Problem Based Learning and
organ / system based
integration
Dr. Md. Ekhlasur Rahman
Associate Professor of paediatrics
Mymensingh Medical College
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‘Spoon feeding in the long run teaches us
nothing but the shape of the spoon’
- E M Forrester
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Learning objectives
At the end of the session, the
participants will be able to
list innovations in ME
describe the changing medical education
in South - East Asia Region
describe a health problem
list goals of PBL
narrate the clinical reasoning process
describe the role of a facilitator
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Preamble
• Many Medical schools globally place too much
emphasis on memorization of facts & too little
on problem solving of self directed learning
• WHO promoting ROME to address the needs
of the community by inclusion of innovations
of Medical Education in South-East Asia
region, since mid seventies.
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Innovations in Medical education
Innovations in Medical education include
•Behavioral Sciences
•Community orientation
•Problem Based learning
•Self directed learning
•Integrated teaching
•Educational media
•Assessment and information technology
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Changing Medical Education in
South -East Asia Region
Thailand : Curriculum Development
1. Traditional curriculum (1974)
Knowledge + Clinical sk
ills
2. MESRAP (1978)
COME + PBL  Attitude, Problem
solving
3. CTPB (1988) COME+PBL, Problem solving , Attitude
4. CT LB PB (1993)
1+2+3
COME covers 16% of curriculum time. CU (1947), a
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Changing Medical Education in
South -East Asia Region...
India
The CHAD program in CMC Vellore provides
integrated community based, Problem oriented
Medical Education, and using block posting. A
regional training center. COME covers 12% of
curriculum.
Myanmar
Introduced COME 15 years back, and PBL into an
established curriculum in premedical course (1st
year) since 1987. COME and PBL covers 15% of
curriculum.
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Changing Medical Education in
South -East Asia Region …...
Nepal
Foreign Consultants developed curriculum. COME
and PBL introduced; COME is effective, but PBL is
on the verge of failure. COME covers 23% of
curriculum.
Indonesia
COME is practiced. Little PBL has been
introduced, little chance of success
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Changing Medical Education in
South -East Asia Region …...
Srilanka
The whole island is well covered, down to the
grass root level, by health services.
Developed a system of post-graduate medical
education -PGIM began to function properly since
1980. It provides degrees and training on
different specialities including Medical Education
and Community Medicine since 1993.
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Changing Medical Education in
South -East Asia Region …...
Bangladesh
1988 undergraduate medical curriculum was
made community oriented by incorporating
Community Medicine from 1st year to the 5th
year MBBS course. Topic specific integrated
teaching had also been recommended. The newer
curriculum developed under the auspices of FIMC
has been made more community and problem
oriented.
WHO recently has selected Mymensingh Medical
College, for the first time in Bangladesh, to pilot
PBL.
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“One change always leaves the way
open for the introduction of others”
- N Machiavelli
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Health problem
• A health problem is a situation about which the
learner knows some information, and by seeking in
some prescribed way, can find more.
• Health problems should satisfy Some or all of
the following Criteria
1. Prevalence
2. Life threatening
3. Prototypically
4. Professional skills
5. Interdisciplinary nature
6. usefulness of illustrating basic mechanism
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Patterns of health problems
Stage 1: Introductory problems with
emphasis on basic concepts
for example : injury response, Immunization,
electrolyte regulation.
Stage 2: Problem desgined around organ /
systems for example : Congestive Heart failure,
Hypertension (CVS), Hematuria, Acute renal
failure (Renal system).
Stage 3: Multi-system Problems
for example : Convulsion, Anasarca, Dyspnoea,
Abdominal pain.
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Health problems...
• Health problems may be presented as
– Scenario ( paper problems),
– real patient,
– video recordings of
• a real patient
• or simulated by an actor
• Health problems are usually presented to a
student with a learning guide; tutor guide
is prepared by the teacher.
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Problem based learning
(PBL)
• PBL is an educational format that is
based on discussion and learning
about a clinically -based problem.
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Goals of PBL
1. To improve the motivation of the students
2. To stimulate integration of disciplines
3. To stimulate small group learning and
development of interpersonal communication skills
4. To improve self directed and long term learning
5. To improve critical thinking, clinical reasoning,
decision making and problem solving
6. To make education more student oriented
7. To stimulate formative evaluation.
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“ You can not teach a man anything,
you can only help him find it within
himself”
- Galileo
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Outline of the clinical reasoning process
Identify problems
General Hypothesis of causes (D/D)
Rank hypothesis
Test hypotheses
a. Current data and knowledge
b New Data and knowledge
Re-rank hypothesis
(most likely hypothesis is the provisional diagnosis)
Make hypothesis of mechanism - how problems occur
Treat
(to manage problems
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Role of a tutor
1. Follow problem based learning concept (using tutor
guide)
2. Identify resources
3. Stimulate thinking
4. Keep discussion on track, facilitate discussion
5. Assist student to achieve objectives
6. Give information (if necessary by non-directed
answers, can contribute)
7. Feedback and evaluation
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“Nothing can be taught, everything
can be learnt.”
Chinese proverb
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