Implementing the CBL^+ Model Allows Scaffolded Instruction to Medical Students Unfamiliar with Features of PBL Structured Learning

10.6145/jme201313

Christopher Johnson；Paul R Saunders；Mei-Ling Tsai

reasoning ； problem-based learning ； scaffolding ； medicine ； case-based learning ； basic science education

Journal of Medical Education

17卷3期（2013 / 09 / 01）

123 - 132

英文

Background: Implementing new educational approaches within medical training programs is now happening. PBL has been highly touted, but it has not had the anticipated success to improve self-directed learning in East Asian institutions. Peer pressure, tutor variation in guidance, and uncertainty on reasoning procedures cause PBL anxiety. Objective: Based on cognitive load theory, guided discussion by one tutor in a large group to identify the problem and small-group discussion to link domain knowledge are introduced to case-based learning, named Case Based Learning program (CBL^+), to scaffold physiological knowledge. Methods: Year 3 medical students, from National Cheng Kung University, taking Physiology in 2012 were included in this study. Case discussion was guided by the lead instructor in a large class, followed by small-group discussion. Students' behavior in this CBL^+ structured curriculum was observed by the lead instructor and self-monitored via student reflections at the completion of the course. Results: Both the instructor and students noticed improvements in logical reasoning yet students expressed the case-based learning seemed ineffective (likely inefficient) and they lacked confidence in the veracity of peer presentations. Despite these attitudes, they did not reject the CBL^+ way of learning. Conclusions: This CBL^+ approach has achieved qualified success with regards to the practical challenge of how to transition these medical students from teacher- to student- centered learning. Additional scaffolding strategies are needed to enhance the effectiveness of the current CBL^+ model; the realized precepts of the current model provide guidance in implementing these refinements.

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