Samy A. Azer

Challenges facing PBL tutors: 12 tips for successful group facilitation

One of the main tasks of a problem-based learning (PBL) tutor is to facilitate group discussion. Group facilitation is about process rather than content. In this process, a tutor helps the group increase their skills and progress in their discussion. Several studies have highlighted strategies and training used in preparing PBL tutors. However, PBL tutors usually feel that it is not that easy to change their teaching style to the PBL format. They are sometimes unsure about their role or what strategy they might use to facilitate their students’ discussion. This article in the ‘12 Tips’ series is a detailed description of, and provides answers to, common challenges faced by PBL tutors. The tips provided in this manuscript should help tutors with practical answers. The article may be useful to PBL tutors, medical and health educators and those responsible for PBL training workshops.

Enhancing learning approaches: Practical tips for students and teachers

Background: In an integrated curriculum such as problem-based learning (PBL), students need to develop a number of learning skills and competencies. These cannot be achieved through memorization of factual knowledge but rather through the development of a wide range of cognitive and noncognitive skills that enhance deep learning. Aim: The aim of this article is to provide students and teachers with learning approaches and learning strategies that enhance deep learning. Methods: We reviewed current literature in this area, explored current theories of learning, and used our experience with medical students in a number of universities to develop these tips. Results: Incorporating the methods described, we have developed 12 tips and organized them under three themes. These tips are (1) learn how to ask good questions, (2) use analogy, (3) construct mechanisms and concept maps, (4) join a peer-tutoring group, (5) develop critical thinking skills, (6) use self-reflection, (7) use appropriate range of learning resources, (8) ask for feedback, (9) apply knowledge learnt to new problems, (10) practice learning by using simulation, (11) learn by doing and service learning, and (12) learn from patients. Conclusions: Practicing each of these approaches by students and teachers and applying them in day-to-day learning/teaching activities are recommended for optimum performance.

Differential effects of cyclosporin a on the transport of bile acids by human hepatocytes

Cyclosporin A (CsA) treatment has been reported to cause rises in serum bile acids both in humans and rats. It has also been shown to suppress bile flow in situ in rats and inhibit the transport of bile salts by rat hepatocytes. The purpose of this study was to examine the influence of CsA on uptake of radiolabelled cholate (CA), glycocholate (GC) and taurocholate (TC) by isolated human hepatocytes. CsA did not significantly change Vmax for CA uptake [0.23 +/- 0.01 vs 0.25 +/- 0.02 nmol/mg protein/min for control and CsA (10 microM), respectively], but significantly increased Km (37 +/- 2 vs 86 +/- 8 microM). Similarly, Vmax for TC uptake was not affected (0.51 +/- 0.02 vs 0.67 +/- 0.05 nmol/mg protein/min) while Km was significantly increased [46 +/- 3 vs 109 +/- 11 microM for control and CsA (10 microM), respectively]. On the other hand, neither Vmax nor Km for GC uptake was affected by CsA. The data indicate a competitive pattern of inhibition induced by CsA on CA and TC uptake. Furthermore, CsA was found to cause a dose-related inhibition of accumulation of both cholate and taurocholate, but not GC accumulation. None of the concentrations of CsA showed a significant effect on the integrity of the human hepatocytes as assessed by ALT (alanine aminotransferase), AST (aspartate aminotransferase) and LDH (lactate dehydrogenase) release. The findings, in human hepatocytes, are generally consistent with the observations reported from rodent studies. They strongly support the contention that serum bile acid increases in CsA-treated patients are due to interference with the hepatocellular transport and accumulation of particular bile acids.

Overview of molecular pathways in inflammatory bowel disease associated with colorectal cancer development.

Patients with long-standing inflammatory bowel disease (IBD) are at a higher risk of developing colorectal cancer (CRC). This risk increases with the longer duration of colitis, greater extent of inflammation, a family history of CRC, severity of bowel inflammation, and a coexistent primary sclerosing cholangitis. The cornerstone for comprehending the development of CRC in IBD and hence early detection is based on the understanding of the molecular pathways of IBD itself. At a molecular level, the pathogenesis of CRC is related to understanding the inflammatory changes and involves multiple inter-related pathways including (i) genetic alterations (e.g. chromosomal and microsatellite instability and hypermethylation), (ii) mucosal inflammatory mediators (e.g. COX-2, interleukin-6, interleukin-23, tumor necrosis factor-&agr;, nuclear factor-&kgr;B, and chemokines), (iii) changes in the expression of receptors on the epithelial cells, and (iv) oxidant stress, mucosal breakdown, and intestinal microbiota. The aim of this review is to provide an evidence-based approach for the role of chronic inflammatory mechanisms and the molecular basis of these mechanisms in the development of CRC. Therefore, understanding the molecular basis of CRC is an important step for the identification of new biomarkers that can help in the early detection of CRC in these patients.

Interactions Between Students and Tutor in Problem-Based Learning: The Significance of Deep Learning

Problem‐based learning (PBL) is an excellent opportunity for students to take responsibility for their learning and to develop a number of cognitive skills. These include identifying problems in the trigger, generating hypotheses, constructing mechanisms, developing an enquiry plan, ranking their hypotheses on the basis of available evidence, interpreting clinical and laboratory findings, identifying their learning needs, and dealing with uncertainty. Students also need to work collaboratively in their group, communicate effectively, and take active roles in the tutorials. Therefore, interaction in the group between students and their tutor is vital to ensure deep learning and successful outcomes. The aims of this paper are to discuss the key principles for successful interaction in PBL tutorials and to highlight the major symptoms of superficial learning and poor interactions. This comprises a wide range of symptoms for different group problems, including superficial learning. By early detection of such problems, tutors will be able to explore actions with the group and negotiate changes that can foster group dynamics and enforce deep learning.

Evaluation of the Educational Value of YouTube Videos About Physical Examination of the Cardiovascular and Respiratory Systems

Background A number of studies have evaluated the educational contents of videos on YouTube. However, little analysis has been done on videos about physical examination. Objective This study aimed to analyze YouTube videos about physical examination of the cardiovascular and respiratory systems. It was hypothesized that the educational standards of videos on YouTube would vary significantly. Methods During the period from November 2, 2011 to December 2, 2011, YouTube was searched by three assessors for videos covering the clinical examination of the cardiovascular and respiratory systems. For each video, the following information was collected: title, authors, duration, number of viewers, and total number of days on YouTube. Using criteria comprising content, technical authority, and pedagogy parameters, videos were rated independently by three assessors and grouped into educationally useful and non-useful videos. Results A total of 1920 videos were screened. Only relevant videos covering the examination of adults in the English language were identified (n=56). Of these, 20 were found to be relevant to cardiovascular examinations and 36 to respiratory examinations. Further analysis revealed that 9 provided useful information on cardiovascular examinations and 7 on respiratory examinations: scoring mean 14.9 (SD 0.33) and mean 15.0 (SD 0.00), respectively. The other videos, 11 covering cardiovascular and 29 on respiratory examinations, were not useful educationally, scoring mean 11.1 (SD 1.08) and mean 11.2 (SD 1.29), respectively. The differences between these two categories were significant (P<.001 for both body systems). The concordance between the assessors on applying the criteria was 0.89, with a kappa score >.86. Conclusions A small number of videos about physical examination of the cardiovascular and respiratory systems were identified as educationally useful; these videos can be used by medical students for independent learning and by clinical teachers as learning resources. The scoring system utilized by this study is simple, easy to apply, and could be used by other researchers on similar topics.

Twelve tips for creating trigger images for problem-based learning cases

A trigger is the starting point of problem-based learning (PBL) cases. It is usually in the form of 5–6 text lines that provide the key information about the main character (usually the patient), including 3–4 of patients presenting problems. In addition to the trigger text, most programs using PBL include a visual trigger. This might be in the form of a single image, a series of images, a video clip, a cartoon, or even one of the patients investigation results (e.g. chest X-ray, pathology report, or urine sample analysis). The main educational objectives of the trigger image are as follows: (1) to introduce the patient to the students; (2) to enhance students’ observation skills; (3) to provide them with new information to add to the cues obtained from the trigger text; and (4) to stimulate students to ask questions as they develop their enquiry plan. When planned and delivered effectively, trigger images should be engaging and stimulate group discussion. Understanding the educational objectives of using trigger images and choosing appropriate images are the keys for constructing successful PBL cases. These twelve tips highlight the key steps in the successful creation of trigger images.

Nervous system examination on YouTube

BackgroundWeb 2.0 sites such as YouTube have become a useful resource for knowledge and are used by medical students as a learning resource. This study aimed at assessing videos covering the nervous system examination on YouTube.MethodsA research of YouTube was conducted from 2 November to 2 December 2011 using the following key words “nervous system examination”, “nervous system clinical examination”, “cranial nerves examination”, “CNS examination”, “examination of cerebellum”, “balance and coordination examination”. Only relevant videos in the English language were identified and related URL recorded. For each video, the following information was collected: title, author/s, duration, number of viewers, number of posted comments, and total number of days on YouTube. Using criteria comprising content, technical authority and pedagogy parameters, videos were rated independently by three assessors and grouped into educationally useful and non-educationally useful.ResultsA total of 2240 videos were screened; 129 were found to have relevant information to nervous system examination. Analysis revealed that 61 (47%) of the videos provided useful information on the nervous system examination. These videos scored (mean ± SD, 14.9 ± 0.2) and mainly covered examination of the whole nervous system (8 videos, 13%), cranial nerves (42 videos, 69%), upper limbs (6 videos, 10%), lower limbs (3 videos, 5%), balance and co-ordination (2 videos, 3%). The other 68 (53%) videos were not useful educationally; scoring (mean ± SD, 11.1 ± 3.0). The total viewers of all videos was 2,189,434. Useful videos were viewed by 1,050,445 viewers (48% of total viewers). The total viewership per day for useful videos was 1,794.5 and for non-useful videos 1,132.0. The differences between the three assessors were insignificant (less than 0.5 for the mean and 0.3 for the SD).ConclusionsCurrently, YouTube provides an adequate resource for learning nervous system examination, which can be used by medical students. However, there were deficiencies in videos covering examination of the cerebellum and balance system. Useful videos can be used as learning resources to medical students.

Introducing a problem-based learning program: 12 tips for success

Background: Worldwide many universities are changing their curricula and introducing integrated problem-based learning (PBL) programs. However, the introduction of a PBL program is a demanding process and requires resources, a lot of planning, and organisation. Aims: This article aims at providing practical tips for preparing a PBL program. It highlights key challenges to create such programs and offers possible solutions to common challenges encountered. Methods: Personal experience in introducing PBL programs in several universities together with key principles highlighted in the literature have been presented and discussed in light of the current medical education research. Results: Introducing an integrated PBL program requires continuous support from the Dean and the Vice Chancellor. An essential step in this process is preparation and engagement of the faculty so that academics and clinicians become aware of the rationales for the change and work as part of a team in the construction of the new program. Consulting with other Departments of Medical Education that have introduced PBL, may help in avoiding common mistakes and providing a practical advice. Conclusion: Although there is no panacea for the introduction of a PBL program, this article addresses keys for successful introduction of such programs.

Assessment in a Problem-based Learning Course: Twelve Tips for Constructing Multiple Choice Questions That Test Students' Cognitive Skills

For over 35 years, multiple choice questions (MCQs) have been used in the assessment of students in medical, dental, nursing, and physiotherapy courses. MCQs enable educators to test a broad range of topics in the curriculum. However, the educational goals of MCQs used currently are to test factual knowledge rather than a deeper understanding or use of information. They do not focus on testing cognitive skills, and many of them test small print in textbooks. With the introduction of problem‐based learning in medical and health professional courses and a full shift from a traditional lecture‐based curriculum to a student‐centered program, many schools are currently reviewing their assessment tools and introducing new strategies that reflect the philosophy of the new curriculum. However, there is limited information in the literature to guide question writers and provide them with guidelines to construct new styles of MCQs that test higher‐order thinking skills. This article provides 12 practical tips to help question writers in creating MCQs that test cognitive skills.