1. Outcome Based Education
Problem Based Learning
What is it ?
How would it run at Medanta ?

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Yesterdays Students
Based on facts
Stress on what does the student know ?
Subject based curriculum
Educational research:
Lecturers from experts doesnot influence practice

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Tomorrows students
What can the student do ?
Competencies
Outcome based curriculum
(competency based)

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Outcome based curriculum
Outcome: What should the student be able to do ?
Outcome based curriculum: decisions about
curriculum are driven by exit learning outcomes
Product defines content & process

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Outcome based curriculum
Clearly define exit outcomes
Curriculum driven by exit outcomes
Learning strategies & opportunities to match
learning outcomes
Assessment process matches outcomes
Regular feedback on progress

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Types of outcomes
Exit outcome:
to diagnose & manage pt with asthma
Intermediate outcome:
take respiratory history of a pt . Perform general examination
of respiratory system.
Introductory outcomes:
Describe airway physiology

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Levels of Educational Outcomes
Level 1. An awareness of procedure
Level 2. A full theoretical understanding of the
procedure
Level 3. Observation of the procedure
Level 4. Carrying out some part of the procedure
Level 5. Undertaking the procedure under supervision
Level 6. Undertaking the procedure unsupervised.

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Levels of competencies & Performances
Dryfus & Dryfus model
1. Student
2. Novice
3. Advanced learner
4. Competent
5. Proficient
6. Expert
7. Master

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Target Zero
Problem Based Learning (PBL)
• begun in 1950’s as a movement to restructure
medical school education
• unlike traditional instruction that culminates in
a problem after basic instruction on facts and
skills, PBL begins with a problem, teaching facts
and skills in a relevant context

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Principles of adult learning
Adults are motivated by learning that:
• Is perceived as relevant
• Is based on, and builds on, their previous experiences
• Is participatory and actively involves them
• Is focused on problems
• Is designed so that they can take responsibility for their
own learning
• Can be immediately applied in practice
• Involves cycles of action and reflection
• Is based on mutual trust and respect

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NJCATE 4 June 2000
Problem-Based Learning
“PBL is any learning environment in which the
problem drives the learning.

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NJCATE 4 June 2000
Problem-Based Learning
“PBL is any learning environment in which the
problem drives the learning. That is, before
students learn some knowledge they are
given a problem.

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NJCATE 4 June 2000
Problem-Based Learning
“PBL is any learning environment in which the
problem drives the learning. That is, before
students learn some knowledge they are
given a problem. The problem is posed so
that the students discover that they need to
learn some new knowledge

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NJCATE 4 June 2000
Problem-Based Learning
“PBL is any learning environment in which the
problem drives the learning. That is, before
students learn some knowledge they are
given a problem. The problem is posed so
that the students discover that they need to
learn some new knowledge before they can
solve the problem.”
- Don Woods

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Problem-solving vs. problem-based
learning
- different but inter-related -
Problem-solving: arriving at decisions
based on prior knowledge and
reasoning
Problem-based learning: the process of
acquiring new knowledge based on
recognition of a need to learn

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Tenets of PBL
• requires students to solve authentic, open-
ended problems with many correct answers
possible
• authentic problems faced by scientists,
doctors, engineers, lawyers, educators,
administrators, counselors, etc.
• Problems given to students are ill defined with
many potential solutions. Problems should be
authentic

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Tenets of PBL
• emphasizes students’ pre-existing knowledge;
“start with what you know”
• students actively participate by helping plan,
organize, and evaluate the problem solving
process
• interdisciplinary connections stressed
• students undertake authentic roles

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Basic steps of PBL
• students divided into groups
• real problem is presented and discussed
• students identify what is known, what
information is needed, and what strategies or
next steps to take (identify gaps)
• individuals research different issues, gather
resources

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Basic Steps of PBL
• resources evaluated in group
• cycle repeats until students feel the problem
has been framed adequately and all issues
have been addressed
• possible actions, recommendations, solutions,
or hypotheses are generated
• tutor groups conduct peer/self assessments

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Teachers as facilitators
• a facilitator is key to these learning environments
• models higher-order process skills
• probes for student understanding
• never identifies issues or states an opinion while
students frame problems
• Asks open ended questions: where can you ..?
What do you think ….? What are the next steps ?

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Advantages of PBL
• greater recall of knowledge, retention
• interdisciplinary, can require accessing and
using information from a variety of subject
domains; better integration of knowledge
• development of life-long learning skills:how to
research, how to communicate in groups, how
to handle problems

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Advantages of PBL
• increased motivation, interest in subject areas
• increased student-student interaction, and
student-instructor interaction
• Shifts paradigm from teacher centered to
student centered

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Traditional system : Teacher centered
…the individuals learning the most in the
teacher-centered classrooms are the
teachers there. They have reserved for
themselves the very conditions that promote
learning:
actively seeking new information,
integrating it with what is known,
organizing it in a meaningful way, and
explaining it to others.

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Comparison of Paradigms
Teacher-Centered
Knowledge is transmitted from professor to
student.
Learner-Centered
Students construct knowledge through
gathering and synthesizing information and
integrating it with the general skills of inquiry,
communication, critical thinking, and problem
solving.

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Comparison of Paradigms
Teacher-Centered
Students passively receive information
Learner-Centered
Students are actively involved.

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Comparison of Paradigms
Teacher-Centered
Emphasis is on acquisition of knowledge
outside the context in which it will be used
Learner-Centered
Emphasis is on using and communicating
knowledge effectively to address enduring
and emerging issues and problems in real-life
contexts.

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Comparison of Paradigms
Teacher-Centered
Instructor’s role is to be primary information
giver and primary evaluator.
Learner-Centered
Instructor’s role is to coach and facilitate.
Instructor and students evaluate learning
together.

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Comparison of Paradigms
Teacher-Centered
Teaching and assessing are separate.
Learner-Centered
Teaching and assessing are intertwined.

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Comparison of Paradigms
Teacher-Centered
Assessment is used to monitor learning.
Learner-Centered
Assessment is used to promote and diagnose
learning.

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Comparison of Paradigms
Teacher-Centered
Emphasis is on right answers.
Learner-Centered
Emphasis is on generating better questions
and learning from errors.

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Comparison of Paradigms
Teacher-Centered
Desired learning is assessed indirectly
through the use of objectively scored tests.
Learner-Centered
Desired learning is assessed directly through
papers, projects, performances, portfolios,
and the like.

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Comparison of Paradigms
Teacher-Centered
Focus is on a single discipline.
Learner-Centered
Approach is compatible with interdisciplinary
investigation.

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Comparison of Paradigms
Teacher-Centered
Culture is competitive and individualistic.
Learner-Centered
Culture is cooperative, collaborative, and
supportive.

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Comparison of Paradigms
Teacher-Centered
Only students are viewed as learners.
Learner-Centered
Professor and students learn together.

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Outcome
Moving away from:
Are students getting the right answer?
Moving to:
Can students demonstrate the qualities that
we value in educated persons, the qualities
we expect of college graduates?

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Outcome
Can students gather and evaluate new
information, think critically, reason
effectively, and solve problems?
Can [students] communicate clearly, drawing
upon evidence to provide a basis for
argumentation?
Do [students’] decisions and judgments reflect
understanding of universal truths[/concepts]
in the humanities and arts [etc.]?

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Outcome
Can [students] work respectfully and
productively with others?
Do [students] have self-regulating qualities like
persistence and time management that will
help them reach long-term goals?
Evidence based, Independent Life Long Learner

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How does a case serve as
a stimulus for learning?

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Example:
PBL tutorial process
1. Case presentation: The tutor provides the group with some
introductory clinical information about a hypothetical patient.
Mary Smith, a 28-year-old office worker and part-time
swimming instructor, comes to see her GP because of
pain in her chest and shortness of breath. This has
been a recurring problem in recent months and seems
to be gradually worse. On the previous evening, while
participating in a swimming gala, she became so short
of breath that she found it difficult to walk.

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2. Identifying key information
3. Generating and ranking hypotheses:
e.g., Infection, cardiac problem, allergy,
asthma, broken rib.
Allergy ˃ cardiac problem
4. Generate an enquiry strategy:
What additional information is required?
e.g., Previous medical problems and
relevant drug, family & psychosocial
histories, physical exam, lab. tests.

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Additional information
Further discussion with her GP reveals that Ms Smith’s chest pain and shortness of
breath come on following exercise, particularly in a cold environment. When she
becomes particularly short of breath, she starts to wheeze. She sometimes has a
dry cough and has never had haemoptysis. There is no recent history of physical
trauma and no personal or family history of heart disease. She had eczema in
childhood but has never had asthma. She has smoked for the past 5 years and
increased her smoking to 40 cigarettes a day since she broke up with her intimate
friend 3 months ago. She takes an oral contraceptive pill but no other medication.

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New information
Revising their hypotheses
Discard / Re-rank / Other hypotheses
• Anxiety attacks with
hyperventilation
• Possible thromboembolic
disease due to oral
contraceptive use
• Asthma
• Cardiac problem
• Broken rib

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5. Defining learning objectives
Once the students have decided on a preferred hypothesis (e.g., allergy), they must explain
the biomedical science mechanisms that link their hypothesis to the presenting
problems.
What students know?
What they do not know?
What they need to know?
to further their understanding of the underlying mechanisms, and their ability to solve the
clinical problem.
e.g., Students may identify gaps in their knowledge of the mechanics of breathing, anatomy
of airways, mechanisms of oxygen delivery to tissues, or mechanisms of pain perception.

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5. Defining learning objectives (cont.)
The identification of gaps in knowledge helps students to define their
learning objectives and these become the focus of self-directed
study in the interval between tutorials.
Learning objectives should be clear and specific and of appropriate
scope to be addressed in the time available between tutorials
(typically 2-3 days).
At each tutorial, the group might identify three to five major learning
objectives and perhaps an equal number of lesser objectives.

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5. Defining learning objectives (cont.)
Although the PBL tutorial is student-centered, major learning
objectives are identified in advance by the case writers as part
of the overall curriculum design. Tutors may need to provide
prompts to ensure that major objectives are identified and
pursue d.
In PBL, as knowledge is acquired in the context of a specific
clinical problem (the problem is encountered before the
student has the knowledge to understand it), it is likely to be
better focused and retained.

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6. Reporting back
In the follow-up tutorial, students reconvene to report
on their self-directed study and share and integrate
new knowledge.
All students should contribute to the report-back and
their unique perspectives are incorporated into the
process of knowledge building. The exchange and
debate of ideas promotes the consolidation and
elaboration of new knowledge and understanding

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7. Integrating new knowledge
• Based on the principle that knowledge is consolidated
more readily in context, students, guided by the
tutor/facilitator, should relate new biomedical knowledge to
the patient's problem.
• Students are required also to extend their discussion
beyond the biomedical and clinical sciences and consider
the public health, socioeconomic, ethical and legal aspects
of the case.

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How does PBL work ?
College of Medicine, Sharjah University , UAE
in collaboration with Monash University, Australia

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Learning Strategies
1. PBL tutorial session
2. Resource sessions
3. Laboratory sessions
4. Review sessions : Team based Learning
5. Clinical skills sessions
6. Hospital visits
7. Community Health visits
8. Self directed learning
9. Student Portfolio
10. Academic Advising

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End of Unit Assessment
Written paper: MCQ & SAQ
Objective Structured Practical Exam: OSPE
Objective Structured Clinical Exam: OSCE

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