Phyllis Blumberg

Development of self-directed learning behaviors in a partially teacher-directed problem-based learning curriculum.

Data from three sources (self‐reports of students, review of accreditation and program evaluation documents, and library circulation statistics) supported the hypothesis that students in a problem‐based learning (PBL) curriculum with significant teacher‐centered components nevertheless acquire behaviors reflecting self‐directed learning skills. These PBL students exhibited differences in the extent to which their learning was self‐directed when compared to lecture‐based students. The learning process and features of this partially teacher‐directed, PBL program that fostered the development of self‐directed learning are discussed. Development of these skills depended on the curriculums adherence to the use of student‐generated learning issues as a guide for defining content to be learned, but also on several other factors.

Do final grades reflect written qualitative evaluations of student performance

An evaluation system should allow for early and continued identification of specific problems. A review of negative evaluations of students throughout a problem‐based program revealed that 66% of these occurred during the last third of the program. Was the evaluation system too insensitive to detect problem students earlier in the program, or was the faculty reluctant to give less‐than‐satisfactory grades regardless of identified problems? A blinded review of 608 written summaries of student performance revealed that the descriptive, non‐numerical system that was used did have the capacity to detect specific student behaviors. Independent reviewers identified student problems and agreed with the final grade given by the original evaluators in 92% of the cases; however, the reviewers identified more performance problems and labeled them earlier. Insensitivity of the evaluation system was of less concern than the facultys reluctance in awarding negative decisions. Reasons for this reluctance are explored; ...

Roles of Student-Generated Learning Issues in Problem-Based Learning.

Structured interviews were conducted with key faculty representing seven North American problem‐based learning curricula on their programs’ use of student‐generated learning issues. These are learning objectives that the students decide are prerequisites to a better understanding of the problem. The implementation of problem‐based learning at each of these schools varies. The uses of student‐generated learning issues have evolved and changed in terms of content definition, directing examination planning, student evaluation, and curriculum review. These varied uses form a continuum for defining curricular content to be mastered. At six of these seven schools, students may have access to faculty objectives. Student‐generated learning issues have been de‐emphasized in favor of faculty objectives and reading lists at two schools. At five of the seven schools, students are evaluated on their ability to generate learning issues. The survey results suggest that these curricula may be encouraging the development ...

Multidimensional outcome considerations in assessing the efficacy of medical educational programs.

Background: To be accredited, schools must evaluate the effectiveness of their programs. Educators are looking for specific indicators beyond the traditional measures. Data from multiple methods, including indicators of student performance and of the institutional environment, can be used to determine if educational program goals are met. Summary: This article outlines specific ways to consider three types of efficacy outcomes that are consistent with accreditation guidelines: educational, clinical career, and environmental outcomes. Specific measurable outcomes for each of these categories are derived from higher education literature: for example, learning approaches and information acquisition for education; professional behaviors and interpersonal dimensions for clinical career, and scholarship of teaching and teaching itself as a shared and valued activity for environmental outcomes. These outcomes address student assessment and program evaluation. Data from problem-based learning programs illustrate these outcomes. Conclusions: Educators can determine if educational program innovations have met their goals by collecting efficacy outcome data.

BUILDING THE INFRASTRUCTURE FOR EDUCATIONAL CHANGE

Strengthening educational programs requires a coordinated set of supporting activities. This article describes the infrastructure of the Educational Centre for Aging and Health of McMaster University (ECAH). This center seeks through professional education to enhance the quality of life and self‐determination of older persons, by increasing the number of skilled health professionals to care for aging individuals and by developing educational models concerning aging and health. We describe the clinical settings, technical and developmental support, and a system of data collection that provides feedback about health needs and the establishment of educational priorities. This center is attempting to meet the challenge of changing community needs for education for aging and health. Because of ECAH, aging and health has become more salient within this university. This article illustrates an infrastructure that other institutions can adapt to their own purposes in order to enhance gerontology and health education.

The progress of students who encounter repeated difficulties in a problem‐based medical school

Evaluation summaries for students with two or more grades of “less‐than‐satisfactory “ were identified from the last six graduating classes of a problem‐based medical school and reviewed to study the progress of those students; these were compared with those of their peer cohort who achieved an all‐satisfactory performance record. The evaluations of the problematic group revealed patterns very different from those of the cohort group in terms of the number of concerns raised in each evaluation throughout the program and of the courses and educational dimensions in which their difficulties had occurred. These students had problems with the same dimensions repeatedly, especially problem solving and knowledge. This study supports the need for early identification and remediation of students who encounter multiple difficulties in a single unit or repeated problems with the same dimension over several units. It also provides support for a system that encourages the sharing of previous evaluation information wi...

A comparison of the perceived effectiveness of two educational methods in achieving school‐related and practice‐related goals

This study was designed to compare perceptions of the adequacy of a traditional curriculum (TC) and a problem‐based curriculum (PBC) to prepare students to meet the short‐term goals of passing examinations versus the long‐term goals of becoming competent physicians. One hundred fifteen students and 25 faculty in a TC and 32 students and 17faculty in a PBC rated lists of educational activities according to how effectively each activity helped them in passing examinations and in becoming good physicians. Mean effectiveness scores of individual activities were compared for each curriculum. The results indicate that, in the TC, the educational activities that are most effective in helping to pass examinations are not necessarily effective for becoming good physicians. In the PBC, the key activities are perceived by students as both effective for passing examinations and for becoming good physicians. The more clinically oriented activities were seen as effective for becoming good physicians by both groups of s...

Analysis of academic problems encountered by medical students

An independent review of 632 student evaluation summaries detected 243 items of concern across all assessed educational dimensions. Students were found to provoke significantly more concerns in the first unit than in any other preclerkship unit. Almost twice as many concerns were raised in the clerkship, which occupies only one third of the program, as in the preclerkship. Most of these occurred in the Psychiatry, Family Medicine, and Internal Medicine rotations. Throughout the entire program, the main areas of concern were in problem solving and clinical skills, with knowledge joining these only in the clerkship. A cluster analysis revealed an independence of the six dimensions on which the students are evaluated. Some generalizable findings arising from this study include the following: (a) Students require time to adjust to medical school, particularly to a problem‐based curriculum; (b) simultaneous, interlocking clerkships may be especially problematic to some students; (c) shorter clerkship rotations...

Implications of changing student characteristics for program evaluations in a problem‐based curriculum

Characteristics of students participating in the initial class of an alternative, problem‐based curriculum were compared to those of students entering the same program in successive years to test the hypothesis that there are differences over time in the types of students who participate. The pilot class was not representative of medical students in general or of the students who entered the program in later years. Students in the first class were more introverted, had higher neuroticism scores, more external locus of control, and less confidence in their ability to succeed as medical students. The number of students in each class who majored in a nonscience discipline declined over the three classes studied. These data caution that for purposes of program evaluation, successive classes should be examined individually. There are several reasons why the pilot class of a new program may differ from subsequent classes and should not be used for summative program evaluation. In addition to changes in the type...