Problem based learning… need of the hour:

Dental education forms the foundation of the professional lives of dentists. In this context, the curriculum constitute the crux of dental education that need to be assessed and tailored based on the needs and demands of the dental profession for the benefit of its stakeholders, which includes both the students and the patients whom the profession ultimately is meant to serve.1 Lot of experiments and reforms have been made to dental curriculum and one such reform which has gained acceptance and practiced world over is Problem based learning (PBL).

We in India until now have continued to follow the conventional approach to dental education. The existing method of teaching and training is mostly teacher centered where conventional lectures are delivered by staff in front of huge number of students with limited teacher-student interaction. Each discipline is taught separately in a highly compartmentalized manner. Usually the basic sciences are taught first, followed by clinical subjects in later years with minimal integration between them. Examination mainly focuses on regurgitation of collection of facts. Development of analytical and logical reasoning skills take a back seat and consequently lacks application of knowledge in relevant situations.2

On the other hand, PBL in dental education is a student-centric approach where, instead of traditional lectures, problems form the basis for the organized focus of the group that stimulates learning. students in small groups (usually less than ten in a group) are presented with a problem that they must try to solve. They are assisted by a facilitator who helps them to formulate the problem and generally guides them but does not teach or supply information. The students have to decide what information they need to solve the problem, find it, communicate it to others, and discuss before arriving at a solution. At the end of the session, the student reflects on how he/she performed.3

Recognized benefits of PBL

PBL integrates knowledge with practice. It encourages learning from experience, allowing students to use and organize what has been learnt to understand problems. The problem is a vehicle for the development of problem solving skills. It stimulates the cognitive process and it improves logical thinking. It nurtures the ability to analyse problems and to identify and acquire knowledge and skills needed to deal with real-life situations.4,5 PBL programmes create an environment where students need to become responsible for their own learning from early on.2,3 It has been documented that it facilitates more enjoyable and more effective learning. PBLwill significantly improve students’ participation and discussion, thereby help to develop teamwork, communication, and research skills.5 The goal is not always to find the right answers but to inculcate in students a problem-solving approach and to stimulate them to become self-directed lifelong learners.6

A typical package of PBL3

1. Students are presented with a realistic scenario, perhaps with a video trigger, simulated or real patient, that is designed to draw on prior knowledge but is presented “up-front” prior to formal study of the new topics raised in the scenario.

2. Students work in small groups with a facilitator to clarify terms and concepts, analyse and interpret the situation and identify the issues and problems presented in the situation.

3. The group of students generates working hypotheses about the possible causes and consequences of the identified problems and indicates what additional information is required to assess if their hypotheses are likely and explain what is going on, and to respond to or manage the situation.

4. The group identifies questions arising from the scenario (referred to as learning issues) that it needs to explore and members go away and undertake self-directed learning, together and on their own.

5. Students return later to share their learning experiences, to clarify their explanations and response to the situation, and apply their learning to their analysis and reasoning about the situation, e.g., explaining risks, causes and outcomes about the patient’s problems, making a diagnosis, and/or developing a management plan. More information may be provided by the facilitator leading to a further iteration of the process.

6. The problem is concluded with a review of the students’ current understanding and abilities, with integration of learning achieved through their problem exploration and independent study.

Challenges in implementing PBL

Despite the awareness of various pitfalls in the present curriculum, PBL is not being widely implemented in India, although some dental colleges are experimenting with this method as an adjunct to traditional teaching. There exist numerous challenges for its implementation which includes - familiarity with traditional methods of teaching; conservatism of the faculty and untrained status of teachers in PBL; no fixed curriculum / textbook; lack of proper mechanism for assessment of students’ progress; absence of fixed guidelines from dental council of India for PBL inclusion in curriculum;financial constraints in providing necessary resources; and time-consuming nature of the training process have been identified limiting the application of problembased learning in dental education presently in India.7

A common question raised by academicians, clinicians and students about PBL is “Does conversion to PBL always have to be 100%”? “Is it possible to integrate both systems”? Pure integrated PBL programmes, as defined by Barrows involve virtually no lectures at all.8 However, there are relatively few of these pure programmes in existence anymore. Hughes and Wood acknowledge the difficulties in changing to PBL and suggest that PBL does not need to be all or nothing. One can choose those bits and pieces that are thought to be best and implanting them into conventional curricula.9 They believe that well-planned and integrated hybrid PBL programmes, adapted to take account of the local situation works better. There are various hybrid versions of PBL in dental education that consist of a combination of both PBL packages and more conventional lectures supported by learning laboratories, tutorials, online modules, resources and clinical practice. These sessions provide a relevant context for active student learning and enable key issues to be reviewed and discussed, rather than merely serving as a means of providing factual information.10,11

The regulatory body Dental Council of India (DCI) should take note of the above and should bring about necessary amendments to incorporate PBL in hybrid form as a teaching methodology and implement it judiciously in dental college settings, and also conduct faculty training programmes to equip teachers for the changing scenario.

Conclusion

Dental education aims at training the students to have ample knowledge, right professional attitudes, acquire appropriate clinical skills so as to prepare them to handle real-life situations. It should motivate students toward active, self-directed learning rather than just being passive recipients of information in the classrooms. Teaching-learning method is an evolving concept requiring regular update of both the students as well as the teachers.12 In recent years, problem-based learning (PBL) is one such innovative approach to teaching that has international credibility. It is a student-centric approach that is found to be most effective technique for learning, applying, integrating, and retaining information while promoting life-long habits of active and self-directed learning. It is now, a well-established method of facilitating basic science education intended for clinical application.

The dental Council of India has to bring about a change in the undergraduate curriculum by implementing innovative teaching methods like PBL which aim to make the training more exciting and challenging to the students. Initially the transition from the traditional didactic teaching to PBL might be difficult for most senior teachers and hence rather than a full-scale implementation of PBL in the curriculum, it would be prudent to use a combination of traditional teaching methods with PBL. This change is especially required for nonclinical specialties to make it more interesting as well as to make the students understand the importance of these subjects in their clinical curriculum. However, for PBL to gain a strong foothold, teachers first need to be trained in this method and should develop a favourable attitude toward it and create a suitable academic environment for its implementation.