Oral pathology in a PBL course
Dr Mary Toner
School of Dental Science
Trinity College, Dublin.
Previous course
• Oral pathology delivered in series of
lectures
• Given in 4th year of 5 + year course
• Not integrated with oral surgery or
medicine, overlap in some lecture topics
• Practical classes held in one whole week at
year end, with whole class together
• Examinations separate until finals
Change of learning style to PBL
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In context, immediacy of application
Integrated
Self directed
Students must take responsibility for
learning
Implementation for oral
pathology
• Collaboration with oral surgery and oral
medicine to agree areas/topics to be covered
• Development of blocks of associated areas
• Problems and guidelines were written with
staff together to achieve “right” balance
• Practical classes changed to go with each
block, small groups
Changes that were also made
with change to PBL course
• Exams integrated, exams previews for quality
• Exam reviews attended by staff and students –
feedback
• Evaluation of tutors, problems, course, feedback
strongly encouraged
• Assessment of whole course for timing and
content, course at a glance available
• A lot of work! But stimulated staff interest in
teaching immensely
How did it go?
• Staff (and even some students) worried about gaps
- self directed therefore learning goals varied – but
students are still exam driven – sample questions/
labs / tutors /exam reviews/ grapevine helped
• Tutors worried about lack of ability to answer
question outside their field – guidelines,
tutor/planning meetings
• Problems in trying to include some small not very
common topics – adjusting of problems
How did it go?
• Students and staff engaged in culture
change (some slowly)!
• At start, motivation made up for lack of
expertise at the process; later expertise of
students and tutors evolved
• Integration of benefit in oral surg/ med/ path
Current status (7 years)
• Now reviews produce minor adjustments and fine
tuning
• Some lectures, audiovisual aids
• Staff finally trust the process
• Students arrive with 3 years experience of PBL
• Commitment to student and tutor training and
support
• Exams: changed to send strong message as to what
we value eg 10% of finals mark on dissertation
that requires critical evaluation of information in
literature,
PBL tutors: expert vs non expert
our experience
• Integration means that students may always look
at areas outside expert’s area
• Some experts tended to give tutorial on their pet
subject, excluding other areas, need to trust and
value process
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Good guidelines and tutor training help a lot
Best tutors seem to be recent graduates
Allow tutors access to planners/ experts
Options to request wrap up session if needed
Advantages (for oral pathology)
• Staff much more aware of content of other
related areas
• Pathology learned in relevant clinical
context e.g. OKC learnt in clinical situation
along with ameloblastoma, not in
“classification of cysts”
• Better distribution of exam questions
Drawbacks for pathology
• Possibility of disappearing as an entity?
• Integrated exams mean an area may be
poorly covered while student passes
• Large class numbers may mean less impact
in practical classes
Pathology disappearing from
curricula ?
• Many papers and reports are concerned
about invisibility
• “pathology becoming invisible” Herdson
1998
• “concern need to list core concepts” Dick
1998
• DOH Feb 2004 “need to address invisiblity
to patients”
Pathology disappearing? – Royal
College Pathologists of
Australasia
• Pathologists must be active at all levels and
planning of curriculum
• Pathologists must be tutors and expert
resource personnel
• Pathology should be present throughout the
course
• Images and path reports should be key in
PBL cases
“Protecting” pathology as an
entity – what we do
• Use of images in problems – clinical and
histologic – examined in OSCE (practical exam)
• Indicate the need for students to use pathology
sources in some problems
• Practical classes (given at end of block) geared
towards relating clinical and pathologic with
illustrations, conundrums
• Protecting pathology in exam structure including
final exam
Protecting pathology – what we
do
• Use opportunities for visibility – exam
reviews, case reports for prizes
• Planning process – need to contribute
• Tutoring, even occasionally
• Reminding colleagues of need to prompt
consideration of pathology questions in
clinics
PBL -Would I do it again?
• Students acquire a lot of skills: sorting
information, questioning, chairing a group,
assertiveness
• Making them take responsibility for learning so
they are prepared for life-long learning
• Interactive nature of tutorial means weakest
students are better standard
• You have better idea of what has been and is being
learnt (as opposed to what you lectured)
• Lots of evaluation done = lots of communication
• Fun!