USC Moves to Problem-Based Learning
By Janyce Hamilton
http://www.cda.org/cda_member/pubs/journal/jour1201/impress.html
Six years after the University of Southern Californias problem-based-learning pilot program was initiated, people are still saying "Huh?"
The USC School of Dentistry transitioned to the innovative problem-based-learning approach to encourage students to become engaged in their learning and develop critical thinking skills essential for success in dental practice. Traditionally, the first few years of dental school involve sitting through disconnected lectures presented in multiple courses on different themes. Lectures introduce curricular content that students are to memorize and master for subsequent application to patient care, however actual clinical application may not occur for months to years. Unfortunately, the delay from passive learning to active implementation challenges retention in even the brightest students.
In the problem-based-learning changeover, USC joins the ranks of Harvard Medical School, Harvard School of Dental Medicine and Indiana University, which make problem-based learning a significant component of their education programs. USCs Medical School is currently transitioning to the format as well.
"The traditional approach involves lectures often unrelated to one another, and few other overarching themes exist that allow the students to relate physiology to biochemistry to other disciplines," said Malcolm Snead, DDS, PhD, professor of USC School of Dentistry, Center for Craniofacial Molecular Biology. Dr. Snead is one of the faculty actively involved in problem-based-learning program development and student facilitation.
Instead of waiting until the last two years of dental school to give students real-world problems to solve, problem-based learning is done throughout all of dental school for all courses and involves no scheduled lectures. The problems serve as the vehicle for learning for all curricular content, including both the basic and clinical sciences.
During freshman year, the application of content learned through the cases is applied as the student progresses from simulator to the clinic. The student provides care and completes clinical procedures that are at his or her level of competency, such as examinations, data collection, and initial periodontal therapy. Right from the beginning, this approach to learning serves as an engaging means of learning "the basics" and how these pieces of knowledge fit into the puzzle of a case scenario. The problem cases naturally lead to the delivery of dental care, and the sequence of learning is established so that the students progress to more-complicated therapies in the later years of dental school. For example, a senior would do complicated restorative, prosthodontic, and periodontal procedures.
This problem-based-learning approach is often likened to the process that a clinician follows when working up a patient.
The typical steps of problem-based learning include:
* The facilitator provides a small group of students with a case scenario that includes a series of signs and symptoms exhibited by a patient.
* The students first establish the facts of the case and then brainstorm hypotheses in analyzing the facts, thereby determining a course of investigation. This course of investigation involves the students formulating their learning needs so they further understand the facts, their hypotheses, and the mechanisms behind the signs and symptoms. In doing so, they go to the literature and acquire the knowledge needed to understand the patients presentation (a skill development critical for lifelong learning);
* The students meet and review the facts based on their newly amassed knowledge, revising and rejecting ideas and establishing new lines of investigation to further expand their knowledge base.
* The cycle of learning continues when the facilitator provides the group with an additional page of information about the case scenario, from which the students begin to triage their ideas, link facts, and identify new learning needs. The cycles of critical thinking, mastery of new material and application to the problem occur continually.
This process of learning integrates all the content mastered by the student and provides a high degree of relevance through the application to a patients condition. One result of the problem-based-learning process can be summed up by the "high-fives" students sometimes give each other when they discover that they have successfully diagnosed and identified treatment for solving the patients problem.
The problem-based-learning students begin clinical experiences in the first trimester and continue to increase the number of clinical experiences per week throughout the four years of the curriculum. Compared with students in the traditional DDS program at USC, the problem-based-learning students have more than 50 percent more clinical sessions during their four years in school. All clinical experiences occur at the students level of clinical competency since they enter the clinic to perform a procedure once they have demonstrated preclinical competency. Early clinical experience is a valuable incentive for students and helps them to appreciate the rationale for the content of the curriculum and the application of the basic and clinical sciences they have mastered.
The problem-based-learning students meet the same set of clinical competencies as all other graduates of the school. Currently, there are 24 competencies established by the faculty that define the abilities of a new dental graduate. These competencies require both breadth and quality of clinical experience as important criteria to establish student ability. There is little difference between the criteria used to establish graduation competency for either the traditional or problem-based-learning programs.
According to Charles Shuler, DMD, PhD, associate dean of student and academic affairs, the problem-based-learning format is breeding a new crop of critical thinkers who investigate the evidence presented to them.
"Analyzing the student achievements, it has been shown that the students performed at a much higher level on standardized tests and had a much greater interest in learning," Shuler said.
Traditional naysayers resisting the changeover to problem-based learning at other dental schools claim its flaw is the potential for "gaps in knowledge" because students may not address some issues in a case. Countered Snead: "For that reason, we employ cases that overlap learning themes," which he claims results in reinforcement in detail and refined knowledge, correcting misunderstandings.
The case scenarios chosen are in fact carefully selected to, at minimum, equate learning imparted through a traditional lecture, but minus the yawning, bobbing heads.
In fact, more than 20 U.S. dental schools, and several international dental schools, have contacted USC for more information on problem-based learning. According to Shuler, whose office has played a central role in the transition, several visiting faculty have sat in to observe the process and learn the teaching skills of being a problem-based-learning facilitator.
Snead said practicing dentists who have observed the problem-based-learning process say it is identical to the process they use in their practices every day.
