most educators reported a lack of skills and resources necessary to implement new educational strategies

Transcription

1 Problem Based Learning and the Development of Critical Thinking Skills Objectives Share results of a systematic literature review identifying teaching methods that demonstrate a positive impact upon the development of students critical thinking skills. Present the implications of problem-based learning on graduate clinical performance in the workplace. Discuss examples of PBL activities and student assessment. Critical Thinking Defined by Facione (1998) as a purposeful exercise resulting in evaluation and inference to explain contextually-based situations upon which to base the reflective judgment Does this definition apply to the radiologic science professions? 1. Yes 2. No Critical Thinking in the Radiologic Sciences A 2009 survey of program directors of JRCERT accredited radiography and radiation therapy programs assessed the directors perception of the benefits and barriers to the incorporation of critical thinking activities in their educational programs (Kowalczyk, Hackworth, Case- Smith, 2011) most educators reported a lack of skills and resources necessary to implement new educational strategies Critical Thinking in the Radiologic Sciences Barriers to the use of learning techniques to foster critical thinking included: the educators lack of PBL curriculum development skills; unfamiliarity with the best techniques to assess student critical thinking skills; and a perceived lack of resources to implement the changes needed to teach critical thinking effectively Critical Thinking in the Radiologic Sciences These findings clearly emphasize the lack of required resources currently available for implementation of learning methods necessary for the development of critical thinking skills Therefore critical information is needed to inform radiologic science educators, regarding exemplary educational strategies by examining educational approaches utilized by other health professions Objective of Systematic Review To systematically assess the literature to identify the best evidence of teaching methods which demonstrate a positive impact upon the development of student critical thinking skills The review was conducted using an a priori design with research questions and specific inclusion criteria Objective of Systematic Review This systematic review adhered to the AMSTAR evaluative framework (Shea, Grimshaw, Wells, et al, 2007) and Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) statement (Liberati, Altman, Tetzlaff, et al, 2009) Research Questions Can educational best practices that foster critical thinking be gleaned from the nursing and health professions literature to inform radiologic science educators? Which educational best practices best translate from other health professions to the radiologic sciences classroom? 1

2 Levels of Evidence Two systematic reviews Concept mapping in nursing students PBL in nursing students Four randomized studies (3 with control or comparison groups) PBL in nursing students(3) Collaborative group learning in allied health students Six cohort studies (all include control or comparison group) PBL in nursing students (4) PBL in physical therapy and occupational therapy students (1) Cooperative learning in physician assistant students (1) Two one-group pretest/posttest design PBL in nursing students Logic models in nursing students Four cross-sectional surveys PBL in nursing students (2) Collaborative testing in nursing students (1) Video simulation in nursing students (1) One case report PBL in nursing students Can educational best practices that foster critical thinking be gleaned from the nursing and health professions literature to inform radiologic science educators? These results suggest that educational strategies used in nursing education should serve as examples to inform educators in the radiologic sciences. Which educational best practices best translate from other health professions to the radiologic sciences classroom? The primary teaching strategy is PBL, with 46% demonstrating a statistically significant difference in the improvement of student critical thinking skills All are learner-centered activities: PBL, concept mapping, collaborative group learning/testing, and video simulation Definition of Problem-based learning A specific self-directed learning activity which must begin with a problem or a query which the learners must solve. In this context, a problem is defined as any situation or circumstance in a particular setting where specific knowledge and understanding must be applied to provide explanation and elicit appropriate action. Are the critical thinking skills required in nursing different than those required in radiologic sciences? 1. Yes 2. No Is it more important for RT graduates to know facts or theoretical concepts? 1. Facts 2. Theoretical concepts Problem-based learning In the purest sense, PBL requires an entire curriculum organized around problems relevant to learning outcomes versus a curriculum organized by topics or disciplines and it is applicable to both classroom and clinical settings 2

3 difficult to implement due to specific accreditation requirements Hybrid PBL Many nursing and allied health educational programs have adopted a hybrid approach in which the curriculum includes some courses offered utilizing a traditional teaching approach and some courses offered utilizing a PBL teaching method However, to fully implement PBL, the curriculum must be revised allowing course content applicable to PBL to be identified and integrated from a variety of topics typically taught in discrete courses within the educational program Think about your current position How much of what you do on a daily basis is directly related to concepts your learned in your radiologic sciences program? 1. <10% % % 4. > 90% Implications in Clinical Practice Where did you gain the skills to perform your current position? What skills are most valuable in a recent graduate? 1. Post-primary certification 2. Independent thinker 3. Life-long learner PBL Activities Hybrid model Advanced Exposure Course Completion of junior year Small group activity (3-5 students) Two week assignment PBL Activities Principal idea: The starting point for learning is a problem; a situation in radiography where knowledge and understanding have to be applied to provide explanation and elicit appropriate action Preparation for PBL activities What do I want to get out of this learning situation? What do I know? What do I need to know? What will it look like when I get there? What are the limits? What should I do in this situation? Where does this all fit in? Steps in PBL Process 1. The problem is presented, terms are reviewed, and hypothesis is generated Learning issues, data gaps, and sources are identified Information gathering and independent study occur The knowledge acquired is discussed and debated critically. Steps in PBL process 5. Knowledge is applied to the problem in a practical way. 3

4 30 6. Reflection on the content and process to help students attribute meaning in the learning experience Revisit and retrospectively describe the experience Attend to feelings that help or hinder learning Validate previous learning and apply new learning 1- Strongly disagree 2- Disagree 3- Slightly disagree 4- Slightly agree 5- Agree 6- Strongly agree Hypothesis generation I am unable to suggest an initial explanation. I did not know where to start. I am able to suggest an accurate and appropriate initial explanation. I identified reasonable alternative explanations Data gathering and interpretation I used a systematic approach to seeking information. I had no idea of the important items to be gathered. I used an accurate rationale for data collection. I utilized credible and current resources. I did not critically evaluate each resource. Management Plan I was unable to identify an appropriate action plan. I proposed options that were irrelevant or off target. I was able to prioritize actions appropriately. Current Knowledge I have a limited knowledge base relative to the scenario. I had difficulty thinking through unfamiliar concepts. I am able to apply explanations of underlying mechanisms in the scenario. Overall Assessment: Circle the appropriate number; 1 = Major errors and omissions 6 = Excellent Scenario A- Part 1 A level one trauma has been announced due to an MVA involving a semi-truck and car. The ETA is approximately 8 minutes. A 40 year old female was driving down the highway with her 16 year old son when she went left of center. The mother was dead on arrival but the son is currently being transported to the hospital via Life Flight. The only information the Trauma Team is given is that the teenage boy weighs approximately 200 lbs, has coded 2x on the way to hospital, and was successfully intubated on scene before Med Flight arrived. What preparation is necessary in anticipation of this patient arrival? Provide your rationale for each step in the preparation. 4

5 Part 2 Todd Smith, a 16 y.o. Caucasian male arrives in Trauma Suite 1 the ED and is placed on a ventilator. He is semi-conscious, restrained, and somewhat combative. His head is stabilized by blocks and he is in a cervical collar. Personnel in the area include the ED physician, trauma nurse, orthopedic surgeon, circulating nurse, and respiratory therapist. Once the initial patient assessment is complete, the physician first requests a portable chest, pelvis and lateral cervical spine. Through the patient s assessment the doctor believes there is a right broken humerus. Create an imaging plan including your rationale addressing: The order in which images are obtained Technical factors to be considered and controlled Technical factor selection Image processing Image assessment Management of critical results Scenario C Part 1 An 86-year-old female named Evelyn is brought into the main radiographic department by a transporting service. Evelyn is complaining of bilateral hip pain that began after she was moved from her bed to a wheelchair at the Assisted Living Center in which she resides. The paramedics from the transporting service give very limited information concerning Evelyn s medical history. The only information that is passed along to the radiographers is that she has Alzheimer s disease and high blood pressure. What considerations need to be thought about before moving Evelyn from the transport cot to the x-ray table to ensure a safe transfer? Please explain thoroughly. Part 2 Upon evaluation, the radiographer learns that Evelyn has limited mobility and she could not bear weight and ambulate prior to the fall. Her right leg is externally rotated and her femur is at a sharp angle from her hip. The physician from the Assisted Living Facility has requested images of the pelvis, hips and bilateral femurs to ensure that no fracture is missed. Create an imaging plan including your rationale addressing: The order in which images are obtained Technical factors to be considered and controlled Technical factor selection Image processing Image assessment Management of critical results Part 3 A fracture of the right femoral neck is identified on the pelvis and right hip radiographs. What additional follow-up is necessary and why? PBL Response References 5

6 Facione P. Critical thinking: What it is and why it counts. Millbrae, CA: The California Academic Press; Kowalczyk N, Hackworth R, Case-Smith J. A Survey of Radiation Science Program Directors' Perceptions of the Use of Critical Thinking Teaching Methods. Radiologic Technology (in press) Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, Porter AC, Tugwell P, Moher D, Bouter LM. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Medical Research Methodology 2007; 7: 1-7. Moher D, Liberati A, Altman J, Tetzlaff, C, Altman DG. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Journal of Clinical Epidemiology 2009; 62 (10): e1-e THANK YOU!!! 6