Problem based learning (PBL) as a teaching-learning method is a Spectrum. Barrow's classification enables educators to design a wide variety of PBL modules for effective learning of problem solving. Problemistics is an innovative and holistic way to approach the "science of dealing with problems". I have presented different versions of this talk since 1994. This is 2014 "copy-left" version.

1. Problemistics
and
Problem-Centred
Health Professional Education
Prof KR Sethuraman. MD, PGDHE
Email: krs@sbvu.ac.in

2. Overview
•
•
•
•
•
What is Problem Centred Learning (PCL)
Why PCL?
Types of PCL: PBL versus PSE
Challenges of implementing PBL
Problem-Knowledge coupling (PKC) for finding
holistic solutions to patient problems
• Problemistics – the science of Problem dealing
• Spectrum of PBL / PSE

3. Memorize and Recite!
T: “Tell me 10
causes of Anemia”
S: “I know 50 Sir!
Shall I tell all of
them?”
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4. Bowled by a simple Problem!
T: How will you
treat a pregnant
woman with
anemia for Rs.30
per month?
S: Hmm…Errr…
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5. COGNITIV
E
“Tomorrow’s Doctors” 1993 & 2009 http://www.gmc-uk.org/education/undergraduate/tomorrows_doctors_2009.asp
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6. Hybrid Curricula
The S P I C E S model
||
Student-centred ..……………...…….Teacher-centred
Problem-based ……………...……Passive acquisition
||
Integrated ………...…………...……Discipline-based
| |
Community……..……………...……..Hospital-based
|
|
Electives ……………...………...…….Standardized
|
|
Systematic...……………….....……….Opportunistic
|
|
| | = Where We Are
Harden

7. What is Problem-Centred Learning?
•
–
–
–
Essential principles of PCL  The problem,
activates prior learning
resembles real life cases
facilitates transfer of learning to other problems
• Solving the problem involves
– elaboration of knowledge via group-discussion and
– reflection to consolidate learning experiences.
• Includes problem-solving exercise (PSE) and
problem-based learning (PBL)

8. Why Problem-Centred Learning?
• Solving authentic problems
matches 21st Century skills
• What are 21st C Skills?

9. 21st Century Education
• Learning ‘to be’
– not ‘learn about’
• Learn by doing
– not just listening
• Learning how to learn
– Generation Y (web-2.0 gen) is
– participatory
– cooperative & adapted for
– constructivist learning

10. Goals for Problem-Centred Learning
• Structure knowledge for practice
• Develop clinical reasoning
• Develop self-directed learning
• Increase motivation
• Problem-centred learning predates 21st century
skills but is more relevant now

11. PCL Types: PSE & PBL
- Different but Related -
Problem-solving - arriving at
solutions based on prior
knowledge and reasoning
Problem-based learning - the
process of acquiring new
knowledge based on
recognition of a need to learn

12. T: How will you
treat a pregnant
woman with
anemia for Rs.30
per month?
Teach & Solve = PSE
Learn by Solving = PBL
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13. PBL & PCL begin with a problem
– Group analysis of what needs to be known
– Individual research
– Developing a solution
– Reflection on process & learning

14. Characteristics of PBL
1. Starting point is a problem
2. Authentic for professionals
3. Knowledge organised around problems
4. Students have responsibility for learning
5. Most learning in small groups, not lectures
6. Andragogy (adult learning) - Not pedagogy

15. The Relative Proportion of PSE to PBL
Changes with Curriculum Progress
Problem
solving
Mostly
New !
Problem-based
learning
 Time in the curriculum 
Mostly
Known !

16. How “pure” must PBL be?
PBL
– Barrows proposed a
taxonomy
– Spectrum of methods
Achieving objectives by
degrees
PCL

17. Six methods in
the spectrum

18. Barrows’ taxonomy of PBL methods
SCC
CRP
SDL
MOT
Lecture-based cases
1
1
0
1
Case-based lectures
2
2
0
2
Case method
3
3
3
4
Modified case-based
4
3
3
5
Problem-based
4
4
4
5
Closed-loop problem-based
5
5
5
5
Complete case or case vignette
Abbreviations:
CRP - Clinical Reasoning Process
SCC - Student Centered Curriculum
SDL – Self Directed Learning
MOT – Motivation to Learn
Partial problem simulation
Full problem simulation (free inquiry)
Teacher-directed learning
Student-directed learning
Partially student & teacher directed

19. Fidelity in PBL - i
• Presentation format:
– simulated patient (high fidelity) to
– "case write up"(low fidelity).
• Manifestation:
– ill structured with a range of possibilities (high
fidelity) to
– a "text-book case" (low fidelity & 'bookish').

20. Fidelity in PBL - ii
• Signal-Noise Ratio
– “noise” (associated problems) overlaying the
“signal” (main problem) = high fidelity
– pure filtered one-dimensional problem = low
fidelity
• Context:
– permit real-life situations, eg., talk with family
members of the patient (high fidelity)
– more contrived (low fidelity).

21. Fidelity in PBL - iii
• Objectives:
– patient-centred and integrated across disciplines
(high fidelity)
– only disease-focussed, discrete and piece-meal
(low fidelity and artificial)
• Low-fidelity problems borrowed from
textbooks are counterproductive in terms of
the Goals of PBL.
– Jayawickramarajah. Problems for Problem-Based Learning: a
comparative study of documents. Medical Education, 1996;30:272-282

22. Effectiveness of PBL Curricula:
Research and Theory
• “No convincing evidence that PBL
improves knowledge base and
clinical performance,
– at least not of the magnitude that
would be expected given the
resources required for a PBL
curriculum.”
• Jerry A. Colliver, Acad. Med.
2000;75:259–266.

23. Individualising Solutions
"Give me ‘standard patients’
and I'll practice standard
medicine."
--James S. Todd, MD. AMA Executive Vice President, 1990-1996
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24. Problem Knowledge Coupling
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25. What is Problemistics ?
• It is the science of dealing with
problems
• It is an activity aimed at – the resolution of a Problem &
– the development of Well-Being
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26. Problemistics – contd…
• It is concerned with  Problem Framing – Context
 Problem Finding – Holistic approach
 Problem Solving – Appropriate
resolution
 Problem Acting - Systematic action
*
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27. Spheres of Problem Experience
• Bio-sphere environment
infections)
nature and
(e.g.,
• Socio-sphere - individuals & groups
(e.g., phobic neurosis)
• Techno-sphere - tools and artifacts
(e.g., implant malfunction
iatrogenesis etc) 27
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28. Problem Dealer (Professional in Making)
• Cultivate following characteristics –
– Dimensions - cognition, emotion
& volition
– Qualities - thrill, skill, will
• Thrill - emotive ( enthusiastic )
• Skill - cognitive ( mindful & critical *)
• Will - volitional ( proactive )
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29. Range of Problem-Centred
Education

30. DURATION =
SEMESTER(S)
Example -
FULL TIME P B L or
HYBRID CURRICULUM

31. DURATION =
Hours to Days
Example -
Integrated Modules
Orientation Workshops

32. DURATION =
1 – 3 hours
Example -
Problem Solving
Exercises
Simulation Games

33. DURATION =
3 to 10 minutes
Example -
Buzz Session
Simulated Initial
Management

34. We must make our Graduates
• Think critically and be able to solve complex, realworld problems
• Find, evaluate, and use appropriate learning
resources
• Work cooperatively in teams and small groups
• Demonstrate versatile and effective communication
skills, both verbal and written
• Become life-long learners to update their
knowledge and skills acquired at the university
Can We Do it ?

35. We can !
If we have the self belief
and motivation like this
modeler, who shapes
“mere Clay” in to
“Desirable objects”

36. THANK YOU All !
The Handout has more details on PKC & Problemistics
(visit www.problemistics.org and
www.pkc.org for more information)
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