The Problem-Based Learning Pathway (PBL) at LECOM emphasizes student-centered, self-directed learning. Groups of eight students meet with a faculty facilitator three times per week. Faculty members do not teach in the traditional sense. Instead, they serve as facilitators.

A series of cases focus on learning the basic sciences required to understand patient problems. Students then work independently and in small groups on learning issues before the next meeting, at which time the new information is discussed and refined in the context of the case.


The Tutorial Process in Problem-Based Learning

The heart of a Problem-Based Learning Pathway is the tutorial group (8 students plus one faculty facilitator). Each member of the group has responsibilities which are important if the process is to succeed (See Roles of Participants). Members must feel free to challenge one another in a constructive manner and feel comfortable with being challenged, but without feeling personally threatened or insulted. In the early stages of group dynamics, this is difficult because members are uncomfortable with this behavior, but with familiarity, it becomes an enjoyable exercise which serves to help the group and its members focus on those areas where their knowledge must be extended.

The PBL cases are based on actual patients. The Progressive Disclosure Model is used. Initially, only the name, age, gender and chief complaint are made available. Following discussion, the group will request additional information, such as the results of a history and physical. Additional discussion follows and the students begin to form initial differential diagnoses. After this discussion, the group will request new data, such as the results of an EKG or an MRI, and again, discussion follows. During the process, the students raise learning issues, topics that they need to know more about. Following completion of a case, the students submit their final learning issues to the PBL office. The final learning issues serve as the basis for examination questions.

The facilitator will monitor the direction of the group, and redirect them by asking appropriate questions for discussion if they digress too far, but this is done only if absolutely necessary. The students are given the latitude to pursue unproductive directions, and decide for themselves that a particular learning issue was not germane to understanding the patient's problems.


The Group Tutorial Process

Initially, a case requires several tutorial sessions to complete. The group tutorial process may be divided into three phases. In the first phase, one student reads the case while another serves as a "scribe" and writes information on a blackboard. The blackboard is divided into three areas, for facts, general ideas and learning issues. Facts are listed as they are read. The students then begin to discuss the facts, to decide as a group which facts are important and which are irrelevant, and to probe for scientific explanations and correlative information relating to the clinical picture presented. This is accomplished first using existing knowledge of the group members.

At this point, the students must challenge any information presented for accuracy and understanding. As they arise, ideas are listed which are eventually formulated into hypotheses to be tested. With each hypothesis, one or more learning issues (topics about which there is insufficient knowledge to understand the clinical picture or to pursue without additional research) are presented, as well as which resources the students should utilize in order to obtain the appropriate information.

During this process, the students must take particular care to not become preoccupied with making a diagnosis, but to adhere to their primary goal: that of understanding the basic mechanisms, not the diseases, responsible for the clinical symptoms and signs. The final activity of each session is for the group to evaluate its effort. The program objectives may be re-read at this time and recommendations made as to how to improve the group's performance.

During the second phase, the students engage in independent and small group study, addressing the learning issues adopted in the group session. Appropriate resources for acquiring this knowledge include textbooks, journals, microscope slides, X-rays and tomographic scans, audio-visual materials, and designated resource faculty, who may upon request provide information on a topic.

During the third phase, one student will present the patient using a format in which the known subjective and objective information is summarized and assessed, and a plan for continued management is proposed. This will initiate continued discussion, not only of the new knowledge and its use in evaluating their hypotheses, but also for the seeking of more information about the patient. In light of the new information they approach the case fresh, listing new ideas, formulating new hypotheses and learning issues, as new case information is provided and added to that which they already have. This is followed by another group self-evaluation, another period of independent study and another meeting. This process may be repeated several times during a single case, as additional learning issues are added until the group is satisfied that it has gained sufficient knowledge of basic scientific concepts to understand the basic mechanisms underlying the clinical picture presented in the case. At this time, a final self-evaluation occurs, and the group evaluates its activities and summarizes what it has learned.


Role of Participants

The facilitator is responsible for providing the case information at the appropriate times during the discussion. He/She also assures that each member of the group participates by prompting, if necessary, the more timid members. In addition, the facilitator monitors how accurately the group is addressing the desired objectives.

The facilitator will also evaluate the efforts of the group members in terms of the willingness to contribute and willingness to complete their independent study to the extent that they are able to contribute to the group effort.

The students have the responsibility to participate actively in the discussions of the group. They must be willing to both give and accept constructive criticism, be willing to admit to knowledge deficiencies where they exist and to conscientiously complete their independent study assignments so as to contribute effectively to the group effort. Students also have the responsibility to honestly evaluate the activities of each other, themselves, the facilitator and the group as a whole. Only in this way is improvement possible.


Content Examinations

Each exam includes board-type multiple choice questions, and may include practical questions about laboratory material such as interpretation of slides. The questions will be generated by the faculty and will be based upon the learning issues identified since the last examination. The exam process will be used to identify the students' strengths and weaknesses as well as contribute to their overall evaluation.


Faculty Evaluation of Student Performance

Students will be evaluated by each facilitator. In general, students performance in the small group will be evaluated in each of the following categories:

• Group participation and contributions;
• Preparation and learning skills;
• Interpersonal skills and professional behavior;
• Contributions to group progress.

General Overview

The core of the program is the series of problem-based learning cases which occupies much of the time in years 1 and 2. While Anatomical course are taken, groups meet only once per week, thereafter groups meet three times per week for the remainder of the first year, and three times per week for the entire second year, up to approximately one month prior to the national administration of the NBOME COMLEX Level 1 Examinations.


Other Coursework

Students in the Problem-Based Learning Pathway will participate in course from the LDP curriculum during the first and second years. These include the following:


Human Clinical Gross Anatomy
Osteopathic Manipulative Medicine I - IV
Healthcare Management I and II
History and Physical Examination I, II, and III
Spirituality, Medicine and Ethics
Public Health and Preventative Medicine
Geriatric Medicine
Basic Life Support / Advanced Cardiac Life Support
Medical Jurisprudence
Histology
Embryology
Behavioral Medicine
Human Sexuality
(NOTE: Osteopathic Principles and Practice is presented throughout in a format identical to that of the LDP)

Following the conclusion of the second year, PBL students take the national administration of the NBOME COMLEX Level 1 and then enter clerkships to complete their third and fourth years via the existing curriculum.