Attitudes and opinions of faculty tutors about problem-based learning.

BACKGROUND: There has been little systematic attention to the opinions of faculty in evaluating problem-based learning (PBL). The purpose of this report is to describe the attitudes and opinions of tutors in PBL programs about the relative merits of PBL and traditional medical education, and to examine the influences of selected variables on these attitudes. METHOD: Questionnaires containing both Likert-type and open-ended questions were sent to 1,287 faculty members who had served as PBL tutors at 22 U.S. and Canadian medical schools during the 1992-93 academic year. All schools with identifiable PBL programs (broadly defined) were included in the survey. RESULTS: The overall response rate was 69% (882 of 1,287). As a group, the respondents were experienced in both PBL and traditional curricula, with an average of 3.75 years of experience in the former and 11.41 years of experience in the latter. Regarding both their overall attitudes and their opinions about seven of nine specific areas, the respondents evaluated PBL more positively than traditional methods. This was especially evident in the ratings of student interest and enthusiasm, faculty interest and enthusiasm, the respondents' personal satisfaction, student reasoning, and preparation for clinical rotations. The two methods were judged to be approximately equally efficient for learning. Traditional methods were judged to be superior for teaching factual knowledge of basic sciences. PBL was particularly popular with faculty in PBL-track programs, with faculty in both the newest and the oldest PBL programs, and with faculty in either primary care or "nontraditional" specialties. CONCLUSION: The findings confirm and extend the picture of PBL strengths and weaknesses that can be derived from prior anecdotal program descriptions and small sample studies. Experienced faculty seem to prefer PBL in most respects, although they have some serious reservations. The present findings also agree with prior outcome studies of PBL, suggesting that the most strongly held faculty opinions may have a factual basis.

Faculty attitudes and opinions about problem-based learning.

BACKGROUND: Systematic research on faculty attitudes toward problem-based learning (PBL) has focused exclusively on the opinions of tutors. The purpose of the present study was to examine the attitudes of faculty at a single medical school who either (1) did not participate in the first year of a new PBL curriculum or (2) participated in ways other than as PBL tutors. METHOD: In 1993-94, at the end of the first year of a new PBL curriculum, a questionnaire used in an earlier, larger study of PBL tutors was sent to all 494 faculty at the University of Missouri-Columbia School of Medicine. RESULTS: The response rate was better for participants (76%, 115 of 151) than for non-participants (28%, 96 of 343). Overall, nonparticipants judged the new curriculum to be approximately equal to the "old" curriculum that preceded it. In contrast, participants were significantly more positive and judged the new PBL curriculum to be superior in most respects. For both groups the new curriculum received its highest ratings in the areas of student interest, clinical preparation, and medical reasoning and its lowest ratings in the teaching of factual knowledge in the basic sciences and efficiency of learning. The attitudes of participating faculty varied with their teaching roles in the new curriculum. Those whose primary roles were as PBL tutors or as leaders of other small discussion groups were more favorable to the new curriculum than those who primarily served as lecturers. Faculty who served in several different roles were more positive than faculty who served in only one role. There were also plausible qualitative differences among the teaching-role groups in what they liked and disliked about the new curriculum. CONCLUSION: In general, the attitudes and opinions of the faculty varied with the degrees and types of participation in the new curriculum. The attitudes and opinions of faculty with different teaching roles were plausibly related to differences in these roles. The opinions of the faculty about the strengths and weaknesses of PBL that emerged in this survey are much like those found in prior research. In addition, student performances on Step 1 of the United States Medical Licensing Examination suggest that the faculty may have underestimated the value of the new PBL curriculum for helping students acquire factual knowledge in the basic sciences.

Does problem-based learning work? A meta-analysis of evaluative research.

The purpose of this review is to synthesize all available evaluative research from 1970 through 1992 that compares problem-based learning (PBL) with more traditional methods of medical education. Five separate meta-analyses were performed on 35 studies representing 19 institutions. For 22 of the studies (representing 14 institutions), both effect-size and supplementary vote-count analyses could be performed; otherwise, only supplementary analyses were performed. PBL was found to be significantly superior with respect to students' program evaluations (i.e., students' attitudes and opinions about their programs)--dw (standardized differences between means, weighted by sample size) = +.55, CI.95 = +.40 to +.70 - and measures of students' clinical performance (dw = +.28, CI.95 = +.16 to +.40). PBL and traditional methods did not differ on miscellaneous tests of factual knowledge (dw = -.09, CI.95 = +.06 to -.24) and tests of clinical knowledge (dw = +.08, CI.95 = -.05 to +.21). Traditional students performed significantly better than their PBL counterparts on the National Board of Medical Examiners Part I examination--NBME I (dw = -.18, CI.95 = -.10 to -.26). However, the NBME I data displayed significant overall heterogeneity (Qt = 192.23, p < .001) and significant differences among programs (Qb = 59.09, p < .001), which casts doubt on the generality of the findings across programs. The comparative value of PBL is also supported by data on outcomes that have been studied less frequently, i.e., faculty attitudes, student mood, class attendance, academic process variables, and measures of humanism. In conclusion, the results generally support the superiority of the PBL approach over more traditional methods. Acad. Med. 68 (1993):550-563.

Research on children's behavior after hospitalization: a review and synthesis.

Despite the presence of considerable research on techniques for reducing distress associated with childhood hospitalization, few studies have examined the more basic issue of whether the event negatively affects children after discharge. A meta-analysis was conducted of studies using the Posthospital Behavior Questionnaire (the most commonly used method of examining posthospital behavior) to determine whether hospitalization results in negative behavioral change, the duration of this reaction, if detected, and factors potentially related to its strength. The mean weighted effect size was +.29 (Confidence interval .95 = +/- .07). Thus, in the absence of interventions, negative behavior tends to increase significantly after discharge (z = +3.99; p < .00006). However, this response diminishes with time and has largely disappeared after 2 weeks. Contrary to expectations, neither age of subjects nor their medical condition was related to their degree of upset. Subjects hospitalized for periods of 2 to 3 days exhibited more behavioral distress than did those hospitalized for either shorter or longer periods.

Research on the effect of experimental interventions on children's behavior after hospitalization: a review and synthesis.

Despite continued interest in ameliorating the posthospital psychological effects of hospitalization on children, there have been no analytic reviews of the research on this topic. The present study synthesized all known research that evaluated experimental interventions through the use of the Posthospital Behavior Questionnaire (PHBQ), by far the most commonly used method of examining posthospital behavior. The mean weighted effect size (ES) was +.44, Confidence Interval (CI).95 = +/- .10. Thus, on the average, children who received experimental interventions tended to change their behavior in the direction of psychological upset less than children who did not (z = +4.81; p < .00006). Analyses of ES moderators indicated significant variations (p < .05) associated with (1) the year of the report, (2) questionnaire format, (3) study design, (4) variations in experimental treatment, (5) subject's age, and (6) length of hospitalization. Psychoeducational preparation was not effective with younger children. The benefits of experimental interventions persisted up to 4 weeks after discharge.