British Journal of Medicine & Medical Research 4(9): 1836-1843, 2014 SCIENCEDOMAIN international www.sciencedomain.org Faculty Perception and Attitude on Problem Based Learning (PBL) in Medical College from Central India A. Singh 1*, A. Saxena 1, P. Bhambani 1, S. K. Nema 1, R. Gaur 2 and R. Ambey 3 1 Department of Pathology, Index Medical College Hospital & Research Centre, Indore, India. 2 Department of Pathology, G R Medical College, Gwalior, India. 3 Department of Pediatrics, G R Medical College, Gwalior, India. Authors contributions This work was carried out in collaboration of all authors. Author AS designed the study, perform study, author ASaxena, wrote protocol, design questionnaire, author PB performed the statistical analysis, author SKN wrote the first draft of the manuscript, author RG and author RA managed the analyses of the study, managed the literature searches. All authors read and approved the final manuscript. Original Research Article Received 29 th April 2013 Accepted 16 th October 2013 Published 9 th January 2014 ABSTRACT Background: PBL is an innovative teaching learning method that enhances intrinsic motivation, promotes self learning, encourages clinical reasoning, and develops longlasting memory. It is an established leading educational innovative method in medical sciences throughout the world. In India, it is used by only few institutions. The reason may be the lack of awareness or negative perception on PBL. Aims: To study the response of medical faculty on PBL. Material and Methods: The study was conducted at the Index Medical College Hospital and Research Centre, Indore, India. The introductory sensitizing lecture cum discussion was organized on PBL. Pre-Test, Post-Test and feedback data from the faculty was encoded in numerical variables and analyzed by the SPSS. Results: Fifty eight faculty participated, 82.14% were entry and junior level, 80.34% didn t attend any course on medical education, 94.6% have not attended any kind of formal training on PBL, 78.5% desired to acquire special training and 83.9% were in the *Corresponding author: Email: dr_arjun12@yahoo.co.in;
favor of PBL. There was significant improvement in the knowledge of faculty on PBL as evidenced by post test and feedback data (Unpaired t test P value equals to 0.0009). Conclusion: The faculty s attitude was receptive on implementation of the PBL but majority of them required special training which can be conducted by the medical education department of the institute with the collaboration and support of other institutions that run the PBL in their curriculum. It should be integral part of the PBL implementation programme at institute. Keywords: Problem based learning; traditional curriculum; faculty attitude; medical education. 1. INTRODUCTION The problem based learning (PBL) is an innovative teaching learning method that imparts knowledge, enhances intrinsic motivation, promotes self learning, encourages clinical reasoning, and develops long-lasting memory [1]. The three principles for acquiring new information are activation of prior knowledge, encoding specificity, and elaboration of knowledge; all of these are applied in PBL [2]. PBL is a learning method based on the principle of using problems as a starting point for the acquisition and integration of new knowledge [3]. Barrows and Tamblyn defined problem based learning as The learning which result from the process of working towards the understanding of a problem [4]. Problem-based learning occurs in small groups of usually five to six students with a faculty tutor whose principal role is to facilitate the learning process. The tutor guides students in their problem solving and self-directed learning, as opposed to giving the students information or telling them what to study and in what sequence. This method requires minimal scheduled activities, such as lectures, so that the groups are free to schedule their own time, individualizing the learning process to meet varying student needs [3]. PBL was originally introduced and developed in 1969 by Mc Master University Canada; it is established as a leading educational innovative teaching learning method in medical sciences [5,6]. Currently in USA, about 82% of the medical schools have some elements of PBL in their curriculum [7]. In Asia PBL has been adopted by various newly established medical colleges within Nepal, China, Singapore, Hong Kong, and Malaysia [8,9]. But in India, after 4 decades, PBL is still in its infancy, and its use is limited to particular subject or topics of a few premier institutions [10]. Most of the faculties from large number of institutions are unaware with the PBL [11]. Though Medical council of India (MCI) encourages the integrated teaching using PBL approach [12], but it is still not implemented by most of the medical colleges in India [10]. The reason may be due to lack of awareness regarding Problem based learning or negative perception about the role of teacher in PBL [11]. Spencer et al. [13] clearly shows the advantages of PBL curriculum over traditional system of educational delivery methods like lectures. PBL students generate explanations that are more accurate, coherent and comprehensive than non PBL students [3]. 1837
Kiguli Malwadde E et al. [14] observed that faculties in the developing countries used to resist the modifying the existing traditional curriculum, teaching and learning methodologies. Why was this or what are the informing factors? What has changed (if at all)? Literature in medical education has repeatedly pointed out that implementation of PBL in institution require more than the development of new ways to present the curricular methods; it requires changes in the role of students and faculty [15]. It is not easy to incorporate PBL in existing curriculum; it is only possible by multidirectional effort, proper faculty training and well planned strategy [16]. Only few studies have been conducted in developing countries to demonstrate behavior of faculty towards PBL incorporation in existing traditional curriculum [11,17]. We are in the process of introducing PBL in our institution in sequential manner; we planned to introduce PBL in a Faculty meeting as a lecture cum discussion Problem based learning, What and Why? this lecture cum discussion was a preliminary event to introduce and familiarize our faculty to the PBL methods. This study was conducted to establish the knowledge, attitude and the perception of participating faculty toward PBL. 2. MATERIALS AND METHODS This study was conducted at the Index Medical College Hospital and Research Centre, Indore, India. The institute is recognized by the Medical Council of India (MCI) and affiliated with the Devi Ahilya Vishwavidhyalaya (University), Indore, India for the ba sic medical degree Bachelor of Medicine and Bachelor in Surgery (MBBS) and Post graduate degree Doctor of Medicine and Master in Surgery (MD & MS) in various disciplined. The faculty was informed that in the upcoming session, our institute is planning to introduce PBL in the MBBS curriculum in a sequential manner. Institute is in the process of faculty development for PBL. The institution has scientific committee called Involve Academic Meet (IAM) which is used to conduct the academic activities in medical college among the faculty. This committee is responsible for organizing the department wise talk, seminars and workshop on various common interest topics among the faculty. The first initiative towards PBL incorporation in the existing curriculum is taken by the IAM under the umbrella of Medical Education Unit (MEU) by organizing Introductory sensitizing lecture cum discussion. Pre-test before sensitizing lecture and discussion to assess the level of awareness of faculty toward the PBL consisting of six questions in the Pre-Test questionnaire paper were taken. At the end of lecture cum discussion on PBL, the Post-Test was conducted with same question as Pre-Test. The feedback from faculty is also taken, under three heading, personal detail, views on present lecture and PBL. The items on PBL were in the five point Likerd scale (Strongly agree -1, agree-2, neutral-3, disagree-4 and strongly disagree-5), scale 1 and 2 as well as 4 and 5 were merges for the analysis purpose. The results of the Pre-Test, Post-Test questionnaire and feedback forms were encoded in numerical variables and analyzed by the Statistical Package of Social Sciences software (version 16.0; SPSS Inc., Chicago, IL). The sensitizing lecture and discussion were part of incorporation PBL project in the institution. The project was approved by the Institutional Research Ethics Committee (IREC). 1838
3. RESULTS Fifty eight faculty (out of 110) had attended the sensitizing lecture and discussion session on PBL and 56 (n=56) had given Pre -Test, Post-Test and feedback. The faculties were at various academic levels of their career and from different discipline of medical sciences. There were 4 (7.1%) Professor, 6 (10.7%) Associate Professors, 34 (60.7%) Assistant Professors and 12 (21.42%) residents. We have not revealed the identity of the departments of the faculty, for sake of confidentiality. The majority of the faculty were entry and junior level (82.14%) these included Assistant Professors and residents. The facu lty included had wide range of teaching experience ranging from 03 to 46 year with mean age of 16.8 years. The 80.34% faculty not attended any course on medical education and majority 60.6% were from the junior or entry level faculty. The 94.6% of the faculty did not attend any kind of training on PBL while only 5.35% have got PBL training (Table 1). Table 1. Faculty profile Age Age range Mean age 27-67 year 35.6 Sex Male Female M:F Ratio (1.54:1) 34 22 Designation Total (n=56) Professor Associate professor Assistant professor Residents/ Tutors 4 6 34 12 Experience of teaching after post graduation (in Range Mean yrs) 03-46 16.8 Training in Medical education Yes No 11 (19.6%) 45 (80.34%) Training in Problem based learning (PBL) Yes No 3 (5.35%) 53 (94.6%) The 85.7% faculty has been sensitized by the introductory sensitizing lecture cum discussion and 32.14% faculty has doubt on the PBL. The 78.57% of faculty want special training on PBL. The 83.92% faculties were in the favor of the implementation of PBL than traditional teaching and want to become PBL facilitator than a traditional teacher (Table 2). Table 2. Opinion of faculty on sensitizing lecture cum discussion S.N. Question Yes (n=56) No (n=56) No opinion (n=56) 01. Do you think that today s session has 48 06 02 sensitized you for PBL? 02. Do you still have doubt on PBL? 18 34 04 03. Do you require special training on 44 10 02 PBL? 04. Do you advocate implementing PBL 47 06 03 than traditional teaching? 05. Do you want to become PBL facilitator than a traditional teacher? 47 06 03 1839
The opinion of faculty towards PBL was studied on the five point Likert scale (Strongly agree-1, agree-2, neutral-3, disagree-4 and strongly disagree-5), scale 1 and 2 as well as 4 and 5 were merges for the analysis purpose. The result shows faculty opinion that PBL facilitate self learning 82.2%, help students to make diagnosis in real clinical practice 83.9%, better way of understanding of learning objectives 71.8%, create interest in topic 76.8%, strengthen the intrinsic motivation of students 82.2%, it is the scientific 80.3% and systemic 73.2% approach of teaching (Table 3). Table 3. Opinion of faculty on problem based learning (PBL) S.N. Problem based leaning (PBL) Agree No. & % Neutral No. & % Disagree No. & % 01. PBL facilitates self learning. 46 (82.2) 06 (10.7) 04 (7.1) 02. PBL help students to make diagnosis in 47 (83.9) 07 (12.5) 02 (3.6) real clinical practice. 03. PBL is better way of understanding of 40 (71.4) 12 (21.4) 04 (7.1) learning objectives. 04. PBL creates interest in topic. 43 (76.8) 03 (5.3) 10 (17.8) 05. PBL is more scientific way of teaching. 45 (80.3) 03 (5.3) 08 (14.8) 06. PBL strengthens student s intrinsic 46 (82.2) 03 (5.3) 07 (12.5) motivation. 07, PBL gives systematic approach or attempts to apply findings of cognitive psychology to educational process. 41 (73.2) 09 (16.1) 06 (10.7) The pre test and post test shows significant improvement in the post test score which indicate faculty are receptive towards newer innovative method of teaching and learning (Table 4). Table 4. Result of pre-test and post-test questionnaire S.N. Question Pre-test (n=56) Post-test (n=56) 01. What is PBL? 05 (8.92%) 40 (71.42%) 02. What are the three principles of acquiring 03 (5.37%) 34(60.71%) new information? 03. What are the characteristics of Students in 16 (28.57%) 45 (80.35%) PBL? 04. What are the characteristics of tutors in PBL? 10 (17.85%) 41 (73.21%) 05. How PBL is different from traditional tutorial? 10 (17.85%) 38 (67.85%) 06. What are the advantages of PBL? 39 (69.64%) 52 (92.85%) The unpaired t test shows pre test mean 13.83 and post test mean 41.67. The Standard deviation (SD) 13.14 and 6.22 for pre test and post test respectively. The standard error means (SEM) is 5.36 and 2.54 for pre test and post test with two tailed p value equal to the 0.0009. 1840
4. DISCUSSION The educational goals have changed from teaching facts to facilitating and helping students to learn how to find relevant information through active process of self directed learning [18]. The roll of the teacher is shifted from presenter of knowledge to the promoter of learning. In India, most of the faculties in medical colleges are trained in traditional, discipline based methods. The PBL is still in infancy period though there are 335 medical colleges in India as at the end of 2011[19]. The national knowledge commission, established in 2005, recommends in the report of its working group on Medical education regarding the need for all institutions to have training programme for trainers at up-gradation of their teaching skills and awareness of new medical education technology [20]. This study is an attempt to investigate the achievement, experience and response of faculty after the introductory lecture cum discussion on PBL. There are many causes for nonacceptance of PBL as educational means in India [21] like faculty shortage, lack of proper training etc. Our study shows that proper orientation and faculty development workshops are essential for the change of attitude and belief of faculty, since PBL is a newer technique in Indian higher institution. Therefore its implementation definitely requires proper planning and strategies to adopt and incorporate it, to break hundred years old monotonous traditional pedagogical system of medical education in India. Collaboration between institution having PBL curriculum, sharing faculty and resources may be the key to promote curricular reforms [22]. Organizing hands on workshop can helpful to create awareness amongst faculty on PBL [23]. Azila et al also found that hands on PBL workshops helped in familiarizing the faculty to PBL [24]. If we compare the studies conducted by Pandya H et al (2008), we found that our findings are similar to previous workers [11]. There is significant improvement of the post test score over pre test score. Most of the participant were motivated and felt that further training is essential to implement PBL in traditional curriculum. Faculty were interested to change their role from teacher to facilitator and more enthusiastic to adopt PBL. Our findings indicate that by proper communication i.e. lecture, seminar, workshop on PBL the attitude of the faculty can be changed and positive perception is possible. This study demonstrates the change in faculty perception in the early stage, but what changes in attitude occurred for longer duration was not studied. The changes in attitude need to be evaluated later on. It is also felt that feedback is not true reflections as majority did not have real life experience in PBL. Without feedback from real life practice their training cycle will not be completed [25]. 5. CONCLUSIONS The faculty attitude is receptive toward implementation of the PBL but majority of faculty required special training that can be conducted with the help of the institution who have already PBL components in their curriculum and medical education department of the institution. The faculty development workshop should be an integral part of the PBL implementation programme at institute which can alter the attitude of the faculty towards PBL. 1841
CONSENT Not applicable. ETHICAL APPROVAL Ethical approval was taken from the Institutional Research Ethical Committee (IREC) for study and publication. ACKNOWLEDGEMENTS We would like to express our thanks and gratitude to our Dean Prof. Dr. M. K. Saraswat and Chairman Sri S. S. Bhadouria to allow present study and their research orientation motivational support. COMPETING INTERESTS Authors have declared that no competing interests exist. REFERENCES 1. Jayawickramarajah PT. Problem based learning: An educational strategy for better health care. Trends in Med Edn. 1995;2:12-15. 2. Office of Research in Medical Education. Report to the Faculty. Urbana, IL: University of Illinois, College of Medicine, 1964. 3. Barrows HS. Problem based, self directed learning. JAMA. 1983;250:3077-80. 4. Barrows HS, Tamblyn RM. Problem-Based Learning: An Approach to Medical Education. New York, Springer Publishing Co Inc, 1980. 5. Neufeld VR, Barrows HS. The McMaster Philosophy : an approach to medical education. J Med Educ. 1974;49:1040 1050. 6. Neufeld VR, Norman GR, Feightner JW, Barrows HS. Clinical problem solving by medical students: a cross-sectional and longitudinal analysis. Med Educ. 1981;15:315 322. 7. Joans HS, Etsel SI, Fisel SI, Barzansky B. Undergraduate medical education. JAMA. 1989;262:1011 1019. 8. Lam PT, Lam BYY. Medical education reforms: the Asian experience. Acad Med. 2009;84:1313 1317. 9. Shankar PR. Integrating subjects through Problem- based learning: A south Asian perspective. Med Educ Online. 2006;12:1 3. 10. Bhattacharya N, Shankar N, Khaliq F, Rajesh CS, Tandon OP. Introducing problembased learning in physiology in the conventional Indian medical curriculum. Natl Med J India. 2005;18:92 95. 11. Pandya H, Ghosh S. Sensitizing faculty to the problem oriented approach as an instructional method: Experience of a brief faculty development workshop. Natl Med J India. 2008;21:243-5. 12. Medical council of India. Salient features of regulations on graduate medical education. Gazette of India. 1997;3(4). 13. Spencer JA, Jordan RK. Learner centred approaches in medical education. British Medical Journal. 1999;318:1280-3. 1842
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