Problem-Based Learning & Task-Based Learning Curriculum Revision Experience of a Turkish Medical Faculty

doi:10.4236/ce.2013.412A2017

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Creative Education

2013. Vol.4, No.12B, 116-119

Published Online December 2013 in SciRes (http://www.scirp.org/journal/ce) http://dx.doi.org/10.4236/ce.2013.412A2017

Open Access 116

Problem-Based Learning & Task-Based Learning Curriculum

Revision Experience of a Turkish Medical Faculty

Berna Musal*

Department of Medical Education, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey

Email: [email protected]

Received October 29th, 2013; revised November 29th, 2013; accepted December 7th, 2013

tion License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original

by law and by SCIRP as a guardian.

The aim of this paper is to introduce the basic principles of Dokuz Eylul University Faculty of Medicine’s

educational program and curriculum revision studies carried out within the last three years.

Keywords: Medical Education; Problem-Based Learning; Task-Based Learning; Curriculum Revision

Introduction

The first part of the article, which aims to introduce the basic

principles of Dokuz Eylul University Faculty of Medicine’s

(DEUFM) educational program and the curriculum revision

studies carried out within the last three years, offers summa-

rized information on the educational program model, general

principles and the methods used. The second part includes in-

formation on the curriculum revision studies carried out with

the outcome-based approach since 2009 and the basic principles

and block structures of the new curriculum.

Basic Principles of the Educational Program

DEUFM applies the Problem Based Learning (PBL) program

which has been applied in Turkey for the first time since the

academic year of 1997-1998 in the first three years of the edu-

cational program; and Task Based Learning (TBL) as of the

academic year of 2000-2001 in the fourth and fifth years. The

sixth year is maintained as the internship period. DEUFM’s aim

is defined as training the physicians who are equipped with

basic professional knowledge and skills, capable of seeing the

human as a whole with their biological, psychological and so-

cial aspects, capable of communicating with their surroundings,

sensitive towards the health problems of the community and

capable of producing solutions, willing to learn during their

professional life and capable of improving themselves (Musal

et al., 2002). In configuring the educational program, six edu-

cational strategies (student-centered, problem based, integrated,

community based, involving electives and systematic) which

are representatives of innovative approaches of SPICES model

described by Harden were adopted in 1997 (Harden et al.,

1984).

PBL is the principal educational strategy in the first three

years of the undergraduate program. The curriculum covers

primary health problems of the community. The scenarios

which are used in the PBL sessions are built to involve not only

biological objectives but also societal and behavioral objectives.

Through the field studies, it is aimed to have students go out of

the borders of the university hospital; and gain sensitivity about

the health problems of the community and social factors influ-

encing health and health policies of the country. Students learn

new things, concepts, use their knowledge, notice where to use

them and better understand, and improve their analysis, synthe-

sis and problem solving skills in PBL sessions. Lectures, usu-

ally limited to one hour per day, provide some clues to increase

students’ motivation and curiosity and support the students

during the periods of independent learning. Basic clinical and

procedural skills are acquired in clinical skills laboratories and

basic science practices are implemented in laboratories. There

are special study modules in the first three years’ program,

elective programs in the clinical years so that students can gain

deep knowledge and skills in the subjects of their interest. Due

to the nature of the PBL program; knowledge and skills are

repeated and connected in the related blocks among years and

tasks in higher levels through the existing interdisciplinary

integration as well as a spiral configuration. Approximately

20% - 30% of the educational program is allocated to the inde-

pendent learning process (Musal et al., 2002).

The TBL method for the 4th and 5th years of the educational

program as the continuation of PBL in clinics was adopted in

the 2000-2001 academic year. TBL is an educational strategy

primarily defined by Harden which combines PBL and inte-

grated system with multidisciplinary learning and training per-

spective and offers the student rich learning opportunities of

different disciplines. The tasks which deal with a symptom or a

clinic problem of a patient, provide a focus for learning in TBL.

However, the aim of learning is not limited only to objectives

such as getting task oriented histories, making physical exami-

nation, referring diagnosis and treatment, but also includes

acquiring general professional skills. (Harden et al., 1996;

Harden et al., 2000; Race, 2000; Virjo et al., 2001). The objec-

*On behalf of all faculty members contributing to the educational manage-

ment and curriculum study groups of Dokuz Eylul University Faculty o

Medicine’s educational program.

B. MUSAL

tives of DEUFM 4th and 5th year program are defined as getting

task oriented histories, making physical examinations, referring

differential diagnosis and treatment, being able to make task

related procedures, gaining knowledge and skills in the social

dimension of the diseases and preventive medicine. The objec-

tives for general skills, on the other hand, include the ability to

integrate basic and clinical sciences with each other, critical

thinking, problem solving, gaining communication skills,

learning ethic and legal responsibilities. The tasks include the

basic clinical problems with which students encounter in their

profession. The selected tasks enable students to gain knowl-

edge and skills in relation to their clinical problems, and inte-

grate with basic medical sciences. Attention is paid to the selec-

tion of the clinical problems in relation to more than one de-

partment in order to transfer learning facilities and experiences

of different disciplines and to gain multidisciplinary approach.

Interdisciplinary practices, lectures and patient visits are organ-

ized in each task’s schedule.

There are total 38 tasks in each eight-week “Internal Medical

Sciences”, “Gastrointestinal system-Masses”, “Paediatrics” and

“Surgical Medical Sciences” blocks within 4th year program.

There are total 36 tasks in each eight-week “Emergency Medi-

cine”, “Nervous System-Mental Health and Mental Disorders”,

“Skin and Joints-Locomotor system”, “Eye-Ear Nose and

Throat” and “Obstetrics and Gynecology” blocks in 5th year

program. At the beginning of 4th year program, students attend

rational drug use, evidence-based medicine and infection con-

trol courses. Elective internship period is determined as two

weeks in the 4th year, one month in the 5th year (Ozkan et al.,

2004; Ozkan et al., 2006).

Internship program is predominantly applied as the use, im-

provement of knowledge and skills learned in the previous

years and preparation process for becoming a physician. The

educational objectives of 6th year program were reviewed again

in line with the national core curriculum and constantly updated

DEUFM curriculum objectives. In the process of reviewing the

objectives, some changes were made in the structure of two-

month Internal Medicine, Obstetrics and Gynecology, Paediat-

rics, Emergency Medicine-General Surgery, Public Health and

one-month Psychiatry and Elective blocks (Ergor et al., 2009).

Starting with the academic year of 2009-2010, one-week dura-

tion “Cardiology”, “Chest Diseases”, “Neurology” and” Ear

Nose and Throat” blocks were added within the 6th year pro-

gram. It was intended to configure those blocks to include the

primary health problems to be encountered by the physician in

the primary health care units and predominantly maintain it

through policlinic studies. Internship program is constantly

evaluated and revised through the regular monthly meetings of

the intern representatives and faculty members who are in

charge of internship and program evaluation studies.

Educational Program Revision Studies

In DEUFM, all components of the educational program,

verbal and written feedback and the qualitative, quantitative

studies which are implemented within the scope of the program

evaluation project are constantly evaluated and necessary

changes are made (Musal et al., 2008). After a 12 years of ex-

perience in PBL curriculum, in 2009 we decided to make an

extensive revision in the program for thorough review and up-

date of the program objectives and to reanalyze what we ex-

pected from the graduates. It was intended to have no changes

in the basic principles of the educational program, have it stu-

dent-centered, focus on active learning methods such as PBL

and TBL, and community oriented, allow community based

practices, have skill training based on competency, offer the

students opportunities to gain deep knowledge and skills in

their area of interests (Musal et al., 2010).

Competencies expected from the students at graduation

phase are defined as follows:

 Understand basic and clinical sciences and assess the scien-

tific foundations of medical knowledge in critical terms,

 Address patients and diseases with their biopsychosocial

dimensions and understand the effects of ecosystems on

human health,

 Apply basic principles for the protection of individual and

community health,

 Have knowledge and skills to diagnose, treat and monitor

diseases,

 Have the skills of self-learning and self-assessment,

 Have effective communication with patients and their rela-

tives, colleagues and other healthcare workers and take the

lead,

 Effective utilization of information technologies in physi-

cian’s practices,

 Perform physician’s practices in compliance with profes-

sional values and ethic principles,

 Assess the effects of health systems, policies and practices

on individual and community health.

Blocks, stages and themes which will exist in the general

structure of the educational program were determined as a re-

sult of the presentations and discussions made in the Under-

graduate Level Education Board. The educational program was

planned to be dealt with in four stages. Stage 1 which includes

normal structure and functioning covers the whole 1st year and

the first half of 2nd year; Stage 2 which includes pathological

processes covers the second half of the 2nd year and the whole

3rd year; Stage 3 covers clinical clerkship and Stage 4 covers

internship period. The list of the blocks which is available in

the six-year educational program is given in Appendix 1.

In the curriculum revision study, it was decided to use the

outcome-based approach (Harden et al., 1999; Harden, 2007)

which stipulates the clear definition of what is expected from

the graduate and planning the educational program by consid-

ering the competencies to be demonstrated by the student at the

end of the education. Block and theme study groups were cre-

ated taking the representations of the relevant field specialists

into account.

The names of the block study groups are presented below:

 Introduction to medical sciences 1

 Introduction to medical sciences 2

 Reproduction, urogenital, endocrine

 Information management-research 1 and 2

 Gastrointestinal system, nutrition, metabolism

 Respiration, circulation, blood

 Neural sciences

 Locomotor system and skin

 Blood, infection, immunity

 Multisystem

 Life Cycle

 Introduction to clinical sciences

The names of the theme study groups are presented below:

 Community Health and Preventive Medicine,

 Human Behaviors and Their Foundations,

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B. MUSAL

 Ethics and Law,

 Professional Skills and Values.

In line with the study plan and calendar which were prepared

by the Deanship and the Department of Medical Education

(DME), the groups created the lists of diseases, conditions/pro-

blems, symptoms to be frequently encountered/important/life

threatening in relation to the block/theme. The lists which were

created by the study groups in which 193 faculty members from

41 Departments took office were later sent to all Departments

and the review of the list and the determination of the compe-

tence levels (information, diagnosis, diagnosis-treatment man-

agement, emergency attempt, preventive medicine) expected

from the graduate in relation to the defined diseases, condi-

tions/problems, symptoms were requested. The opinions of the

primary health care physicians were taken in the same time

period. The study groups considered the opinions coming from

the Departments and primary health care physicians, and de-

termined the six-year objectives of the blocks and themes and

then objective levels in compliance with the lists and compe-

tence levels. Information and counseling support was provided

by DME at all phases. The determined objectives were com-

pared to the national core curriculum, previous curriculum ob-

jectives and international references. Following the completion

of the distribution of the objectives defined by all block study

groups to different stages, “Community Health and Preventive

Medicine”, “Human Behaviors and their Foundations”, “Ethics

and Law”, “Professional Skills and Values” study groups im-

plemented the distribution of the objects which were simulta-

neously determined with block study groups to the blocks at

different phases. Following the three-month intensive effort of

the study groups, the block boards which consisted of the fac-

ulty members commissioned by the Deanship from the De-

partments associated with the objectives of the blocks started to

prepare block programs and educational materials based on the

defined objectives.

The new educational program includes system blocks which

repeat in different stages as well as Introduction 1 block for the

purpose of preparation for normal structure and functioning,

Introduction 2 blocks for the purpose of preparation to patho-

logical processes. In Information Management Research I and

II blocks, basic principles of the scientific principles, research

types, research ethics, biostatistics concepts and tests, informa-

tion management in healthcare, article and report preparation

objectives are handled and the information and skills obtained

in these blocks are applied through special study modules. In

the Multisystem block which exists at the end of the first three

years, it is aimed to use and synthesize the key biological in-

formation obtained in the first three years through themes such

as shock, sepsis, metastatic cancer, autoimmune disease and

polytrauma. In the Life Cycle block, on the other hand, it is

aimed to address the health problems that may be encountered

in all periods of human life from birth to death predominantly

with their social, behavioral, ethic and forensic medicine di-

mensions for the reinforcement and development of the knowl-

edge and skills obtained by the students in the first three years

in health risks, health protection and improvement. The three-

week Introduction to Clinical Sciences block which exists at the

beginning of the 4th year program, on the other hand, was in-

tended to include diagnostic medicine objectives in addition to

rational drug use, infection control, evidence-based medicine

items which were available in the previous years. The existing

block structures in the 4th and the 5th year program were up-

dated in compliance with the objectives defined in the new

curriculum study.

Conclusion

Integration has been described as an important educational

strategy in medical education (Harden, 2000). A great effort

had been made to achieve integration throughout the new cur-

riculum at all levels in DEUSM. The vertical and horizontal

integration levels of the new curriculum were reviewed and

necessary arrangements were made through the meetings which

were held once a week for one year in the academic year of

2010-2011 by the Curriculum Integration Board which was

created by taking the representations of the study groups and

Departments into account. The block programs are revised in

line with the block board reports and student feedbacks in the

periodical meetings which are still made by the Curriculum

Board.

The new educational program is applied in all years’ pro-

gram commencing from the 1st year program in phases as of the

academic year of 2009-2010. All components of new educa-

tional program are evaluated and revised within the concept of

program evaluation studies which include qualitative, quantita-

tive studies, and block reports.

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Appendix. Blocks That Exist in the

Educational Program

1st Year STAGE 1

 Introduction to medical sciences I-8 weeks

 Reproduction, urogenital, endocrine-8 weeks

 Information management-research-1 week

 Gastrointestinal system, metabolism, nutrition-8 weeks

 Respiration, circulation, blood-9 weeks

2nd Year

 Neural sciences-8 weeks

 Information management- research-1 week

 Locomotor system, dermatology-8 weeks

 Introduction to medical sciences-6 weeks STAGE 2

 Blood, infection, immunology-6 weeks

 Gastrointestinal system, metabolism, nutrition-6 weeks

3th Year

 Reproduction, urogenital, endocrine-6 weeks

 Neural sciences-6 weeks

 Locomotor system, dermatology -6 weeks

 Respiration Circulation-6 weeks

 Multisystem -6 weeks

 Life cycle-6 weeks

4th Year STAGE 3

 Introduction to clinic-3 weeks

 Paediatrics-8 weeks

 Internal medicine-8 weeks

 Gastrointestinal system-masses-8 weeks

 Respiration Circulation-8 weeks

 Elective-2 weeks

5th Year

 Emergency medicine- 8 weeks

 Obstetrics and gynecology -8 weeks

 Nervous system-Mental health-8 weeks

 Locomotor system- dermatology-8 weeks

 Ear nose and throat, Eye-4 weeks

 Elective-4 weeks

6th Year STAGE 4

 Internal medicine-6 weeks

 Chest Diseases-1 week

 Cardiology-1 week

 Obstetrics and gynecology-8 weeks

 Public health-8 weeks

 Emergency medicine-6 weeks

 Surgery-2 weeks

 Psychiatry-4 weeks

 Neurology-1 week

 Ear nose and throat-1 week

 Elective-2 weeks