

• the possibility to work on, answer and discuss questions that arise.

Advantages



Disadvantages

• inadequate acquisition of knowledge in the online or self-directed learning phase

(It may be lack of time, lack of motivation, or highly complex content )

• The significance of a careful selection of preparatory material is correspondingly great.

• there is a danger that the online material and classroom instruction will not be congruent

• instructors must initially expend more effort

(selection of teaching material; content- and format-related planning of the classroom phase)

• Valid Students’ assessment is challenging.


PBL FL Lecture


PBL Flipped Learning

Start 1969 in medical education

1990 in dental education

2012 in high school chemistry

Process • Problem – Content – Problem

• Each students learn different content, and

share their learning.

• Content – Problem – Content

• Each students learn same content, and help each other

apply those content.

Strength • Students can develop self-directed learning,

life-long learning all through the learning

process.

• Students should evaluate and identify

learning materials by themselves.

• Credible learning materials are provided. Students search

further learning materials by their own.

• Knowledge can be efficiently structured.

• Online lecture can repeatedly learned on individual pace.

Weakness • Cognitive load to stay self-directed from the

beginning

• Insufficient “cognitive scaffolding” in the

basic sciences

• Faculty loads in the starting semester (developing online

lectures, designing learning activities)

• Online lecture is suitable for lower order cognitive skills .

• Students should have access to online learning resources.

PBL vs. Flipped Learning














process.








beginning


basic sciences



















process.








beginning


basic sciences



















process.








beginning


basic sciences







Medical Education vs. Dental Education

• Clinical problem-solving in ME: focus on diagnosis

• Clinical skills in DE: focus on mechanical hand activities, psychomotor skills for treatment

• Outcome variables of PBL in DE (Bassir et al., 2013)

- knowledge acquisition,

- knowledge application,

- clinical hand skills,

- perceived preparedness, and

- a wide range of behavioral characteristics


Learning Psychomotor Skills

• Cognitive phase – learning the

vocabulary and procedural rules

• Associative phase – learning how to

physically perform the skill

• Autonomous phase – practice and

feedback guide learner to smooth,

precise movements.

Bloom (1956)

Moore (1998)

When do we need self-directed learning?

When do we need guidance?

Shall we implement PBL or FL?

Smith & Ragan (2005)


Paradigm Continuum

Objectivism Constructivism

Lecture PBLFlipped Learning

knowledge

acquisition

knowledge

application

clinical hand

skills

perceived

preparedness

a wide range of

behavioral

characteristics

FL O O O O

PBL O O O O

Psychomotor Skill Learning

O

PBL Future DirectionMixFL

• a growing commitment to competency-based curricula that focus on

learner acquisition of specific competencies while a more growing

concern for diverse teaching method to nurture self-directed lifelong

learner to think critically and independently

• move beyond individual competence to a collective competency or team

competency

• advances in digital media that enhance the delivery of content outside of

the lecture hall and free up resources for synthesis and application of

content

• evidence-based decision making in education based on educational

theory and research


Changes in healthcare and society

• Movement toward total wellness

and prevention-focused model

rather than treatment-focused

• Team-based care

• Advances in digital media

• Education as a significant agent

of social and scientific change

Thank you!감사합니다

Documents

Flipping Dental Education