Dr G Srinivaulu MD(Hom)
Adoption of p.b.l. concept for holistic learning
“If I hear I forget, if I see I may remember, if I do all by myself with involvement & interaction I will remember it forever” – Chinese Educationist.
The art of learning is as old as the human civilization. Every era has witnessed a steady growth in the field of education at different levels. The primary, secondary and tertiary (higher) education is the three-tier method of imparting education all over the world. Now-a-days education is starting with the womb and ending with the tomb.
This continuous process of education is leading to quantitative expansion at the expense of quality. Medical education in particular seems to have begun during the Hippocrates Era and has passed thorough several centuries and attained a scientific outlook in the present Human Genome Era (HGE). There is a tremendous growth in the infrastructure of education, research and health care delivery system, each one influencing the other in the development of medicine.
MEDICAL EDUCATION: NEW TRENDS: Learning the smart way:
In order to prepare a student for a definite purpose of prevention, promotion, cure and rehabilitation of the sick, a holistic module of training is needed. This is the aim of our earliest medical teachers from the Stone age to the present Space age. The Science & Art of medical education has fascinated several people in incorporating some techniques in this field. One among such new technique is the problem based learning (PB.L Medical teachers are well ware of the patient oriented teaching (P.O.T) at the bed side on the lines of teachings of Hippocrates. But in the present era we have to blend traditional methods with the new concepts for better results.
EDINBURG DECLARATION : Aims of Medical Education:
The later part of 20 Century has witnessed enormous growth & development in the fields of Science, Technology and Medicine. Medical Education has been considered as a top priority in the 218t Century. The Edinburgh Declaration of August 1998 includes improvements within the medical schools to “Train teachers as Educators, not sole experts in content, and reward educational excellence as fully as excellence in biomedical research or clinical practice.”
1.The primary aim of the undergraduate courses is for the student to acquire understanding of health and disease, and of the prevention and management of the latter, in the context of the whole individual in his or her places in the family and in society.
2.The second main aim is to develop an attitude to learning i.e., based on curiosity and the exploration of knowledge rather than its passive acquisition.
3.Reduction of the excessive burden of information in the existing undergraduate course.
4.Introduction of substantial component of problem based learning.
5.A clinical component in which students have direct contact with patients and with the analysis of their problems through out the five and half years of the course
6.An understanding of the basic research methodology.
HOMOEOPATHIC EDUCATION: NEW HORIZONS:
Medical Education Technology (M.E.T) has contributed a lot towards improving medical education in India. The Central Council of Homoeopathy (C.C.H) emphatically stated that “Teachers’ training is emerging as a powerful and efficient tool for improving the quality of education & it is committed to support all initiatives to usher quality into homoeopathic education’
The concept of teacher training has gained ground in the medical education field in general and Homoeopathy in particular, during the past few years. There is a great need to incorporate the new Anthological techniques (Adult learning) being adopted and implemented by mainstream medicine into our medicine. Training the teachers in the practice of higher education & sensitizing them to transform practices for the needs of learner benefit is a task that needs to be accorded a high priority.
QUALITY EDUCATION Several Steps away:
Quality of education at higher levels is more important than mere quantitative expansion. It is often said that quality of higher education in the country is deteriorating with quantitative expansion. The quality of education of a student depends on various factors like the teaching to which he is exposed, the educational facilities and environment available in the institution of his study and his own temperament and approach to studies. So to determine the quality of education of a student the factors mentioned above have to be considered. The teachers’ have to grow beyond the traditional concept of chalk & talk method of teaching.
MODERNIZING HOMOEOPATHIC EDUCATION: P.B.L. WAY:
The objectives of the Teaching Learning Process (T.L.P) is to bring about definite changes in the behavior of the learner which are indicative of his achievement. To elaborate this point, learning is said to have taken place only when the learner is able to perform certain (may be choosing a drug, inserting a catheter, applying bandage,problem solving etc.,) which hé could not do prior to the instructional process. Many method innovative techniques have been evolved with the passage of time towards realising this single objective: learner centered approach; individualized instructions, tutorials, seminar methods, small and large group discussions and interactions; team teachings; question-answer techniques; creative objects; computer assisted learning; computer managed instructions; syndicate sessions; plenary sessions and so on. Each technique has a scope in one particular area of education or the other.
P.B.L. – A HOLISTIC CONCEPT IN EDUCATION: a tool and technique
The Problem Based Learning is one among the techniques devised by psycho – logists and educationists to realise the goals of education. The P.B.L. Concept in medical education is known to every medical teacher unconsciously and has never made a conscious attempt in making this technique as a chief tool in imparting clinical skills to his student. If this new tool and technique is imparted in a systematic way one can certainly witness a paradigm shift in the quality of medial education in general and Homoeopathy in particular.
HISTORY OF P.B.L EXPLOSION:
The use of problem-based learning in medical education and other educational settings has escalated. What once was considered a “fringe” innovation has become much more main stream. Problem-based learning (PBL) in medical education began with the Faculty of Medicine at McMaster University in Canada in the mid 1960’s. Soon after, three other medical schools – the University of Limburg at Maastricht in the Netherlands, the University of Newcastle in Australia, and the University of New Mexico in the United States – adapted the McMaster model of problem-based learning and developed their own spheres of influence in addition to the “mecca” at McMaster A variation of problem-based learning at Michigan State University called “focal problems” antedated some of these efforts, but did not develop “followers” as did the McMaster model From these four institutions sprang one of the more important educational movements of this century.
The educational significance is that, unlike other important innovations, such as organ-based” curricula or “interdisciplinary” courses, the use of problem-based learning in medical school incorporated goals for students that are much broader than the acquisition & application of content. Indeed, PBL is expected to influence the “whole” student, or, at least, many aspects of the students’ learning experience. There is so much that is different about a PBL curriculum as contrasted with the curriculum model of the previous decades that any real movement to PBL would have to be considered a paradigm shift”, implying a very different way of providing, medical education.
From the origin at McMaster thirty years ago where the model for student-centered, problem-based, small-group learning took shape, adoption of PBL at other medical schools experienced a slow, though gradual increase through the 1970’s and 1980’s. Now, however, we are seeing an explosion in the use of PBL in its various adaptations. Today, most US medical schools and many in almost every country of the world are implementing (or are planning to implement) PBL in their curricula to a greater or lesser extent
Health University : Healthy Trends in Medical Education
The premier N.T.R. University of Health Sciences, A.P., had organized an international conference on Medical Education & Technology from 18-20, January, 200 at Hyderabad, in collaboration with South Illinois University school of medicine, US, W.H.O & Medical Council of India. Eminent speakers have reiterated the need ft introduction of P.B.L. method in medical education. Several studies have shown significant increase in the quality of skills, long-term memory and pass percentages etc., All these studies have validated PBL as an effective and thought providing educational method. It is high time that the Central Council of Homoeopathy (C.C.H sees the potential of PBL and seriously considers its implementation.
WHAT IS P.B.L? Learning through doing:
P.B.L.is an approach to learning and instruction in which students tackle problems in small groups under the supervision of a teacher/tutor. Most problems consist of a description of a set of phenomena or events that can be perceived in reality. These phenomena have to be explained by the tutorial group in terms of their underlying principles, mechanisms or processes. This approach is considered a systematic approach or attempt to apply findings of cognitive psychology to educational practice This also indicates that competence is fostered not primarily by teaching to import knowledge, but through encouraging an inquisitive style of learning. This style of learning is assumed to foster increased retention of knowledge, improve students’ general problem solving skills, enhance integration of basic science concepts into clinical problems, booster the development of self-directed learning and skills strengthening students’ intrinsic motivation.
Therefore, PBL as an instructional approach can be characterized as a collection of carefully constructed problems presented to small groups of students. These problems usually consists of a description of a set of real-life phenomena that are in need of some kind of explanation.
Thus, PBL, by virtue of its nature brings about student or learner-centered activity which emphasizes on “strategic enquiry”. It facilitates “self directed learning”. It also brings in an integrated approach to learning and internal motivation. Many educational institutions have blended PBL with their traditional curriculum as science & art are blended for better results.
AIMS & OBJECTIVES OF P.B.L:
I .To make Medical Education more relevant to the needs of society.
2. To integrate Basic Science Teaching & Clinical Education for Clinical problem solving.
3. To make teachers as facilitators rather than spoon-feeders.
4. To enable students to achieve problem solving skills.
5. To make teaching-learning a two way active phenomena.
P.B.L. Remedies for maladies of Medical Education:
I. Enhances clinical reasoning: Doubts lead to Discoveries:
The traditional didactic teaching emphasizes knowledge accumulation while assuming that clinical reasoning is a skill which the student must acquire on his own. PBL becomes an effective method of enhancing the students critical deductive skills and applying basic science knowledge to clinical reasoning.
2.Knowledge Acquisition: Teacher as a Catalyst:
Today’s teacher has to evolve into an information manager than information provider. They should use methods to promote active learning faced with an information explosion the medical curriculum is ever expanding its knowledge base. To convey Entire information through teachers is not feasible. It becomes important that the student is taught the skills of knowledge acquisition and self directed learning. PBL helps students to identify their learning needs and how best the information can be acquired.
Small group environment also provides scope for informal peer evaluation & improving communication skills. However farther our medical researchers proceed, whatever sophisticated approach we adopt in medical field, one day or other the common student and his environment is to be cared & viewed.
CRITICISM & SKEPTICISM: Deviating from the traditional methods of teaching?
What is the change? Why should there be a change? How to change? Whom to change? How fast can we change? Is it practicable? Can it be the persistent change? Will it work in my field of Organon of Medicine/Materia Medica / Medicine etc., Is it worth making an attempt? All questions either with curiosity or contempt for new concepts. All genuine doubts lead to discoveries and inventions. So is the case with education. The best way is Hahnemann’s technique of self experimentation or Human Pathogenic Trials (H.P.T or Proving). The results will decide the course of action. Perhaps the best way to answer all our queries on P.B.L. is proving it on our pupils for its positive effects.
PBL is an innovation which has definitely caught on in medical schools in Canada, USA, Pakistan, Nepal & in India in certain universities & in numerous settings. This androgogical technique would be tremendously useful in imparting Homoeopathic Medical Education. This logical and wholistic tool can be better utilized for better understanding of our system The interrelationship and intricacies of MAN, MALADY and MEDICINE can be better correlated and comprehended through PBL way of Medical Education
Michael de Mantaigne says, “whenever a discovery is reported to the scientific world, they say first, it is probably not true. There after when the truth of the new proposition has been demonstrated beyond question, they say, yes it may be true, but I. it is not important, finally, when significant time has elapsed to fully evidence its importance, they say, yes, surely it is important, but it is no longer new’. This is what exactly is happening to the principles of Homoeopathy & Homoeopathic Medical Education. For want of scientific in formation we ignore several important things in our life. It is the science which has to evolve to reconfirm the truth but not the other way.
Teaching is a noble job, for the teacher has to give more than he receives & what he gives is priceless. “Education is not filling up a pail, but is very definitely lighting up a candle in a dark room.
May Homoeopathic Educationists keep their heart & mind open for new concepts, techniques, and methods and implement them for the advancement of Homoeopathic Education. May Homoeopathic Medical Education flourish & grow from good to better and better to best in terms of quality and meet the challenges of the 21St Century in the field of medicine.
The National Homoeopathic Postgraduates Scientific conference would open a new chapter in the history of Homoeopathic Medical Education by setting new goals and in redefining the purpose & plan of postgraduate homoeopathic medical education. May Homoeopathic Medical Education grow from strength to strength and preserve the Hahnemann’s legacy, dreams and aspirations in its pristine purity.
I .Ananthanarayanan, RH., Problem – Based Learning, Medical Education Principles & Practice, 2000.
2.Gwendie Camp, Problem Based Learning: A paradigm shift or a passing fad? The University of Texas Medical Branch Bulletin, Oct’2002.
3.Pragna Rao, Problem Based Learning in Medical Education Time to make a beginning, Proceedings of International Conference on Medical Education & Technology Jan 2002, Hyderabad.
4.Munir Ahmed , Exploring Homoeopathic Education, Sept,2002.
5.Lalit Verma, Exploring Homoeopathic Education, Sept2002.
6.Sastry, G.LN, Tryst with destiny, 1999, Hyderabad.
7.Prasant, N.S. Guidelines for Qualitative Education and N.A.A.C. Accreditation, August 2000
8.K. Subramanyam, Quality Control in Higher Learning, The HINDU speaks on education, pages 76-81.
9.Naik, S.R. Better Scientific Communication, New Delhi, 1988.
I0.Eswar Das, Future Trends in Homoeopathic Education, Homoeopathic Teachers’ Seminar, Sep 2002, New Delhi