Problem-Based Learning in Health Education

Madeleine Rohlin and Christina LindhMalmö University Malmö, Sweden

Goiania October 2010

SWEDEN in some FIGURES

• Oldest population in the world (aged 80 and over) • Education spending: 7.7% of GDP (Nr 9) (Health spending: 8.7% of GDP Nr 20)

• Teritary education (all levels of post-secondary education) enrolment: 70%

• Highest human development index ~ quality of life after Norway and Iceland. Highest environmental sustainability index after Finland and Norway

The Malmö-model Examples on different levels

Programme

Course

Week

Weekly timetable for course 2 ‘Diagnosis and Treatment of simple Periodontal Disorders’

Monday Tuesday Wednesday Thursday

Friday

am Study-group

Problem

introduction

Clinical setting

Examination of patients with periodontitis

Study-group

Review and

Problem-solving

pm Skills lab

Practice of different skills

Seminar

 RELATIONSHIP BETWEEN PROBLEM AND KNOWLEDGE GAINED

 

Traditional or Case-based Students have to have

education the knowledge required to approach the problem

(situations)

PBL Students’ knowledge arises from work on the problems (situations)

Centre for Oral Health SciencesMalmö University, Sweden

Semester 2Course: Diagnosis and Treatmentof Simple Periodontal Disorders

Scenario: Karin

Karin notices bleeding from the gum in the upper jaw she brushes her teeth.

PROBLEMS (formulated by students)Why is the gingiva red and swollen at one placebut not at another?

HYPOTHESIS (formulated by students)The amount of tissue fluid and blood increases in aregion due to the microorganisms. The bleeding is due tothe increased number of blood vessels with fragile walls.

Weekly timetable for course 2 ” Diagnosis and Treatment of simple Periodontal Disorders”

Monday Tuesday Wednesday Thursday

Friday

am Study-group

Problem

introduction

Clinical setting

Examination of patients with periodontitis

Study-group

Review and

Problem-solving

pm Skills lab

Practice of different skills

Seminar

Examples on questions posed by one cohort after they have studied ’Karin’. The questions are handed to

experts and discussed during a seminar.

•When the tooth surface is covered with a bacterial film do the body defence mechanisms regard the tooth as ’foreign’ and try to remove it

– leading to the breakdown of bone?

• How can H2S produced by micro-organisms cause tissue damage?

• Does pushing the probe into several pockets, without cleaning it in-between, lead to the spread of periodontits?

• Does a deep periodontal pocket which bleeds necessarily mean that periodontits is active?

• Can a pocket be 4-5 mm deep without being classified as diseased?

• Why does platelet-activating factor cause vasodilatation at low and vasoconstriction at high concentration?

LEARNING

Based on students’ own questions and

self-generated discovery

MEANING-MAKING

The Malmö-Model

COURSE LEVEL

Clinical situation SKILLS LABORATORY STUDY GROUP

COURSE 2. Students should be competent to take care of adult patients with simple periodontal disorders

REGISTRATION OF

bleeding

plaquecalculus

pocket depthattachment level

EXAMINATION OFTHE PERIODONTIUM

DIAGNOSIS

TREATMENT

Pain

Local anaesthesiai

Information on diseaseOral hygiene instruction

Health conditionAnamnesis

Inflammatory reactions and their regulation

Virulence of subgingival microfloraCalculus formation

Action of cytokines. Mechanisms forbone resorption

Radiographic image quality. Radiationphysics

Biological effects of radiationSelection criteria for X-ray examination

Healing processes. Blood coagulation and fibrinolytic system

Progression and treatment of periodontitis

Innervation of the oral cavityTopographic anatomy

Nervtransmission and receptors

Pain and pain experience

Pain relief and action of local anaestheticsCommunication. Health perceptionHabits and personality

Respiration and cirkulation

Hemoglobin and oxidative metabolism

Heart failure. Vascular diseases

Scaling

Bitewing

Problems consist of events that are need

of explanations in terms of underlying

processes, principles or mechanisms.

INTERDISCIPLINARY INTEGRATION

Knowledge Domains in Professional Education

Applied Science

Knowledge

Social ScienceHumanitiesKnowledge

BehaviouralScience

Knowledge

BiomedicalScience

Knowledge

The Role of Science Knowledge

Clinical Science Knowledge

Health Promoting Strategies

Diagnosis – novel situations

Prevention Strategies

Treatment Strategies

Social Science and HumanitiesKnowledge

Biomedical ScienceKnowledge

Behavioural ScienceKnowledge

STRUCTURE AT PRESENT

………clinical problems can not be embedded into basic science contexts

BUT

basic science can be embedded within the clinical context

Patel et al. (1990)

Problems consist of events that are need

of explanations in terms of underlying

processes, principles or mechanisms.

INTERDISCIPLINARY INTEGRATION

This has radically restructured the curriculum, quality assessment, the nature of the relationship between staff and students and last, but not least,

the basic vision that underlines Odontology

The MALMÖ-Model - Curricular Level

Holistic View Team-work

Self-directedLearning

Oral Health

LEARNING- Learning is about the process of discovering

knowledge, not just the content (Kolb's circle)

- Intelligence is shaped by experience..(Piaget)

- Any experience that does not violate expectations is NOT worthy of the name experience (Hegel)

What is PBL?• An educational approach (not a method)

• Multiple learning and teaching methods and learning environments

• Organised around problem: small groups, collaborative & independent research, peer learning and teaching, reflection and self-management

CASE1. Define problems

2. Generate hypotheses Elaborate on knowledge

5. Synthesise newlyacquired knowledge

3. Students formulate learning goalsbased on prior knowledge

4. Collect additionalinformation

outside the group

The learning goals are told(what is important to know)

Elaborate on knowledge

CASEApply information

Collect information

PBL

CASE-BASED orPROBLEM-ORIENTED

EDUCATION

 

 

The half-life of scientific information in nature sciences is about 5 years.

Thus 50% of what we have taught the students

in a 5-year curriculum will not be up-to-date when they graduate.

 Unfortunately we do not know which half!

 

WHY LEARNING?

EDUCATIONAL RATIONALES

• Learning based on students’ own question and self-generated discovery –

Meaning Making

• Problems consist of events that are in need of explanations in terms of underlying processes, principles or mechanism - Interdisciplinary Integration

• Learning activities referring to real-life situations reinforces what is learned – Relevance

RUBRIK I VERSALER

Clinical situations that a newly qualified graduate should recognise and be able to manage alone

or to refer appropriately.

Oral conditions, which are commonly found in the community and in which oral health care

plays a role.

Note: Care includes both caring for the patient and caring for the condition.

EDUCATIONAL RATIONALES

• Learning based on students’ own question and self-generated discovery – Meaning Making

• Problems consist of events that are in need of explanations in terms of underlying processes, principles or mechanism - Interdisciplinary Integration

• Learning activities referring to real-life situations reinforces what is learned – Relevance

• Learning activities have a degree of complexity adapted to students´ prior knowledge, skills and attitudes - Spiral Curriculum

SPIRAL CURRICULUM

Learning activities have a degree of complexity adapted to

students’ prior knowledge and skills.

’Focusing and ordering are thus the two aspects of direction….

Activity must be centered at a given time in such a way to prepare for what comes next’.

Dewey J. Democracy and education. 1916

Centre for Oral Health SciencesMalmö University, Sweden

Semester 1Course: The Oral Ecosystem

Scenario: Helene

Helene is in her last year at high school and is waiting to give a presentation.As she waits, her mouth feels very dry and she feels that she will not be ableto say anything.

HELENE

EDITH

ALMA

HELENE

Learning Situations and

Situations of Application

• Every learning situation includes the potential for application (of something learned previously)

• Every situation of application implies the potential for learning (something new)