The PBL approach to education is both stimulating and challenging. Every facet of this innovative approach to education is related to some practical aspect of patient care.
Problem-Based Learning Curriculum (PBLC) (Phase I and II)
The Problem-Based Learning (PBL) curriculum format is an innovative method of integrating and developing the medical knowledge, cognitive skills, and interpersonal growth required to produce an SIUC physician assistant graduate. The PBL model has been in existence at the SIUC School of Medicine (SIUC SOM) for several years. The faculty at the SIUC SOM, are well versed in this curriculum. SIUC SOM data indicate that board examination scores for medical students trained in the PBLC format are as high as, or higher than, those of medical students trained in the standard curriculum. Based on these data, we are confident that the PBL format is a more effective method of preparing PA graduates for placement and retention in underserved communities.
Problem-based learning curriculum is very challenging. PBLC students are motivated by patient cases (problem-based learning modules- PBLMs) and the challenge to determine and pursue their own identified learning issues. The group, the tutor, and the problem all help to focus the learning efforts. The PBLC is structured so that students work in groups to investigate faculty sequenced patient problems. It requires a considerable amount of self-directed study.
Problem-Based Learning Modules
Problem-based learning cases are based on real patient problems that are carefully selected by faculty to stimulate students’ learning in all relevant areas of basic and clinical sciences. A humanistic approach to medicine, as well as clinical and interpersonal skills, are developed during both years of the curriculum. As students learn the major concepts from these disciplines, they also acquire the terminology, thought processes, and teamwork necessary for effective medical practice. The problems also include pertinent laboratory data and test results; many also include radiographs, electrocardiograms, and other diagnostics. Problems are introduced to students at a rate of approximately one per week during the first year of the curriculum.
During the second year, students meet one time per week with a clinical tutor at their assigned hubsites to work on cases that augment their learning experiences. A problem-based learning module is used as a stimulus for comprehensive, integrative learning by students as they work through the patient problem with faculty tutor facilitators. The SIUC PA Program uses PBLMs organized in a life cycle format, encompassing birth to elderly populations. A problem-based learning module is a copyrighted, bound, sequential book that represents an actual patient case.
Each case presentation incorporates a photograph of a stimulated patient and the chief complaint. Student are encouraged to ask as many questions as needed to investigate the presenting problem, symptomatology, past medical history, habits, lifestyle and environmental considerations, psychosocial information and open-ended inquiry. There are answers to 202 questions that the student can ask, with patient responses as appropriate. Students then proceed to examinations which include 121 possible physical exam components. Additionally, 382 laboratory tests and diagnostics are available to students for their interpretation and synthesis. Patient progress is then documented in a temporal profile which enables students to learn about patient outcomes. Consultation reports, expert write-ups of each patient case, objectives lists, and medical databases are included in the PBLM.
The PA program utilizes a public health study of the 40 most common health problems in the rural areas of the state, where we are targeting the placement of graduates. The content areas of the curriculum and specific PBLMs were created to emphasize this focus.
Tutor group assessments and performance-based assessments provide students with continual input on their academic progress. This curriculum enhances self-motivation. The desire to help solve each patient’s problem is highly motivating as is the desire to share one’s load of the group process. As always, each student is responsible for individual study areas, which require a high level of personal motivation.
The PBLC format enables students to gain a sense of accomplishment and self-control in their own education, as they must identify and pursuer both learning objectives and resources, rather than having these spelled out by faculty. Students in the program learn to work toward a common goal with peers and faculty. Through the curriculum they learn to resolve interpersonal conflicts within tutorial sessions in an appropriate and professional manner. By developing and refining these skills in the pre-clinical setting, students are well prepared for the teamwork required in the clinical rotations as well as in practice. Students meet in tutor group approximately 12 hours a week and spend an additional 30+ hours in self-directed learning.
The tutor group in the problem-based learning curriculum (PBLC) format requires that students study relevant disciplines as they pursue each patient problem. Thus, information from each discipline is integrated, and the inter-relationships among the information are emphasized, resulting in information being structured to facilitate application to patient problems. Since the curriculum forces students to develop self-directed learning skills, they will possess the necessary ability to investigate unfamiliar patient problems that they encounter during their professional careers. Because medical knowledge continues to expand at a rapid rate, the importance of these professional skills cannot be underestimated.
PBLC provides students with continuous opportunities to encounter patient problems, allowing them to enrich clinical reasoning skills, self-directed learning and interpersonal skills, thus providing students with self confidence in dealing with patient problems. Tutor group assessment is a process in which each student assesses him/herself and constructively assesses peers. By performing this self-assessment and receiving feedback from peers, students have the opportunity to correct their deficiencies. This assessment and feedback takes place at the end of each case in the unit (approximately once a week). The curriculum is designed to help students develop effective and efficient clinical reasoning skills, because their roles as physician assistants require the resolution of intricate, yet urgent managerial problem.
Problem-based learning was developed from the belief that students who acquire medical knowledge while working with actual patient problems and who developed their clinical reasoning skills at the same time, will have greater recall and use of that knowledge as a practicing health are professional. The PBLC is a challenging format which makes the study of medicine intriguing for students because their need to learn is driven by a need to understand real patient problems. The relevance of information learned is immediately apparent; students become aware of a need for knowledge as they work to resolve the problems. Continuing clinical experiences provide students with the chance to leave their books and labs behind temporarily, in order to reinforce what they have learned and to apply knowledge in a real clinical setting. This combination provides a realistic balance of study efforts and opportunities. Faculty at SIUC firmly believes in the benefits of problem-based learning and enthusiastically pursues continuing innovations in the PBL concept. These facts, as well as the great success of PBL in helping to produce top-notch professionals for practice in underserved communities, has led SIUC to choose problem-based learning as the curriculum of the Southern Illinois University Carbondale Physician Assistant Program.