Problem-Based Learning in Health Education

1. Problem-Based Learning in Health Education Madeleine Rohlin and Christina Lindh Malmö University Malmö, Sweden Goiania October 2010

2. SWEDEN in some FIGURES • Oldest population in the world (aged 80 and over) • Education spending: 7.7% of GDP (Nr 9) (Health spending: 8.7% of GDP Nr 20) • Teritary education (all levels of post-secondary education) enrolment: 70% • Highest human development index ~ quality of life after Norway and Iceland. Highest environmental sustainability index after Finland and Norway

3. The Malmö-model Examples on different levels Programme Course Week

4. Weekly timetable for course 2 ‘Diagnosis and Treatment of simple Periodontal Disorders’

8. RELATIONSHIP BETWEEN PROBLEM AND KNOWLEDGE GAINED Traditional or Case-basedStudents have to have education the knowledge required to approach the problem (situations) PBL Students’ knowledge arisesfrom work on the problems (situations)

9. Scenario: Karin Karin notices bleeding from the gum in the upper jaw she brushes her teeth. PROBLEMS (formulated by students) Why is the gingiva red and swollen at one place but not at another? HYPOTHESIS (formulated by students) The amount of tissue fluid and blood increases in a region due to the microorganisms. The bleeding is due to the increased number of blood vessels with fragile walls.

10. Weekly timetable for course 2 ” Diagnosis and Treatment of simple Periodontal Disorders”

11. Examples on questions posed by one cohort after they • have studied ’Karin’. The questions are handed to • experts and discussed during a seminar. • When the tooth surface is covered with a bacterial film do the body • defence mechanisms regard the tooth as ’foreign’ and try to remove it • – leading to the breakdown of bone? • How can H2S produced by micro-organisms cause tissue damage? • Does pushing the probe into several pockets, without cleaning it • in-between, lead to the spread of periodontits? • Does a deep periodontal pocket which bleeds necessarily mean • that periodontits is active? • Can a pocket be 4-5 mm deep without being classified as diseased? • Why does platelet-activating factor cause vasodilatation at low • and vasoconstriction at high concentration?

12. LEARNING Based on students’ own questions and self-generated discovery MEANING-MAKING

13. The Malmö-Model COURSE LEVEL

14. Clinical situation STUDY GROUP SKILLS LABORATORY REGISTRATION OF Inflammatory reactions and their regulation bleeding Virulence of subgingival microflora Calculus formation plaque calculus Action of cytokines. Mechanisms for bone resorption pocket depth attachment level Radiographic image quality. Radiation physics Bitewing Biological effects of radiation Selection criteria for X-ray examination Scaling Healing processes. Blood coagulation and fibrinolytic system EXAMINATION OF THE PERIODONTIUM Progression and treatment of periodontitis DIAGNOSIS Innervation of the oral cavity Topographic anatomy TREATMENT Nervtransmission and receptors Pain Pain and pain experience Pain relief and action of local anaesthetics Local anaesthesiai Communication. Health perception Habits and personality Information on disease Oral hygiene instruction Respiration and cirkulation Health condition Anamnesis Hemoglobin and oxidative metabolism Heart failure. Vascular diseases COURSE 2. Students should be competent to take care of adult patients with simple periodontal disorders

15. Problems consist of events that are need of explanations in terms of underlying processes, principles or mechanisms. INTERDISCIPLINARY INTEGRATION

19. Problems consist of events that are need of explanations in terms of underlying processes, principles or mechanisms. INTERDISCIPLINARY INTEGRATION • This has radically restructured the curriculum, • quality assessment, the nature of the relationship • between staff and students and last, but not least, • the basic vision that underlines Odontology

20. The MALMÖ-Model - Curricular Level Oral Health Holistic View Team-work Self-directed Learning

21. LEARNING • Learning is about the process of discovering knowledge, not just the content (Kolb's circle) • Intelligence is shaped by experience..(Piaget) • Any experience that does not violate expectations is NOT worthy of the name experience (Hegel)

22. What is PBL? • An educational approach (not a method) • Multiple learning and teaching methods and learning environments • Organised around problem: small groups, collaborative & independent research, peer learning and teaching, reflection and self-management

24. The half-life of scientific information in nature sciences is about 5 years. Thus 50% of what we have taught the students in a 5-year curriculum will not be up-to-date when they graduate. Unfortunately we do not know which half! WHY LEARNING?

25. EDUCATIONAL RATIONALES • Learning based on students’ own question and self-generated discovery – Meaning Making • Problems consist of events that are in need of explanations in terms of underlying processes, principles or mechanism - Interdisciplinary Integration • Learning activities referring to real-life situations reinforces what is learned – Relevance

28. EDUCATIONAL RATIONALES • Learning based on students’ own question and self-generated discovery – Meaning Making • Problems consist of events that are in need of explanations in terms of underlying processes, principles or mechanism - Interdisciplinary Integration • Learning activities referring to real-life situations reinforces what is learned – Relevance • Learning activities have a degree of complexity adapted to students´ prior knowledge, skillsand attitudes - Spiral Curriculum

29. SPIRAL CURRICULUM Learning activities have a degree of complexity adapted to students’ prior knowledge and skills. ’Focusing and ordering are thus the two aspects of direction…. Activity must be centered at a given time in such a way to prepare for what comes next’. Dewey J. Democracy and education. 1916

31. EDITH ALMA HELENE HELENE

32. Learning Situations andSituations of Application • Every learning situation includes the potential for application (of something learned previously) • Every situation of application implies the potential for learning (something new)

34. Are we offering these students in this dental school university in this ? environment good learning a