Section 3

Educational Strategies

By: Dr. Samrood Akram (PT)

Assistant Professor
Riphah Rehabilitation Sciences Department
Learning Objectives
• To enable graduates to self-formulate their goals and objectives of learning of
particular topics.
• To develop lifelong learning in students the potential to determine their own
goals, locate appropriate resources for learning and assume responsibility for
what they need to know.
• To implement TBL(Team based learning) to improve communication and problem-
solving skills, interprofessional collaboration, and life-long learning that are
achieved by the teamwork.
 Contents
Chapter 18 Outcome based Education
Chapter 19 Independent learning and study skills
Chapter 20 Problem based Learning
Chapter 21 Team based learning
Chapter 22 Integrated learning
Chapter 23 Interprofessional Education
 Chapter 18

Outcome Based Education

 Discuss Learning Outcomes
• One of the most effective ways a teacher can facilitate students’ learning is to
discuss the expected learning outcomes with them on day one of the course.
• The Association of American Medical Colleges (AAMC) initiated a Medical Schools
Objectives Project (MSOP) which encouraged educators to think about what was
expected of medical students no matter which medical school in the United
States they attended.
• Medical education is on the brink of a major paradigm shift from structure and
process-based to competency-based education and measurement of outcomes.
 Outcome Based Education

• Outcome-based education or outcomes-based education (OBE) is an educational

theory that bases each part of an educational system around goals (outcomes).
By the end of the educational experience, each student should have achieved the
goal.
 Reasons Description
1.Attention to neglected areas identified include: communication skills, clinical reasoning,
neglected areas of decision making, self-assessment, creativity, patient safety and social
competence responsibility: all important abilities for the practicing doctor.

2.The problem of Advances in medicine and the medical sciences, with the doubling of
information overload knowledge every 2 years, poses a significant problem for the medical
curriculum. While the length of the course has remained relatively constant,
what the student might be expected to learn has expanded hugely.
We need to specify more clearly from the wide range of possibilities what it
is we expect the student to learn.

3. Assessment of the Learning outcomes provide a vocabulary to support the planning of the
learner’s progress continuum of medical education across the different phases: undergraduate,
and the continuum of postgraduate.
education
 Implementation of OBE
Learning outcomes differ from instructional objectives, and five important differences
can be recognized:
1. Learning outcomes, if set out appropriately, are intuitive and user-friendly. They can
be used easily in curriculum planning, in teaching and learning and in assessment.
2. Learning outcomes are broad statements and are usually designed.
3. The outcomes recognize the authentic interaction and integration in clinical practice
of knowledge, skills and attitudes.
4. Learning outcomes represent what is achieved and assessed at the end of a course
of study and not only the aspirations or what is intended to be achieved.
5. A design-down approach encourages ownership of the outcomes by teachers and
students.
 Dundee three-circle model
The Dundee three-circle model as adopted in the Scottish
Doctor is an example of an outcome framework.
2. In the middle circle (doing the thing
right): the intellectual, emotional and
analytical competencies – how the doctor
approaches his or her practice. This
includes an understanding of basic and
3. In the outer circle (the clinical sciences, appropriate attitudes
right person doing it): and appropriate judgment and decision
the personal intelligences making.
– the doctor as a
professional including 1. In the inner circle (doing the right
the role of the doctor thing): the technical competencies – what
and the doctor’s a doctor should be able to do, as classified
personal development. in seven domains, e.g. communication
skills and practical skills and procedures.
Criteria for an outcome/competency framework

• The framework is clear, unambiguous and intuitive to the users

• It reflects accepted and defined areas of competence.
• The vision and mission of the programme are reflected in the domains chosen.
• It is manageable in terms of the number of outcome domains.
• It supports the development of enabling outcomes in each of the domains.
• The relationship between different outcomes is indicated.
AN OUTCOME-BASED CURRICULUM

• In OBE decisions about teaching and learning methods, curriculum

content, educational strategies, assessment, the educational
environment and even student selection should be based on the
specified learning outcomes.
• Model for the curriculum emphasizing the importance of educational outcomes in curriculum planning
(with permission from Harden et al: An introduction to outcome-based education, Medical Teacher.
ACGME- AccredattationCouncil for Graduate Medical Education.
 Chapter 19
Independent Learning and Study skills
Independent study
• Description
• Independent study is a form of education
offered by many high schools, colleges, and
other educational institutions. It is
sometimes referred to as directed study,
and is an educational activity undertaken
by an individual with little to no
supervision.
 What are independent learning and study skills?
• The concept of independent learning means different things to different people. It
incorporates six key principles:

1. Students learn on their own.

2. Students have a measure of control over their own learning, in that they choose: !
where to learn (deciding the context of learning) ! what to learn (diagnosing personal
learning needs) ! how to learn (identifying methods and resources) ! when to learn
(deciding time and pacing).
3.Students may be encouraged to develop their personal study plans.
4.Differing needs of individual students are recognized and responded to appropriately.
5. Learning is supported by learning resources and study guides prepared specifically for
this purpose.
6. The role of the teacher changes from transmitter of information to manager of the
learning process: a more demanding but a more rewarding role.
Many terms are used, often interchangeably, though different meanings
may be implied, to describe this approach to learning:

• Independent learning: emphasizes that students work on their own to meet their own
learning needs.
• Self-managed learning, self-directed learning or self-regulated learning: emphasizes
that students have an element of control over their own learning, with responsibility for
diagnosis of learning needs, identifying resources and assessing the degree of learning
by themselves. Implicit in this approach is that students have a clear understanding of
the intended learning outcomes.
• Resource-based learning: emphasizes the use of resource material in print or
multimedia format as a basis for students’ learning and the freedom this gives the
students.
• ‘Just-for-you’ or flexible learning: emphasizes the wide range of learning opportunities
offered to students and flexibility in responding to individual student needs and
aspirations.
 Terms..
• Open learning: is often used interchangeably with flexible learning. It
emphasizes the provision of greater access for students to their choice of
education.
• E-learning: learning is facilitated by information and communication
technology.
• Distance learning: emphasizes that students work on their own at a
distance from their teacher. Implicit in this approach is that the teacher
interacts with students at a distance and facilitates the students’ learning.
• ‘Just-in-time’ learning: resources are made available to learners when
required. This facilitates ‘on-the job’ learning and the integration of theory
and practice
 Why is independent learning important?
• Learning is continuous, with new learning built on what has already
been learned. Medical education is a continuum which starts at entry
to medical school and ends with cessation of professional practice.

• 1. Active Learning
• 2. Student Motivation
• 3. New Learning Technologies
• 4. Distance and Blended Learning
1. ACTIVE LEARNING
• The independent learner who is properly guided has the
opportunity to develop these component skills while in medical
school, while adopting a more active approach to learning.
• Students adopt a deep rather than a superficial approach to
learning and search for an understanding of the subject rather
than just reproducing what they have learned. They are
encouraged to think rather than just recall facts. A learning
approach does not describe a particular attribute of the student,
but a relationship between the learner and the learning task.
2. STUDENT MOTIVATION
• Independent learning gives students more
responsibility for their learning and greater
participation in the learning process. It allows them to
choose the appropriate level for their studies. This in
turn gives them a sense of ownership of their learning,
which has a positive effect on their motivation.
Readiness for learning depends on intrinsic motivation,
an inner urge to learn, as well as the acquisition of
prerequisite learning on which new learning is built.
3.NEW LEARNING TECHNOLOGIES
• “Web and Internet technologies are
transforming our world, presenting
opportunities we could only imagine a few
years ago.
• Social networking sites provide several
combined features, including instant
messaging and logs and could be used to
develop personalized learning.
4. DISTANCE AND BLENDED LEARNING
With the development of e-learning, distance learning has increased
in popularity in undergraduate, postgraduate and continuing
education.
The CRISIS criteria for effective continuing education, developed in
the context of distance learning, recognize the potential advantages
implicit in independent learning.

• Convenience for the student in terms of pace, place and time

(‘just-in-time’ learning).

• Relevance to the needs of the practicing doctor.

• Individualization to the needs of each learner (‘just-for-you’

learning).

• Self-assessment by the learner of his or her own competence.

• Interest in the programme and motivation of the learner

• Systematic coverage of the topic or theme for the programme. A
blended approach can be adopted where e-learning is combined with
face-to-face learning to create an integrated learning experience.
 Trends in independent learning
“The only man who is educated is the man who has learned how to learn.”
There has been a significant change, however, with independent learning playing an
increasingly important role in the curriculum:
• Time previously scheduled for lectures or small group work is often rescheduled for
independent learning.
• Independent learning is now an explicit planned part of the learning activities, and
protected time is allocated for it in the timetable.
• The role of the lecture is changing to lend support to independent learning, rather than
independent learning being used as an adjunct to support the lecture.
• Students make increasing use of the internet as a learning resource.
 Chapter 20

Problem-Based Learning
 Problem Based Learning
• PBL has proved to be effective in promoting
active learning, collaboration, communication
skills and critical thinking.
• A small group of students is presented with a
problem to solve and a structured approach to
solving it.
• A problem usually centres on the clinical
presentation of one or a few patients
(e.g. an individual with Parkinsonism,
a child with a metabolic disorder and the child’s
parents, or
a couple presenting with infertility).
 STEPs of PBL
1. PBL often starts with a vignette(brief) summarizing the clinical presentation.
2. At first, students do not have sufficient knowledge to proceed easily: they are deliberately
confronted with a problem they cannot solve.
3. By working collectively, they identify key elements and seek out additional information,
enabling them to suggest causal hypotheses and identify possible pathophysiological
mechanisms.
4. At the start, students are encouraged to think broadly about alternative hypotheses,
mechanisms and the sociocultural context.
5. They then refine and test their hypotheses in order to arrive at the most likely explanation.
6. Thus, students are supported as they learn about multiple dimensions of a topic in
medicine, greatly enriching and diversifying their learning experiences, especially when
they can link PBL to other learning.
 Key features and strengths of PBL
• PBL is an example of active learning.
• Active learning involves interaction,
pursuing information, collaborative
problem-solving, sharing of ideas,
evolving and testing hypotheses.
• Medical teamwork and communication.
• Students agree to follow up on specific
issues individually or in groups, identifying
and sharing information with colleagues.
 Introduction of PBL problems
• The problem or case can be introduced in different ways.
• If a real patient is the subject of a PBL, the process may
begin with a short summary of his or her clinical
presentation.
• If the problem is based on a hypothetical patient, the
process begins with a trigger statement that briefly
summarizes the characteristics, clinical presentation and
circumstances
• The trigger statement may be read out by a student or the
tutor, played from a recording or presented as a
photograph or computer image to encourage observation.
The students examine the trigger statement and
image, identifying ‘cues’ about the case.
Students collectively observe and interpret the
images that provide the context.
They contribute ideas, suggesting and noting
relevant information, and then identifying issues
to be explored.
Group members typically take turns acting as
scribe, summarizing ideas on a whiteboard, a
computer or paper.
In an effective tutorial, a lively exchange of
Effective tutors avoid taking a traditional
information and ideas ensues as students identify
didactic teaching role, such as that depicted in
issues and explore possible mechanisms. The desirable
Fig.20.2
form of the interaction within a PBL group is depicted
in Fig. 20.1
 Effectiveness of PBL
• PBL has proved to be very effective in promoting active learning, the
development of communication skills and critical thinking in an
environment of mutual support. Evaluations consistently show that
students enjoy PBL and derive great benefit from well-constructed
problems and an effective PBL program.
Assessment of student performance in PBL
• Formal or semi-formal assessment of students’ performance in PBL groups is
important in medical programs that place substantial emphasis on PBL. Both
formative assessments (without penalty) and summative assessments
(determining progression) are needed.

• Tensions can arise if competitive grading and ranking discourage students

from sharing information or contributing effectively to the group
discussions. Peer review (evaluation of scientific, academic, or
professional work by others working in the same field) has gained some
acceptance in PBL programs.
What are the challenges of a PBL-based programme?

• The main challenges of a PBL programme are that it requires detailed

management and maintenance. PBL demands extensive resources of three types.
1.The first is a sufficient number of suitably qualified tutors to provide for the
numbers of small groups.
2.The second is the availability of physical resources. Conventionally, PBL sessions
are conducted in small tutorial rooms with one room per group.
3. The third comprises the need for resources to sustain the organizational
backbone for consistent PBL delivery.
 Chapter 21

Team-based learning
 What is team-based learning?
Team-based learning (TBL) is an active
learning instructional strategy that
provides students with opportunities to
apply conceptual knowledge through a
sequence of events that includes
individual work, teamwork and
immediate feedback.

“The development of a small group into

a learning team is best described as a
transformation process.”
How does TBL work?
• “TBL prompts most students to engage in
the learning process with a level of
energy and enthusiasm that transforms
classrooms into places of excitement that
are rewarding for both them and the
instructor.”
• Team-based learning’s sequence of steps
are forward thinking, guiding students
into thinking progressively, gaining the
ability to look beyond the ‘now’ and
constantly asking, ‘What’s next?’
 STUDENTS’ PERSPECTIVE TBL recurring steps
• Step 1 – Advance Assignment Out-of-Class
• Individual Students receive a list of learning activities, accompanied by a set of
learning goals. Students study materials in preparation for the TBL session. Learning
activities may include readings, videos, labs, tutorials, lectures, etc.
• Step 2 – iRAT – Individual Readiness Assurance Test
• In-Class/Individual, Each student completes a set (10–20) of multiple-choice
questions that focus on the concepts they need to master in order to be able to
solve the Team Application (tAPP) problems.
• Step 3 – tRAT – Team Readiness Assurance Test
• In Class/Team This is the same set of questions that each student has answered
individually! But now the team must answer them through a consensus-building
discussion.
• Step 4 – Instructor Clarification Review
• In-Class/ Instructor Students get clarification from the instructor on the concepts
they have been struggling with during the tRAT.
• Step 5 – tAPP – Team Application
• In-Class/Team This is the most important step! Students, in teams, are presented
with a scenario/vignette that is similar to the type of problem that they will be
grappling with in their careers.
Individual Readiness Assurance Test (IRAT)
Grantor retained annuity trust (GRAT)
What are the ingredients for a successful TBL module?

• Selecting learning activities can be a challenge for those in medical

education since the lecture-based pedagogy has been the mainstay
for so many years.
• TBL can eliminate lectures that are primarily ‘information
transmitting’, for the content can be assigned from a text,
PowerPoint with notes or even a multimedia online tutorial.
What can go wrong with TBL?
• The students hated it because they do not like to prepare for class.’
Solution: Prepare students for TBL
Chapter 22
 Integrated learning

• Integrative learning is a
learning theory describing a
movement toward integrated
lessons helping students make
connections across curricula.
 Types of integration in medical education
• There are two main types of integration in medical
education:
-integration through dedicated approaches and
-integration through specific contexts

• There are two common approaches in medical

education:
1. Horizontal integration
2. Vertical integration
 1. HORIZONTAL INTEGRATION
• In horizontal integration courses the disciplines are combined, organized around
concepts or ideas in each year or level of the course such as in courses organized on a
body systems basis.

The early years of medical courses are frequently organized into blocks or units
corresponding to body systems such as:
• cardiovascular
• respiratory
• renal
• gastrointestinal
• endocrine/reproductive
• musculoskeletal
Horizontally integrated courses are becoming more popular as increasing numbers of
medical schools around the world adopt problem-based or case-based learning
approaches.
2. VERTICAL INTEGRATION

In vertically integrated courses the disciplines are organized into themes or domains
which run throughout all years of the course.
The early introduction of clinical skills and their development alongside basic and
clinical sciences is a good example of vertical integration.

Many medical courses are now organized around four main themes which, while
given different names, generally deal with the following:

• Basic and clinical sciences

• Clinical and Communication skills
• Social, Community and population health
• Law, Ethics and Professionalism
 Chapter 23

Interprofessional education
Interprofessional collaboration
• Interprofessional collaboration is “the process of
developing and maintaining effective
interprofessional working relationships with
learners, practitioners, patients/clients/families
and communities to enable optimal health
outcomes.”
• A number of educational, psychological and
sociological theories underpin the development
and delivery of IPE (Interprofessional education)
The rationale for IPE
“Learn effectively within a multi-
professional team:
• Understand and respect the roles and
expertise of health and social care
professionals in the context of working
and learning as a multi-professional team;
• Understand the contribution that
effective interdisciplinary team working
makes to the delivery of safe and high-
quality care.”
 Planning for IPE
“Being interprofessional means that we:
1. Know what to do: think through what action is needed in a particular setting
and how to do what is needed.
2. Have the skills to do what needs to be done: being competent.
3. Conduct ourselves in the right way when carrying out a particular action:
appropriate attitudes, suitable values and beliefs about what we are doing.”
 Learning outcomes for IPE
Seven objectives of interprofessional education

1. Modify reciprocal attitudes

2. Establish common values, knowledge and skills
3. Build teams
4. Solve problems
5. Respond to community needs
6. Change practice
7. Change the professions