https://doi.org/10.36866/pn.130.15

Dr Clare Tweedy
School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, UK

The core physiological concept of “structure and function” is an important but challenging concept for students to grasp. This is in part due to the overwhelming quantity of anatomical and physiological information, as well as the challenge of understanding how structure and function relate to one another. The use of problem-based learning (PBL) to drive the learning process is one way to address such issues. In PBL, students are asked to search through a large quantity of information and make decisions about what is relevant to learn in a way that is more authentic to how we seek and sort information in a real-world setting. Not only do students consider PBL to be effective and more engaging than traditional lectures (Antepohl and Herzig, 1999), there is evidence that PBL can have positive effects on knowledge retention (McParland et al., 2004) and communication skills (Koh et al., 2008).

While PBL has been widely used in medical schools, implementation in physiology curricula has been hindered in many cases by the lack of staff training in PBL instruction and the time-intensive process of facilitating small groups of students. I therefore wondered if it was feasible to carry out PBL in a large class setting. My aim was to integrate PBL into a 220-student level two module in the School of Biomedical Sciences at the University of Leeds. The first four weeks of the module are centred around neuroanatomy, which means there is a large amount of available information for students to sort through and learn. Not only do students struggle with the seemingly endless nature of anatomical knowledge, they also struggle to integrate their understanding of anatomy with their understanding of physiology and function.

Use of PBL as authentic assessment

An appropriate way to frame a relevant and engaging problem related to anatomy and physiology is through a patient case study. The problem that students are assigned, however, must be sufficiently challenging. Giving the patient ambiguous symptoms, as well as a complicated history, gave students a lot of information to sort through and a clear need to work with each other. Alongside the case study, groups were given a workbook that contained weekly tasks comprised of short-answer questions. The first week centred on the diagnosis of the patient, integrating evidence from the case study with the literature. Students were not marked on whether their diagnosis was correct, but rather on whether they could justify a diagnosis using evidence. They were also tasked with creating a figure to illustrate their decision-making process, for example mind maps or flow charts.

Diagnosing the patient was just the first step. In subsequent weeks, students explained the mechanisms underpinning their diagnosed condition then selected a brain structure associated with the case study. They were then tasked with explaining their chosen structure’s anatomy and function, before integrating the two together to explain what might have gone wrong in their diagnosed condition. For example, what effect might hippocampal atrophy have on hippocampal function and how? This element of choice was well received by students, and from a staff perspective made it more engaging to mark the submissions.

Facilitating large-group PBL with minimal instructors

Had I carried out traditional PBL with this group, I would have been tasked with finding facilitators for 47 student groups. What I instead achieved was large-group PBL with only myself as a facilitator. The workbook replaced the need for heavy staff involvement by structuring and facilitating each week’s activities. As well as the questions they were tasked with producing answers to, I also included prompts for them to discuss as a group, and a reminder of what they should have achieved by the end of each week.

Some facilitation for this process was necessary. Weekly workshops were timetabled in a lecture theatre to introduce that week’s activities. After that, students could remain working in the lecture theatre or move elsewhere with their group. The process was also facilitated through pre-recorded learning material on neuroanatomy and a lab practical, to help students become more comfortable using anatomical terminology in their short-answer responses.

Ultimately, large-group PBL can be successful with minimal facilitation so long as the facilitation is achieved in other ways. Student feedback was extremely positive and for those students interested in careers in healthcare after their physiology-related degrees, the experience of a clinical case study was invaluable.

References

Antepohl W, Herzig S (1999). Problem-based learning versus lecture-based learning in a course of basic pharmacology: a controlled, randomized study. Medical Education 33(2), 106–113. https://doi.org/10.1046/j.1365-2923.1999.00289.x

Koh GC et al. (2008). The effects of problem-based learning during medical school on physician competency: a systematic review. Canadian Medical Association Journal 178(1), 34–41. https://doi.org/10.1503/cmaj.070565

McParland M et al. (2004). The effectiveness of problem-based learning compared to traditional teaching in undergraduate psychiatry. Medical Education 38(8), 859–867. https://doi.org/10.1111/j.1365-2929.2004.01818.x