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 Table of Contents  
ORIGINAL RESEARCH PAPER
Year : 2010  |  Volume : 23  |  Issue : 3  |  Page : 440

Training Workshops in Problem-based Learning: Changing Faculty Attitudes and Perceptions in a Pakistani Medical College


1 Foundation University Medical College, Islamabad, Pakistan
2 Aga Khan University Medical College, Karachi, Pakistan

Date of Submission29-Dec-2009
Date of Acceptance11-Oct-2010
Date of Web Publication30-Nov-2010

Correspondence Address:
Z Zaidi
Jinnah Avenue, DHA Phase 1, Islamabad
Pakistan
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Source of Support: None, Conflict of Interest: None


PMID: 21290363

  Abstract 

Background: Problem-based learning (PBL) has over the years become a learning strategy established for teaching students in medicine. In order to use PBL as a teaching tool, faculty must be familiar with PBL and comfortable with the role transition from 'teacher' to 'facilitator'. This transition is critical for the success of PBL. This article describes the faculty development process undertaken in Pakistan at the onset of introduction of PBL in the curriculum.
Methods: At the Foundation University Medical College (FUMC), we initiated a faculty development program in PBL. The program consisted of two-day, hands-on facilitator training workshops conducted five times over the year and led by in-house faculty. A total of 180 faculty members completed these workshops. The workshops consisted of interactive sessions on the philosophy of PBL, small group dynamics, the role of the facilitator, an introduction to case design, wrap-up PBL sessions and assessment in PBL. Participants were provided with pre-workshop reading material in the form of 'PBL Handbooks', which contained details of the PBL process and specific responsibilities of the facilitator. Participants were also given a chance to experience the role of the facilitator by facilitating the faculty-learner group through a PBL session and receiving feedback. A retrospective pre-post survey was conducted to gauge changes in participants' perceptions of PBL.
Results: The faculty reported a significant increase in their regard for PBL as an instructional paradigm (p=<0.001). They also generally became more interested in empowering students with self-directed learning using PBL as a teaching tool and showed a greater desire to be facilitators (p=<0.001).
Conclusion: This evaluation reveals that facilitator training workshops can help not just to improve the facilitation skills of participants but also to stimulate interest amongst faculty to use PBL in the curriculum. Such workshops can be run in Pakistan at minimal cost: the only cost we incurred was for photocopying the reading material. How much difficulty the faculty will actually have serving as facilitator in the PBL process will only become evident when they lead PBL groups over the coming year.

Keywords: Problem-based learning, faculty development, developing countries, change in faculty perceptions about PBL, PBL workshop format, low cost workshop


How to cite this article:
Zaidi Z, Zaidi S M, Razzaq Z, Luqman M, Moin S. Training Workshops in Problem-based Learning: Changing Faculty Attitudes and Perceptions in a Pakistani Medical College. Educ Health 2010;23:440

How to cite this URL:
Zaidi Z, Zaidi S M, Razzaq Z, Luqman M, Moin S. Training Workshops in Problem-based Learning: Changing Faculty Attitudes and Perceptions in a Pakistani Medical College. Educ Health [serial online] 2010 [cited 2020 Oct 26];23:440. Available from: https://www.educationforhealth.net/text.asp?2010/23/3/440/101470

Introduction



Problem-based learning (PBL) was developed in the late 1960s at McMaster University, Canada, in response to the limitations of the traditional didactic teaching methodology which was believed to limit the development of students’ critical thinking and integrated learning1. Since its inception, PBL has gained wider acceptance and application internationally, including within the developing world2. Literature has shown that PBL increases student motivation, knowledge application and interest in subject matter3. In a pattern similar to the western world4, faculty in developing countries are often resistant to modifying the existing traditional curriculum, teaching and learning methodologies5.This resistance, along with concerns of increased demand on resources for faculty training and program implementation, tend to discourage medical schools from adopting PBL as a learning strategy in the curriculum6.



The literature in medical education has repeatedly pointed out that implementation of PBL at an institution requires more than the development of new ways to present the curricular matter; it requires a change in the roles of students and faculty7. Resistance to change from the faculty often stems from an inadequate comprehension of the pedagogical philosophy of PBL. Such concerns may be alleviated during planned PBL facilitation training workshops. Workshops can develop the faculty’s understanding of the strengths and limitations of PBL, as well as give them a chance to practice their PBL facilitation skills8. This is essential before the introduction of PBL in the curriculum and can have a major impact on its eventual success8.



Experience from Pakistan with PBL faculty training is limited. Although several universities have implemented this curriculum, to our knowledge only the Aga Khan University holds regular PBL facilitator training workshops for its own faculty. These have demonstrated significant improvements in the self-perceived teaching skills of the faculty and residents that took part in these courses9.



Other than the Aga Khan University, which is in the south of the country, there was no faculty training program available in Pakistan, when the Foundation University Medical College (FUMC) introduced PBL as learning and teaching tool. The newly established Department of Medical Education was headed by a faculty member trained by FAIMER (Foundation for Advancement of International Medical Education and Research). This article documents how a department of medical education developed a team of faculty members trained to conduct PBL facilitation workshops. It also demonstrates the effect of the training workshop on the attitudes and perceptions of the faculty at the institution regarding the PBL-based curriculum. We describe in this paper a framework methodology incurring minimal costs that can be utilized by other medical schools when introducing PBL-based curricula.



Methodology



Workshop Design




The workshops were spread over two days, with a total of five hours each day. They were held at the Foundation University Medical College (FUMC), Islamabad. The FUMC is a private medical college with approximately 500 students; 100 students enrolled in each of the five years of the M.B.B.S program. In 2008 the Dean of the medical college commissioned a task force to undertake curricular reforms at the institution, with a vision to move towards an integrated curriculum with problem-based learning, early clinical exposure, incorporation of bioethics, evidence-based medicine, leadership skills, communication skills and a community-based education program.



One of the first steps taken towards introduction of PBL at the institution was to train facilitators for the session. Over a period of one year a total of five workshops were held and 180 faculty members were trained. Faculty from a variety of clinical and basic sciences departments were invited to attend the workshops. The first time the two-day workshop was offered, it was conducted by the Head of Medical Education. Then faculty who had completed the workshop were encouraged to volunteer to help conduct the subsequent workshops. Over one year, five faculty members were involved in conducting the workshops.



A pocket-sized PBL guidebook was developed, which covered the philosophy behind PBL, a summary of the latest literature on PBL, and the methodology for case design and evaluation in PBL. The guidebook was to be read by participants prior to the workshops.



Table 1:  Facilitator Workshop Guide







The workshop plan is provided in Table 1. On day one during the introductory session, the faculty were familiarized with the basic concepts of PBL and tutoring as a process aimed at stimulating constructive, self-directed, situated and collaborative learning by students. Common scenarios dealing with student group dynamics that faculty may encounter as facilitators were discussed in an interactive session and the group’s opinions were solicited on how to deal with common, problematic situations, like a silent or a disruptive group.



The afternoon session of day one was designed as an experiential exercise for participants to work in small groups to experience how group dynamics can affect performance. The sessions began with a demonstration PBL session where groups of 7-8 faculty members were facilitated by a ‘master-trainer’. This was followed by a hands-on facilitation session, in which participants took turns facilitating their peer group for 15-20 minutes, while another faculty member was to observe the group dynamics. Participants assumed roles of the group leader, timekeeper and scribe. Feedback was given to each of the facilitators by their peers.



A PBL session was designed for participants on the topic of methods for assessing students. This topic was chosen because it would be of interest to all participants and all were expected to have knowledge gaps and, therefore, they would experience anxieties similar to those students face trying to work through a new problem during PBL. A facilitator guide was designed for the problem and was provided to participants. They used it during their turn to facilitate the group.



The first trigger used by the participants to initiate the discussion during the experiential PBL session presented a situation where the faculty at the medical college were avidly discussing assessment methodologies that could be used to assess student performance. In the scenario, a faculty member brings out an article from the Clinical Teacher (2005) titled “Harry Potter and Assessment by Conn and Elliott” for the group to review. This article innovatively draws parallels between the assessment methodologies used at the Hogwarts School of Wizardry, where the famous imaginary character Harry Potter went to school, and modern day assessment methods used at medical schools. The Harry Potter article was chosen because of its unique style which generated a discussion while at the same time led faculty to comfortably point out gaps in their knowledge through the scenario. During the course of the experiential PBL session, the faculty reviewed the article together while experiencing the PBL facilitation process. They listed their learning objectives, assigned tasks and regrouped the next day to resolve the problem.



On day two, an interactive session on case design was structured such that after a brief outline of it steps participants worked in small groups to design a PBL trigger with its learning objectives. Each group presented their trigger in a large group setting in which members of other groups wrote down perceived learning objectives of the trigger, which were then matched with the case writer’s learning objectives, thus providing them with feedback. Next, shorter sessions gave the audience overviews of assessment in PBL and wrap-up sessions. Participant groups were given time to summarize what they had learned in the PBL session in the form of a concept map, which is a pictorial representation illustrating the relationships between and among a connected set of concepts and ideas. As they presented their concept maps to one another within their small groups, their further questions and concerns were addressed.



This workshop was designed for brevity keeping the faculty’s time constraints in mind. Subsequently, an advanced PBL workshop was designed for those interested in learning further details.



Faculty Perspective Survey



A retrospective pre-post survey form was completed anonymously by the participants to evaluate their change in perceptions regarding PBL (Table 2). At the end of the survey form there was space for additional comments. The phrasing of the questions was discussed among faculty in the Department of Medical Education. The issues that were to be addressed with questions on the survey form were identified and settled on with consensus. The survey form questions were pilot tested to see if their wording needed correction or modification. The survey form consisted of a total five questions with graded responses ranging from 1 to 7 (1: Do not agree, 4: Neutral and 7: Strongly agree). Faculty evaluations from the initial four workshops are presented here, representing evaluations from a total of 133 faculty members who participated (response rate was 74%). Statistical analysis of survey data was carried out using Microsoft Excel Version 2003 and STATA Version 11. Paired t-tests were performed to calculate the significance of the change in the faculty perception. A p-value of <0.01 was considered significant.



Table 2:  Retrospective pre-post evaluation workshop mean item scores and significance







Results



Data demonstrated a statistically significant difference (p<.001) in mean response values for each of the questions posed to participating faculty (Table 2). For example, compared to their retrospective recall of how they regarded PBL prior to the workshop, faculty ratings of PBL as an instructional methodology for FUMC increased from 2.83 to 4.95 after the workshop, their perception that FUMC promotes self-directed learning increased from 3.01 to 5.32, and their preference to be a facilitator rather than a traditional teacher increased from 3.23 to 5.54.



Additional remarks provided by the faculty at the end of the survey form showed that the faculty generally perceived that after the workshops they had a better understanding of the concept of self-directed learning and of their roles as guides rather than tutors. They also better realized the importance of group dynamics, encouraging universal participation and the need for patience when students are expressing their views. A few commented on the utility of various ice-breaking methods in improving teacher-student relationships. A majority of the teachers expressed concern over logistical constraints and the additional commitment of resources that will be required to implement a PBL curriculum. These included the limited availability of tutorial rooms, limited library and other teaching resources, a need for more time commitment from faculty for teaching at the cost of their hospital-based duties and the need for an overall increase in faculty numbers. Some were concerned whether the system would be able to accommodate a comprehensive syllabus, especially for subjects such as Behavioral Sciences, Forensic Medicine and Community Medicine. A few felt that they would be uncomfortable in facilitating topics they had limited expertise in, but believed they would learn more and become more comfortable with experience.



Most faculty commented that they felt that the workshop was well structured and organized. A majority felt that refresher workshops would be needed. Most supported the idea of conducting further workshops.



Discussion



Faculty development refers to a broad range of planned activities that are designed to improve an individual’s skills in various professional areas, such as teaching, research and administration10. Increasing emphasis on faculty training has emerged with the growing recognition of teaching as a skill that is independent of scientific knowledge or clinical expertise11. This is especially pertinent during a process of curricular innovation and reorganization.



Adequate staff development is central to achieving a comprehensive conversion of a traditional curriculum to one that is problem-based12. In this teaching method, tutors are encouraged to modify their role as predominantly transmitters of factual information to that of moderators of a case-centered discussion13. This transition often proves to be difficult and many teachers feel challenged when deciding what degree of intervention is appropriate. In addition, many faculty members need to adopt new roles in a PBL curriculum, including those of case writers, assessors, teaching skills trainers and coordinators of educational committees14.



Faculty training that involves experiential learning, small group work, critical reflection and problem-based learning itself not only resolves these issues but also helps teachers empathize with students’ emotional and intellectual needs13. This enables teachers to progress in their professional development and creates an atmosphere during teaching sessions that is more conducive to learning.



Training workshops have shown to positively influence faculty understanding and appreciation of PBL. A study from South Africa showed that after participating in three-day training workshops, most faculty members believed in the PBL philosophy and felt that it was their responsibility to contribute towards curriculum development15. They also demonstrated a better understanding of the system and their roles as facilitators. A similar study from South Africa showed a greater appreciation of the faculty to allowing discussions and to restricting sharing of their expertise after attending training workshops7. A study from an institute that pioneered the PBL curriculum in Turkey revealed a greater understanding of the rationale for PBL and the appropriate roles of tutors and students14.



The importance of faculty training in the developing world, however, is continually underestimated and many medical schools have not appropriately prioritized faculty development. The lack of faculty development courses and support programs have limited faculty exposure to the latest educational innovations and individuals often must attend foreign courses for further professional development at considerable personal expense10 . The cost of the two-day workshop described in this article was approximately US $50 for training 40 participants, to cover the cost of providing the participants with printed PBL and facilitator guide books and refreshments. The faculty who developed and conducted the workshop were part of the curricular reform task force and of the Department of Medical Education. Therefore, they had protected time for this activity.



The absence of training facilities and education professionals familiar with the faculty development involved in implementing a PBL system have limited the application of this teaching methodology in developing countries. Here we have described an inexpensive method that required only one previously trained faculty member. Through a series of workshops the faculty was made aware of the principles behind this curriculum and of the subtle complexities that enable the learning processes to progress smoothly. These proved to be instrumental in the introduction of the PBL system at this institution. The institution was approached regionally by other medical colleges who invited the faculty who developed the workshop described herein to train faculty at their institutions. As an initial goodwill gesture, the faculty team traveled to one of these institutions to conduct the workshop for free and provided services to help them initiate PBL. Developing countries often face similar limitations in lacking trained faculty. Collaboration between institutions to share faculty and resources may be the key to promoting curricular reforms.



This study’s findings indicate that workshops consisting of direct teaching sessions and simulated practical PBL discussions can have a significant impact in changing the faculty perception of the PBL system. In addition to better appreciating the role of PBL in a student’s academic and professional development, the evaluations suggest that faculty developed greater motivation towards further developing the curriculum. They also expressed a desire to apply its principles in real life scenarios, such as self-directed learning and appropriate group dynamics. Interestingly, following the workshop a significant majority preferred the role of a facilitator to that of a traditional teacher.



This workshop failed to adequately address faculty concerns regarding the strain on existing financial and institutional resources during the implementation process. This is of particular significance in developing countries such as Pakistan where most public institutions are comprised of large student bodies with limited staff and teaching venues. In addition, the participants remained uncertain whether the new system would be as comprehensive as the existing one and feared that certain important topics cannot be addressed in PBL sessions. Some of these concerns have been alleviated as the medical college has embarked on a ‘hybrid-PBL curriculum’ and refresher PBL facilitation workshops have been introduced.



A limitation to this study is that though it demonstrates an initial change in faculty perceptions regarding PBL, whether a lasting change in attitudes occurred was not studied. The success of a program in influencing staff's attitude is therefore better measured after some time at follow-up, for which we are gathering data at present. Informally, a mark of success of the program so far has been a continued interest and support by our faculty of the PBL sessions, demonstrated by all faculty tiers volunteering to facilitate sessions, attending the student wrap-up presentations at the end of each PBL module and continued registration for refresher PBL workshops.



Conclusion



Staff development training workshops are integral to the introductory process of a PBL-based curriculum and can significantly alter the faculty’s initial negative perceptions regarding PBL. Workshops can be effectively conducted at medical schools in developing countries using innovative teaching methods that require minimal resources.



References



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9. Jafri W, Mumtaz K, Burdick WP, Morahan PS, Freeman R, Zehra T. Improving the teaching skills of residents as tutors/facilitators and addressing the shortage of faculty facilitators for PBL modules. BMC Medical Education. 2007; 7(34).



10. Bassaw B, Pitt-Miller P. Modernizing medical education: perspective from a developing country. West Indian Medical Journal. 2007; 56(1):80-85.



11. Wilkerson L, Irby DM. Strategies for improving teaching practices: a comprehensive approach to faculty development. Academic Medicine. 1998; 73(4):387-396.



12. Evans PA, Taylor DC. Staff development of tutor skills for problem-based learning. Medical Education. 1996; 30(5):365-366.



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14. Musal B, Abacioglu H, Dicle O, Akalin E, Sarioglu S, Esen A. Faculty development programs in Dokuz Eylül School of Medicine: In the process of curriculum change from traditional to PBL. Medical Education Online. 2002; 7(2).



15. McLean M. What can we learn from facilitator and student perceptions of facilitation skills and roles in the first year of a problem-based learning curriculum? BMC Medical Education. 2003; 3(9).




 

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