The study compares two modalities of implementing PBL. Since the Neuroscience Committee was required to make a rapid transition from a conventional to a PBL curriculum with limited time and resources, each sub-block was permitted to use its own discretion according to each department's resources.
The psychopathology curriculum was organized around four case-based modules, which defined the core psychopathology curriculum. These consisted of the Psychotic Disorders, Mood Disorders, Anxiety Disorders, and the Dementias. These modules were chosen because they were judged by the committee as central to the psychopathology course and because they lent themselves to problem-generated discussions, using a problem-based learning model.
Nine hours were left for other aspects of the curriculum that either required specialty knowledge, not easily acquired by most mentors, or because they were regarded as less essential to the training of physicians (an example of this would be the Personality Disorders). These disorders were maintained in lecture form.
In order to adhere to the principals of small workshop formats, where faculty would function in the capacity of facilitator rather than teacher, the psychopathology portion of the Neuroscience block was divided into twenty small groups of ten students. This involved the sustained participation of twenty faculty members over a six-week block of time. The following criteria distinguished between "expert" and "non-expert" mentors: An expert mentor would usually be a faculty member at an associate or full professor level with the following qualifications:
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Has several years of graduate teaching experience.
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Has expertise in conducting group therapy with a solid understanding of group process.
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In most cases has participated in clinical research.
Non-expert mentors were either junior faculty members or clinicians lacking consistent experience in teaching or clinical research.
In contrast, the remainder of the Neuroscience curriculum divided the PBL classes into eight groups of twenty-five students choosing to limit their PBL modules to eight groups of twenty-five students, thus exposing students to a much more consistent level of faculty expertise. This also functioned as a comparison construct.
A fundamental premise of the PBL method is that problem-solving and self-directed acquisition of knowledge creates a dynamic tension that leads to a more active, gratifying, and effective education [4]. In order to achieve this, each PBL committee was charged with selecting a prototypical case report containing clinical and basic science principles, with a design that would impose a progression of challenges and decisions for the student based on evolving data.
The students were provided reading assignments and case vignettes two weeks prior to the commencement of the Neuroscience block. They also attended an introductory lecture prior to the commencement of the Neuroscience course defining the nature and objectives of a PBL format. During the orientation, students were charged with the following tasks:
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They would be expected to acquire a core knowledge base via self-learning. An "essential reading list" was provided for this purpose (this was later streamlined after the student feedback session).
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They were provided with a list of basic science and clinical objectives together with a case vignette on each of four subject modules.
In order to create a problem-based learning paradigm, a committee of experts was set up for each module. Each committee was charged with the mission of: 1) generating a case report, 2) using the case as a springboard for fruitful exploration and discussion, 3) providing questions and references for the students that would encourage self-directed reading, 4) creating a user-friendly manual for the mentors, and 5) generating a set of examination questions that would be based upon students' attendance and participation in the case-based learning module. All mentors received orientation sessions in the content and learning objectives in each of the four Psychopathology modules. For instance, the Depression Module presented a simulated patient who overdosed after a broken romance. He had suffered the loss of his mother in early childhood. He was an "overachiever," and somewhat narcissistic, and friends found him difficult to get close to. The vignette purposefully contained a set of data allowing exploration of various developmental theories explaining his vulnerability to depression from the perspective of 1) Self-psychology. 2) Object relations theory, and 3) Psychodynamic theory. Sufficient DSM-4 Criteria for the diagnosis of a Major Depressive Episode were embedded in the case vignette. The students would be expected to identify them. In addition, the vignette contained some personality qualities with sufficient ambiguity to allow discussion about a possible Axis II diagnosis. Learning tasks also included the monoamine theory of depression.
It should be noted that the PBL model employed at SUNY differed from the "pure" PBL model proposed by Howard S. Barrows, where small student groups:
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Review the learning needs after reviewing the case.
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Decide on the best learning resources, such as textbooks, monographs, and journal articles, and then,
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Return from their self-study as "assumed experts, armed with the knowledge necessary to resolve the simulated patient problem."
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The student group then decides on the clinical hypothesis and problem-solving strategies [5].
A questionnaire was circulated at the end of the entire Neuroscience course, probing levels of student satisfaction with conventional lectures, PBL mentors, handout materials and perception of PBL effectiveness in Psychopathology, and the rest of the Neuroscience curriculum. The questionnaires were completed at the end of the Neuroscience block prior to the final exam with a response rate of 80%.
A questionnaire assigning a score of 8 for "strongly agree," 6 for "somewhat agree," 4 for "somewhat disagree," and 2 for "strongly disagree," was provided to the students at the completion of the Psychopathology and entire Neuroscience block. The questions addressed ten items of the course. Favorability was endorsed as positive for a score of 6 or higher. The ratings were subjected to a chi square analysis to assess statistical significance performing multiple chi-square tests on all ten questionnaire items. The results were dichotomised to address the question of favorability versus non-favorability on the ten items in question.
The Course Directors subsequently had a formal feedback meeting with the elected Student Body of eight students to obtain a more specific and elaborate critique of the new curriculum. All second-year students were encouraged to pass on general comments to their representatives in the student body, in an attempt to upgrade the course. The Student Body reported a high turnout to the post-Neuroscience block feedback session, with strong consensus regarding student experiences. These comments also correlated well with the questionnaires but added qualitative depth.