Department of Anesthesia (HSC-2U3), Mcmaster University, 1200 Main Street West

Department of Anesthesia (HSC-2U3), McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada. L8N 3Z5 E-Mail: [email protected] Fax: (905) 523-1224 Phone: (905) 521-2100 ext.75177

October 6, 2003 Dr. Kuo-Inn Tsou, Professor and Chair, School of Medicine, Fu-Jen University.

RE: My report on PBL learning in School of Medicine, Fu-Jen Catholic University

Dear Professor Tsou, It was indeed a pleasure for me to spend September, 2003 at Fu-Jen University, to work with the teachers and students in their medical education using a problem-based learning (PBL) approach. In the following, I will briefly outline my observations on the tutorials, lectures, student performance, and Anatomy teaching.

Tutorials I had sat in 6 tutorials in groups 1-6 from Year 4 who were studying Unit 4. I had also tutored one group from year 3 in their Fundamental Unit for 5 tutorials. Overall, I think the students are showing excellent progress in their learning. They are familiar with the tutorial process, and know how to make maximal use of this process to fulfill their learning needs. Most of them use an integrative approach in their learning, making use of multiple learning resources, and are getting good at presenting materials using powerpoint at tutorials. I am also quite impressed with the caliber of the tutors. They are also quite dedicated and diligent in carrying out their duties. They are facilitative and not directive during tutorials. They are attentive at tutorials, to ensure that the students cover the learning objectives as indicated in the Tutor’s version of the health care problems (HCPs). I would like to draw your attention to the following.

1. The students need to improve on the process of generating learning objectives from learning issues. Very often, learning objectives were generated from the list of learning issues, and these were divided into Major and Minor learning issues, usually matching the number of students in a tutorial group, so that these could be conveniently divided among themselves for presentation at the next tutorial. They need to learn the difference between learning issues and learning objectives, and how to combine learning issues into learning objectives. 2. One consequence of dividing the Major and Minor learning issues among the students, was that when the HCP was revisited at the subsequent tutorial, the HCP was covered with a series of mini-reporting by the students using powerpoint or overhead projections. The HCP was often not used again. Words must be getting around, because with each successive tutorial I had attended, the students were making genuine efforts of trying to engage others in their presentations but with limited success. The process of mini-reporting was still used by most of the groups with very little discussion among the students. This simply took away the advantage of a small group learning process, where students can help each other to resolve difficult learning issues, to share learning resources and methods, to develop critical appraisal skills to evaluate the information they have gathered, and to improve their communication

1 and group skills. One solution is to avoid the assignment of learning objectives to individual students. Instead, at the following tutorial, students can discuss highlights of what they have learned, help each other to understand difficult learning issues and concepts, share learning resources and learning methods/style, and apply critical appraisal skills on their findings. 3. I think this mini-reporting habit is a carry over from their 3rd year experience. The division of Major and Minor learning issues was intended for them to learn how to prioritize learning issues, and the assignment of each issue to a student was intended to ask these students to lead the discussion at the following tutorials. However, these somehow got formalized along the way, and students have fallen into the habit of reporting their findings in a formal manner. This process took away too much of their valuable time during a tutorial. Another purpose of asking students to report on their findings was probably intended to draw quiet students to take part in tutorial discussion. This intended purpose somewhat also got lost in the process. We need to remind the tutors on the whys and hows of asking students to report at the tutorials. 4. The tutorial rooms are well equipped and the size and environment are quite conducive for tutorial learning. The use of the electronic white board and the use of web-based bulletin board to share learning objectives generated by different groups are excellent implementations. 5. The length and content of HCPs in the Fundamental Unit are quite appropriate, and they are suitable for the intended use of introducing the students to the tutorial process and learning, while covering some major concepts on basic sciences. I find the HCPs in Unit 4 tended to be too long with too many details. They can be condensed to highlight major learning issues and channel the students to some of the major learning objectives. The timing of the Mini- and regular HCPs at the beginning of Unit 4 need to be modified, in order that the new HCP can fall on a Friday and Mini-HCP can fall on a Tuesday, so that students would have more time to prepare for their regular HCP. Study of Mini-HCP will not be to the same level of details as a regular HCP if the scheduling of them is changed. 6. I think the election of a Group Leader, and the assignment of the rotating role of a Tutorial Leader among the students, are good measures to be taken in Year 3 when they are getting used to the PBL tutoring learning method. In Year 4, the need for formal assignment of these roles may not be necessary, because students are now familiar with the process, but I am not opposed to having them in Year 4, as they are not detrimental to the tutorial learning process.

Lectures I had attended 7 lectures from Year 3 and one lecture from Year 4. Overall, I think the lectures served as an excellent supplement to the HCPs the students were using in their tutorials. Most of the lectures were quite relevant by focusing on explaining major basic concepts and their clinical relevance, while two of them (Histology and Ion Channels) were quite basic with an obvious lack of clinical relevance for the students to make relational use. The students will forget such factual information quickly. Some lecturers are to be commanded for their lively and meaningful use of clinical situations/materials to explain the relevance of the basic concepts, while some have applied the principles of PBL in their lectures, by using a small group learning process in a large group setting. Some of them had tried to engage the students in their lectures but the students were generally unresponsive, which is quite usual.

2 One approach which can be used in Year 4 lectures, is to start off with a clinical situation, and asked the students to brainstorm. Based on the hypotheses/issues generated by the students, the lecturer can then formulate the concepts with the help of the students, and then explain to the students what these concepts mean, and how they are applied in a clinical situation. I will use the lecture on fetal monitor as an example. The clinical situation would be that a pregnant woman was brought to the emergency with the concern that birth was imminent, and that the fetus may be in distress. Students can be asked to formulate what the critical issues were, such as whether the health of the mother or the fetus was the primary priority, what was meant by fetal distress, and what can be gained from a fetal monitor. The lecturer can then explain some of the basic aspects of fetal monitoring, using actual clinical examples including interpretation of fetal heart sound, intervention taken and outcome to explain the values of fetal monitoring before and during labor.

Anatomy Teaching 王嘉銓老師 kindly showed me the Anatomy teaching area in the basement of the Medical Sciences Building. I was told that ten students share one cadaver and that they take turn to do the dissection. Small group discussion is taking place during this process so that students can learn together basic aspects of human anatomy. Clinicians are invited to explain to the students clinical relevance of various anatomical parts. This process is reminiscence of what used to happen in Unit 4 at McMaster University when clinicians were involved in teaching students locomotory structures using pro-dissected materials in the Anatomy lab. I think this is an excellent approach because it gives the students a first hand experience about human anatomy through dissection and small group learning, while learning the clinical relevance of various anatomical structures. I would like to suggest that this part of teaching be made compulsory, since there is now sufficient number of cadavers for the students for the next 3 years. 王嘉銓老師 is to be congratulated for the excellent job he has done in organizing the teaching area and the teaching of Anatomy to the students.

I have enclosed the notes I had taken on the tutorials and lectures during my visit for your information. Please let me know if you require more information.

Best wishes,

Yours sincerely,

Robert M.K.W. Lee, Ph.D., Professor.