Problem-Based Learning

This week's blog is about teaching -- about my interest in problem-based learning (PBL) and interactive teaching.   My interaction with two students who do not like problem-based learning prompted me to write about this topic. 

First, everyone interested in this question, should, I think, view this resource:  http://americanradioworks.publicradio.org/features/tomorrows-college/lectures/
Under 'audio of the program' you can click on 'listen' and hear the whole program. 

Professor Tan of the Nanyang Technological University in Singapore [O. S. Tan, Problem-based learning innovation: Using problems to power learning in the 21st century. Singapore: Thomson Learning. 2003.] describes PBL as a learner-centered approach that positions students as central to the process. He lists some common characteristics of PBL approach:

We begin the learning process with a problem to be solved. 

The problem is similar to those that professionals or practitioners in the field encounter in the world and therefore has an unstructured feel to it. If it is a simulated problem, it is meant to be as authentic as possible. 

The problem calls for multiple perspectives. The use of multi-disciplinary knowledge is a key feature in many PBL curricula. PBL encourages solutions that take into consideration knowledge from various subjects and topics. 

Self-directed learning is primary. Thus, students assume the major responsibility for acquisition of information and knowledge. The tutor's role is as facilitator, consultant, resource person, and mentor.

Harnessing of a variety of knowledge sources are essential PBL processes. 

Learning is collaborative, communicative, and cooperative. Learners work together in small groups with high levels of interaction. 

The development of skills for how to ask questions and solve problems within the discipline is as important (if not more) than acquiring content knowledge needed for the solution of the problem.

Closure in the PBL process includes synthesis and integration of learning. 

PBL also concludes with an evaluation and review of learner's experience and learning process.

Besides the characteristics mentioned above, the PBL approach highlights the importance of the transfer of skills [Oon-Seng Tan, Problem-based Learning Approach to Human Computer Interaction, World Academy of Science, Engineering, and Technology 76: 462-465, 2011]. Learners are expected to transfer concepts learned previously to new problems although spontaneous transfer can be hard without practice or expertise. Transfer often fails because problem solvers fail to retrieve relevant information or skills that they need. Since in PBL the knowledge is encoded in real-life problems, students are more likely to retrieve the knowledge when faced with future problems. For example, during each unit in my class we consider a DSM diagnosis or clinical condition and the brain areas that might contribute to maintaining that condition.   There are too many diagnoses to fit into the seven units of the course.   The goal is to teach a method of approaching learning how the brain fits into behavior so that students can tackle any diagnosis using the methods and resources they learned and find the information they need to come to an understanding.   Of course, this works better, since the information will substantially change each year.   Memorizing facts from this year will not prepare students for next year. 

In medical education, we try to teach students a systematic way to approach new problems.   Given a disease you have never encountered before, what do you do?   We hope the student will know how to access the literature on that disease, will look for the theories of causation, transmission, risk factors, resiliency, treatments, and interactive effects.   Students will have practice in understanding that diseases that are categorized in any one specialty or organ system affect all organ systems and require knowledge from all disciplines.   The body is full inter-connected.   Similarly, our understanding of diseases changes daily and yesterday's facts are out of date already.

Can we teach classes that are not about memorization?  Can we bring problem-based, interactive learning to an online course? Problem-based learning because is evidence-based and performs so much better than more conventional methods.

The problem with problem-based, interactive learning is that the students have to participate and to interact with the teacher.  The argument for problem based learning is that the students learn up to 60% more material.  Plus, for students who engage in it, after the first shock of realizing that the class won't be memorization based, they report having a much better time and learning more.  Some students resist at first.  The American Radio Works program says, don't try this if you still need tenure(!).  But that is because it feels different.  A Harvard physicist in the program makes the point that it used to be that we couldn't easily get to the library to get information, so we needed to memorize.  Now there are endless online resources at the drop of a thumb, so we need to teach people how to find, translate, and use information. 

Interactive, problem-based learning formats do seem disorganized to students who are used to conventional education .  Conventional educational practice lays out of body of material to be mastered (learned, memorized, etc.) and then tests the students on their temporary retention of that material through quizzes and exams.  These newer approaches to teaching attempt to engage the student in a discipline through interacting with it and learning its questions and challenges and where to find the relevant information.  There's not necessarily a body of knowledge to retain but rather a sense for how to orient oneself and find the information when needed again.  I can see how that could seem disorganized to someone who is used to conventional practices.  However, the literature suggests that the kinds of students who do best with these newer methods are just the ones who flounder at conventional education .  Many of the students who sail through college and graduate school without interruption are found to do well regardless of method used.

I'd like to see us change the culture of education .  The culture seems to resist frequent contact and interactive learning in favor of a kind of hierarchical isolation from the instructor.   This can become especially true in the on-line environment, which doesn't have to necessarily mean low contact with faculty.  I'd like to see students involved from the beginning in shaping the course the way they'd like it to go.  Interactive PBL requires student presence.  The University of Minnesota, Rochester, which is a health sciences campus that feeds the Mayo Clinic, entirely uses this approach and doesn't even have a lecture podium.

I have a way to go to get to where I'd like to be for the online environment.  For example, in one of my on-line classes, I still did two fairly conventional lectures each week with powerpoints though I encourage discussion.  Because I don't know who (if anyone) will attend, I need material upon which to fall back.  I also make my slides available as study guides/resources.  I'm still not generating the level of discussion I would like, so I have to be prepared to lecture.  I usually lecture for one hour and then have a half hour of discussion. 

Here is a summary of what students don't like about this style of education (the full article from McMaster's University is available at http://www.personal.psu.edu/wxh139/PBL.htm):

Students' Readiness for Problem-based learning:
In PBL, students are not passive information receivers any more. They are expected to more actively engage in their learning process. Therefore, you should take into accounts of students' motivation, background and learning habits before you think about employing PBL into the classroom. Since the PBL approach put the responsibility of learning into the hands of students, students who are used to the structured and sequenced information presentation from the instructor may fail to make progress in learning and resent the self-learning challenge. 

Research on students' perception of PBL has reported that students' concerns about PBL include the unfamiliarity of PBL formats, dramatic differences between competitive and collaborative learning, demands on time and self learning, and ambiguous learning situations with direct instruction. Kingsland (1996), in his evaluative study of the architecture program at the University of Newcastle, reports students' reactions to the time issue in the problem-based learning: 

"Architecture 1 students maintain Reflective Design Journals to aid in the development of design and critical analysis skills. Comments in these journals highlight times of high stress due either to the accumulation of assignment or to time management problems." 

MacPherson-Coy, Sullivan and Story (2000) listed students' response to the question " What did you like least about the PBL program?"; stress over lack of time to complete everything and stress over getting familiarized with the PBL format are on the top of the list. 

In order to resolve students' resistance to PBL, enhancing students understanding of and positive attitude toward PBL process can help prepare students to face the challenges of PBL. If instructors perceive that students will have difficulties in self-directed learning, they may either provide more support during the process or accommodate students' different learning styles by balancing the learning activities via lectures, group discussions, and self-directed inquiry. 

Also, PBL relies on collaboration between students to bring in different perspectives and knowledge bases on problem solving. However, students' prior experience and skills in teamwork may either facilitate or impede students' learning in PBL. Therefore, the instructor should be open to any questions and concerns about the collaborative process. Nelson (1999) suggested to give an overview of the basic ideas and ideas about the collaborative problem solving process helping students understand what they will be engaged in and why.

 

Youth need to be heroes now more than ever!

Today, I had to arise at 5 am in order to run and be on time to Mission Australia's Youth Forum.   We had a long taxi ride across Sydney to a beautiful, green-grassed, lake present, conference center, with crazy birds with long thin beaks, who made shrieks from time to time.   The atmosphere was absolutely bucolic and the conference center modern and lovely.

Norma Ingram gave the welcome to country.   We learned that she had earned her Master's degree In Education at Harvard University and had visited Vermont during her year in the USA.   Norma formally welcomed everyone to her ancestral lands after which Rocky and I sang a song for her as the opening to our presentation.   Rocky gracefully allowed me to give the initial 45 minute talk and then we split the room into two groups for an hour break-out session.   I showed my usual slides to introduce my mother's people and land and then my father's people and land.   I began with the idea that youth appear to need to be heroic, now more than ever.   In a 1959 paper entitled The Adolescent Hero: A Trend by James William Johnson In Modern Fiction Twentieth Century Literature: A Scholarly And Critical Journal (Volume 5, Number 1 April, 1959), we learn that the literature of adolescent heroes began to dramatically increase in 1929 and continued to grow through 1959, and, I believe has continued ever since.   Adolescents, especially males, appear to need to feel heroic in some way.   They are saturated with stories extolling heroes and demanding that they be one.   Sometimes they choose pathways to heroism that adults find objectionable.   For example, joining a gang is a pathway to heroism, though often lethal.   I talked about how traditional cultures have historically had procedures for declaring a young person to be an adult and ways for them to be heroic.   I talked about using culture to create other opportunities for heroism, including the challenge of the sweat lodge, of sun dance, of vision quest, and the opportunities to feel heroic.   I talked about a pediatrician I know who prepares Lakota children for a swim from Alcatraz to San Francisco across the Bay -- the journey that was believed impossible when Alcatraz was founded.   We talked about the horseback rides across the reservation that Patrick Chief Eagle provides on the Pine Ridge Reservation.   A man in the audience mentioned that he was working with Maori youth to make and sail canoes in the traditional way.   I mentioned the programs for Native Hawai'ian youth to make and sail canoes between islands.   We just have to find ways to make what we adults consider to be wholesome and healthy seem more desirable and heroic than their alternatives like gang membership or the culture of drugs.   I argued that much of dysfunctional adolescent behavior can be understood as an attempt to save face when the attempt to be heroic or become a hero has gone awry.   I defined narrative units as I did on Day 3 for the Hearing Voices Conference and talked about the importance of creating positive story.   My slides are available to anyone who wants to email me at Email address removed .

After lunch, we heard Leonie Green, the Director of New South Wales Community Services talk about the recently launched Mental Health Strategies for Mission Australia.   She said that their previous strategy did not fully identify the need they had.   She talked about their biggest barrier being how to refer clients into clinical mental health services.   When people rang the mental health outreach services, they didn't get responses because they didn't have the language down that mental health used.   They don't actually see themselves as a provider of mental health support services in the broadest sense, though the majority of their clients presented with mental health issues.   She said, if you look at the social determinants of mental health, they are homelessness, poverty, unemployment, family breakdown, and the like, so it should be quite natural that their clients should present with mental distress.   She said that mental health should be everyone's business.   When people stop being homeless, poor, and unemployed, often their mental health improves.

Six months ago, they started drug and alcohol services which have been rapidly expanding. They call this a community of practice for youth services.   Everyone involved with youth in that area comes to the table to interact around managing these youth with drug and alcohol problems.

Here are some of the highlights of their current strategy:

1)       Replace the term mental illness with the terms "mental distress" and/or "loss of mental wellbeing", as these terms were less stigmatizing and recognize the diversity of experience that bring people into contact with mental health services.

2)       Services should transition from inpatient hospital to integrated community services.

3)       Social determinants of mental health need to be more widely recognized and addressed.

4)       Adopt a Recovery Approach to underpin service delivery.

5)       Establish a Consumer and Carer Reference Group to include the voices of people of lived experience of mental distress and loss of wellbeing and their carers in the planning, design, delivery, and evaluation of services.

We learned that aboriginal people have high rates of mental illness and loss of mental wellbeing in their communities.   Rates of suicide and self-harm are 2 to 5 times higher for aboriginal people than other Australians (http://www.aihw.gov.au/indigenous-Australians).   The New South Wales Social and Emotional Wellbeing Policy (2006-2010) states that the tragic state of Aboriginal mental health is due to a "" complex inter-relationship of individual, historical, social, cultural, economic, and environmental factors (and that) collective distress and trauma exist as underlying stressors to aboriginal life." (New South Wales Department of Health, 2007.

We learned that Mission Australia is at the forefront of responding to the social and emotional wellbeing needs of aboriginal people, especially in rural and remote portions of NSW.   At their Mac River Youth Drug and Alcohol Rehabilitation Service in Dubbo (where Sally made her documentary on elders sharing stories with youth) every referral except one had been an aboriginal youth.   They anticipate providing increasing services to aboriginal persons released from prisons due to their high levels of mental distress.

Next we heard about the Recovery Model, which was also prominent at the Hearing Voices conference from Day 3 and Day 4 of this journey.   It emerged from the consumer/survivor movement following the de-institutionalization era of the 1970's and 1980's.   They define recovery "as a deeply personal, unique process of changing one's attitudes, values, feelings, goals, skills, and/or roles.   It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness.   Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness." (Anthony, W.A. (1993). Recovering from mental illness: The guiding vision of the mental health service system in the 1990's. Psychosocial Rehabilitation Journal, 24(2), 159-168.).   The U.S. does not subscribe to the Recovery Model so much but is steeped in the biomedical model.   My sense of Australia is that its physicians are also steeped in the biomedical model with a large disconnect between psychiatrists and other mental health professionals.

Mission Australia (NSW Mental Health Strategy 2012) wrote that "Recovery is not dependent on professional intervention and can and does occur without it. Recovery does not mean an absence of symptoms. Rather when achieved, it allows people to live meaningful lives regardless of any unremitting symptoms and periods of relapses". [R]ecovery is not a linear process"."

Next Dr. Ramesh Manocha, Senior Lecturer at the Sydney University Psychiatry Department and Founder of Generation Next (you can google him) spoke about meditation -- what it is and what it's not.   He's planning a study with Mission Australia to teach kids at risk how to meditate.   He presented a study of 40 minutes of meditation instruction twice weekly for one term who experienced improved benefits in grades and study habits.   He found that the people who were experiencing mental silence several times per day or more had the highest mental health scores.   People who experience mental stillness less than once per month had the lowest mental health scores.   He reported taking 14 women with hot flashes who were perimenopausal for 8 weeks twice weekly meditation instruction.   They were to meditate twice per day.   They found a 70 to 80% improvement in symptoms using meditation at the end of 8 weeks.   The majority of women maintained a benefit at 16 weeks except for one woman who stopped meditating.

At this point we had to leave the conference for our trip back to Melbourne and the final day of our Australian Cultural Exchange Adventure.