Problem-based learning preparation for physician assistant faculty.
Article Type: Report
Subject: Medical education (Methods)
Medical teaching personnel (Practice)
Medical teaching personnel (Training)
Medical colleges (Faculty)
Medical colleges (Practice)
Medical colleges (Training)
Authors: Midla, George S.
Coryell, Joellen E.
Pub Date: 10/01/2010
Publication: Name: U.S. Army Medical Department Journal Publisher: U.S. Army Medical Department Center & School Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 U.S. Army Medical Department Center & School ISSN: 1524-0436
Issue: Date: Oct-Dec, 2010
Topic: Event Code: 200 Management dynamics; 280 Personnel administration
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 253536853
Full Text: INTRODUCTION

Medicine has evolved greatly over the last century, but the way in which many institutions are educating those studying this discipline have not. The standard continues to be "chalk and talk" and "death by PowerPoint" as a way of depositing information into those seeking knowledge in the medical field. Many lecturers continue to deliver their neatly wrapped presentations. Unfortunately, it has been noted that students become mentally detached within the first 10 to 20 minutes of lectures. Learners are then left with the options of either attempting to extract the information from texts, or possibly questioning others who have taken the same instruction for exam outlines. (1) The issues related to lecture-type teaching are longstanding. Although the banking model (2) still exists in adult education, a variety of options have been explored as possible substitutes for this type of learning.

A search has begun by some to find alternate ways of presenting practitioner-based information. In pursuit of this goal, medical programs have reviewed the way in which this community conducts its business, and have attempted to mirror that in the way students are taught. In reality, practitioners are first presented with a problem. That problem could be a complaint of a headache or abdominal pain. The caregivers then investigate using multiple tools to come to some type of conclusion. Medicine has also incorporated a strong team approach to curing the ill. This team mentality can be observed, whether in an outpatient clinic or in a surgery suite. The ability for a group of individuals to communicate well and work together towards an objective results in positive patient experiences and a happy staff. An educational approach that supports learner development with a strong team mentality, clear critical reasoning skills, and complex medical knowledge and decision-making would be invaluable.

Problem-based learning (PBL) has been considered as a possible educational tool to support this needed evolution. (3) PBL education begins with a problem. Students then explore the problem while working in groups. The learners are required to take a team approach in analyzing the situation and applying critical reasoning skills to ultimately evaluate and formulate solutions. Simply stated, this teaching strategy mimics the course of patient care as seen in a clinical practice. This technique is vastly different from traditional medical education. In this latter form of pedagogy, students are first required to memorize packaged presented material in a lecture format. Later the student is required to retrieve these abstract ideas and apply them to a clinical problem.

Learning through problems has had its origins from before the time humans walked upright. To be first challenged with a problem, then have to resolve it has been the standard for our development. More recently, this method of education was resurrected and studied. To date, this form of teaching has been adopted by multiple disciplines in a variety of pedagogical roles. Although some scientific and medical programs have adopted PBL formats, physician assistant (PA) programs have been slow to implement it. Shared knowledge concerning this particular group and PBL in the form of studies and published literature is limited. Also, some universities have had a difficult time convincing their staffs that the revamping of their educational practices is a wise endeavor. Shifting the curricula and teaching methodology of a program is time-consuming and requires a philosophical buy-in from faculty and administration. These types of changes can often create friction within a program if individuals are unwilling or uninterested in working toward the success of the new approach. (4)

A study designed to examine a skilled way in which to implement a PBL PA program, although important, would be an immense endeavor. Some of the elements that would need to be addressed include logistical support, teaching topics, time, student preparation, and grading systems. Of these possible issues the preparation of a teacher who is not familiar with this particular mode of instruction would also be invaluable.

The teacher takes on the role of facilitator in a PBL format. The facilitator helps to guide students through the curriculum while promoting reasoning skills and self-directed learning. In addition, facilitators offer information in a capacity designed to cultivate enthusiasm and intellect. Students involved in a PBL curriculum then use critical thinking, teamwork, and research to address the topics needed to complete the course requirements. We find that the facilitator's job is multifaceted. In addition to guiding students, a balance between individual and group work must be achieved. The time allotted for student exploration must be managed. In addition, references and resources that fulfill the goals of a course must be identified. Student group dysfunction is also a possibility. The way that this is managed is as equally important as the presentation of rules as to how the groups will conduct themselves. If a new facilitator has a strong background in lecture based education, the change away from a teacher centered classroom to one that is student centered can also be a difficult task. This transition should be well thought-out and executed correctly for this style of instruction to be well received, and learning expectation outcomes to be achieved.

STATEMENT OF THE PROBLEM

Instructors involved with a PBL program must be able to manage both their knowledge of the subject matter and their facilitator skills. Knowledge of the subject matter includes their use of expertise, cognitive congruence, and test orientation. The facilitator skills to be managed are authority, role congruence, and cooperation orientation. (5)

A facilitator must be able to gauge how much of their knowledge of the subject matter should be shared with the students. For some tutors, it may be easy to fall back on previous teaching skills and start lecturing about the material instead of fostering additional research and inquiry. Cognitive congruence as related to how well the facilitator can communicate with the students, at their current level of understanding, must also be managed. Test orientation refers to how well the instructor directs students to what should be learned for the successful completion of the course requirements.

Facilitator skills needed by the teacher begin with the amount of authority used to steer student learning. Constant interruptions by the instructor can be detrimental to the PBL process. Role congruence, or the amount of understanding of the student's situations and perspectives, is also required. Finally, cooperation orientation refers to the ability of the facilitator in the management of group dynamics. Cooperation orientation will vary from relieving any frictions identified within the class to help in building positive relationships.

Therefore, the topic of this study was to determine what types of preparation might be needed for an instructor of a physician assistant program to be successful in the adoption of a teaching style that includes problem-based learning facilitation. In addition, the triservice physician assistant program located at Fort Sam Houston, Texas, is currently restructuring its curriculum. The changes that are planned for this program include portions of the course to be taught in PBL fashion. This study will also directly help with this planned transition of the Army Medical Department.

METHOD

The purpose of this study was to identify what types of preparation would benefit a facilitator who would assume a new teaching role in a PBL program for physician assistants. The research questions were:

1. In what ways have PA instructors been prepared to conduct PBL in a PA program?

2. In what ways have PA programs prepared the curricula, students, and logistical issues which directly or indirectly support PBL instructor readiness?

A qualitative approach in data gathering was used to address the research questions. This method was chosen because the study conducted was exploratory in nature. An open-ended approach to data gathering was essential in finding a descriptive interpretation of the phenomena. Open-ended questions were used to gain insight into PBL facilitator preparation. During interviews, individuals clearly translated their issues to provide a coherent understanding of what they felt was needed for such a transformation. The use of a qualitative approach provided additional insight related to the respondents' attitudes, beliefs, and motives. (6)

SAMPLE

A web search was conducted to locate universities that had physician assistant programs which use problem-based learning in their curriculum. Two American universities were identified and approached for respondents to take part in this study. One institution is located in the midwest and the other in the southwest. A total of 7 PBL facilitators from these programs were interviewed. Six of those participating were certified physician assistants. The last was a practicing family medicine doctor. The average amount of time these individuals had been working as a facilitator in a PA program was 3.3 years, and the average amount of hours per month they were in an active PBL setting was 48.8. Five of the respondents were female, two were male. All of the respondents were currently licensed to practice medicine and were working part-time as providers in local practices in addition to their full time teaching duties. Five of the participants answered "all topics" when asked about the topics of instruction for which they were responsible. Of the last 2 facilitators questioned on teaching responsibilities the first answered electrocardiograms, evidence based medicine, advanced cardiac life support, basic medical procedures, and antibiotics. The last instructor said he was responsible for facilitating physiology, pharmacology, clinical procedures, gastroenterology, and cardiology. The teaching and medical experience and demographic data are presented in the Table.

DATA COLLECTION

In this study, the semistructured interview was used as a data gathering technique. This approach allowed the informants to discuss their experiences in ways that made sense to them, yet was focused enough to connect with the research questions. One to 2 hours of time were allotted for face-to-face meetings. Locations that were both quiet and void of possible interruptions were chosen for these encounters. Anonymity was achieved by hiding the participant's identities through number coding; all the participants were given a number code so that no links could be made between their remarks and them. In addition, no information collected during the interviews was shared within the departments at which those interviewed were employed.

A set of verbal questions to determine demographics was first presented (Figure 1). The demographic questions enabled the researcher to better understand both the teaching and medical experiences of each participant. The interviews were then conducted immediately after the demographic questions were answered. Twelve questions were asked to each participant in the order presented in Figure 2. All interviews were conducted by the investigator and were captured using a digital recorder.

The questions developed for this study were designed to promote open discussion. By supporting this type of dialogue through an open format, valuable insight was gained into the issues under investigation. There was no cost to those participating in these dialogues, nor were there any incentives offered.

DATA ANALYSIS

All interviews were transcribed. The initial information collected was viewed as raw data. This material was then analyzed using the process described by Hitchcock and Hughes. (7) The first goal was to become well acquainted with the interviews. This included multiple reviews of the audio files and transcribed discussions. (8) The texts were then condensed by eliminating information which did not pertain to the study questions. After this had been accomplished, a second approach was initiated.

The data were then examined for repeating words and phrases that might be used to code the information into logical segments. For this technique, the codes were applied in order to develop multiple categories which were originated from the interviews. Grouping and examination of the information further resulted in recurrent themes. In using the collected material to develop concrete meaning, the results were "grounded" in the data. (9) The grounded method for analyzing data was used so the examiner was not as likely to impose his own biases and preconceived perspectives on the information.

The themes derived from the identified codes were then annotated. The themes were used as a basis for interpretation of the information that was initially collected. These summaries captured the essence of what the respondents felt was important or might have been lacking in their experiences when beginning their new roles as PBL facilitators. In the identification of recurrent themes, many of the respondents supported each others' perspectives on PBL facilitator preparation. Because of this agreement, second interviews to clarify the respondent's viewpoints were not requested. (10)

FINDINGS

The questions posed to the interviewees exposed large amounts of information concerning PBL facilitator preparation. There were 2 goals of this study: to identify in what ways PA instructors have prepared to conduct PBL in a PA program, and to identify ways in which PA programs prepared the curricula, students, and logistics issues which directly or indirectly supported instructor readiness.

The first question presented to each of the respondents required them to share personal thoughts on their definition of PBL. The most common remarks made were that PBL was based on problem solving and was student-centered. It was also mentioned that PBL developed both critical thinking skills and life-long learners. All of these comments were congruent with definitions identified in current PBL literature. (11)

Four major themes related to these questions were produced from the data. The themes identified include attitudinal factors and previous experiences that support instructor transitions, insights into new instructor professional development, and the importance of preparing students to learn in PBL programs.

ATTITUDINAL FACTORS AND PREVIOUS EXPERIENCES THAT SUPPORT INSTRUCTOR TRANSITIONS TO PBL

Facilitator Support for PBL

All of those interviewed felt very strongly that PBL was a good approach for the instruction of physician assistants. Common responses from the subjects interviewed included phrases such as:

This support felt by staff members was not without reasons. Interviewees felt that the method supported authentic clinical medicine practices:

This argument has been observed in the past in other cited literature. (11,12) PBL supports clinical medicine in a unique way by mirroring actual medical practice.

Previous Experience

A strong buy-in for this educational forum, although important, was not the only consideration discussed in helping with the transition to PBL facilitation. Staff members were quick to identify their thoughts concerning what previous experiences might support a smooth transition into such a teaching position. All faculty members arrived at their current position through different routes. The variations included previous clinical experiences, educational backgrounds, and for some, other teaching jobs. These differences had an impact on thoughts concerning what previous experiences might cause a new PBL physician assistant instructor to have a smoother time adjusting to this new method of instruction.

Comments were made concerning the need for a generalist's background. It was thought that since they were teaching a variety of medical disciplines, being a specialist in one given field might restrict a facilitator's ability to manage the variety of material that must be addressed. For example, one participant remarked:

The wide range of medical topics presented in these programs and the level of experience students may have will often lead to a variety of differential diagnoses presented by a group. Having a broad range of clinical experience, although important, is not the only criterion concerning facilitator transition that emerged.

Having been exposed to PBL while undergoing initial PA training was another possibility discussed. It should not be surprising that those who attended a PBL program while first becoming a PA felt their experiences gave them greater insight into this method from the start of their new teaching position:

These remarks offer a clearer picture of a new facilitator who would be expected to have the easiest transition into the teaching role. Participants agreed that prior PBL exposure in addition to a broad clinical background may significantly support PBL instructor transitions.

Nonclinical Facilitators

A final subtheme regarding previous experience and transition to PBL instruction addressed the negative feelings about the use of nonclinical tutors as facilitators. The interviewees did not support the idea of nonclinical tutors, although they did recognize that this teaching practice has been described in the literature:

Physician assistant programs do not have the luxury of time. They are required to produce a competent clinician in a very small span of time. Using a nonclinical tutor as a facilitator could cost a program valuable time in educating their students:

Students often relate well to teachers who can offer real-life experiences while working in the field of study under examination. The faculty from the 2 programs stressed this and described sharing their personal trials of being a clinician, which was accepted warmly by their students. Having a nonclinical facilitator negates this important venue when attempting to educate a group. In addition to having previous clinical experience as a prerequisite to applying this method, additional professional development was also identified as critical.

NEW INSTRUCTOR PROFESSIONAL DEVELOPMENT

Faculty preparation upon coming to a PBL program was discussed in depth. Two common themes arose from the interviews. A short preparation course that included some mock PBL sessions and a mentorship shadowing program were identified as critical preparation elements:

Five of the 7 participants interviewed supported the opportunity to attend a one- or 2-day mock PBL session. Participants of this training used role play to prepare themselves through instructional scenarios. New staff members became the students as a senior member took on the role of a facilitator. The role players would take breaks at specific times to review what had transpired and what individuals could have done to maximize the outcome for those involved. Immersion in a training exercise that closely mimicked typical group behavior was the reason this experience was so highly valued.

Finally, a mentorship program was identified as the most important aspect of facilitator preparation. One participant suggested:

The ability to identify and access a trusted advisor was instrumental in this professional change. These relationships included new faculty first observing their assigned mentors in an actual tutorial group. As they became more comfortable, they would assume stronger roles as assistants. Finally, their mentors would observe the new facilitators' work and offer critique until a comfortable level and institutional standard was reached. New faculty arrivals were also expected to review and study the course work so that they would be prepared to address instructional topics in addition to the outlined professional development.

Preparing to Teach for the First Time

Preparations for the first teaching experience was consistent across the data set. In preparation for leading an upcoming group session, the staff liked to review the case, the students' text books, and MD Consult* for any recent changes to the material. This allowed them to have an updated foundation of the course work. One individual made what they called a "word target list" after reviewing these resources. This list was used by presenting the words or phrases compiled at specific times during a session, which were then used by the students as hints to guide them through the material. In addition, the "word target list" was used as a listening tool for the facilitator which helped her gauge the amount of progress that was being attained in the classroom. She offered:

The review of current medical literature for an upcoming tutorial is crucial and common in PA education practices. The medical field is constantly undergoing reforms based on published current studies with the development of new pharmaceuticals, instruments, and techniques. Although the identification of facilitator preparation topics was the main goal of this study, the participants stressed that a continuously updated PBL knowledge base for the students was also critical for a facilitator.

Preparing the Students

The discussions for the participants changed as we began to explore what their programs had done in preparation of such things as the curricula, students, and logistical issues that directly or indirectly helped with instructor transition:

Students are encouraged to read about PBL on their own. In addition they are given the opportunity to observe an actual tutor group. Once they begin the course work, time is set aside to identify ground rules for the groups. The class determines consequences for tardiness, how it makes the group feel, why it is important to start on time, how to give and take criticism, when breaks will be taken, and for how long they will be. Some of the faculty also stated that physical exams should be taught early in the program to support the clinical philosophy of PBL.

One of the interview questions addressed the achievement of a proper balance between individual and group work. The participants in this study suggested this was not a concern in their facilitation experiences. It was stated that all students are responsible for their own individual learning, and, if they do not succeed in their personal tasks, the group fails. It becomes obvious to the group and the instructor if one of the participants is not prepared. A participant also mentioned that the learners are so busy with keeping up with the course work, they do not have time to complete another colleague's assigned tasks. The demanding obligations imposed on each learner ensures individual work will be performed. In addition to extending the time allotted for early group work, student and facilitator preparation defined what was needed for a new facilitator to transition well.

COMMENT

The open-ended questions posed to the interviewees exposed insight into useful concepts regarding facilitator preparation for a physician assistant PBL teaching position. The information collected on the demographics of the participants (Table 1) did not provide the study any additional data which was identified as having an effect on the findings. The first theme presented suggested strong support for the instructional approach for PA education. Not only did those questioned endorse this method, they were excited about being a part of their respective programs. During each of the interviews, every participant used very strong positive verbiage in describing their support for using PBL in PA education. Their commitment to PBL rested heavily in the belief that the method allowed learners to practice, with support, what they would ultimately face clinically in a real-world setting. Others felt that it also proved effective in student preparation for written exams, and that their pass rates on the Physician Assistant National Certification Exam were very competitive with traditional programs. (13)

Past work and educational exposures were also found to be important factors. When they discussed previous experiences that might help a facilitator transition into this new teaching role, many felt that past participation in PBL training would be helpful. They thought that PAs who were initially trained in a PBL program transitioned to PBL instructor roles more easily. It was also suggested by some that generalists might be more suited to teach in this format because of the wide range of medical exposure they have had. This experience would help them with the broad range of differential diagnoses that are discussed during a case study. Many interviewed also felt that a physician assistant, rather than another type of medical provider (to include medical doctors) would be the best suited for this teaching position. It was pointed out that a PA has a better understanding of the student's clinical role after graduation. The students in these programs were being trained for a primary care setting and not a specialty clinic. This awareness was felt to be important in recognizing when a PA would refer a patient out of their clinic due to the complexity of the case. For a primary care PA, the initial diagnosis and treatment plan of a case study concerning colon cancer is much different from the same patient's situation at an oncology or general surgery clinic. Becoming too in-depth in a case study might result in the use of extra time when these types of programs do not have this luxury.

The last theme related to previous experiences was the use of nonclinical tutors in a physician assistant PBL program. The traditional PBL model suggests that a facilitator need not be well versed in the subject studied. As Woods14 explains:

He further advises that eventually students will self-correct and develop the right answers without a clinical expert present. The findings of this study suggest otherwise. All respondents agreed that this might be true in theory, but they did not feel that it was plausible in the PA education context. PA programs are under great time constraints to cover large amounts of critical material. Without a facilitator with a clinical background, it was believed that increased lengths of time for the students to adequately address all the learning issues would be needed. Having an experienced clinician as a facilitator helps refocus the group when it gets too far from the required learning topics. Learning topics are designed into the curriculum at specific levels within the course work. Students may begin to address material that is designed for exploration at a later date in the program. Refocusing group work saves time and supports curriculum sequencing. In addition, an experienced clinician is better apt to question incorrect information presented in the group. Facilitators without a medical background would not be in a position to identify incorrect data. Having clinical experience would better support efficient learning.

A preparation course for new facilitators was offered at both institutions that took part in this study. Although, each institution felt that their training program was important, those interviewed also felt that it should be limited to one or 2 days, if possible. A training program designed around role playing or a mock PBL session was recommended. In addition, a mentorship program was stressed. It was felt that a new facilitator would benefit greatly by observing and team-teaching in an actual PBL class for a period of time and then having a seasoned tutor observe their first few classes. This experience allowed constructive criticism to be offered on tutor session management. Insight into facilitator techniques was gained through this process as well. A mentoring program was considered vital in the preparation of new faculty.

Part of ensuring facilitator success is a program that prepares learners for their role in this setting. A tutorial group aware of how problem-based learning is constructed helps ensure that these gatherings will attain the goals set by the curriculum. Student preparation in PBL was conducted through a multifaceted approach. It was pointed out that it is important for students to recognize if such an independent educational venue is right for them.

Interviewees stressed the requirement for additional time allotted for early PBL group work. This increase is required for students during their adjustment phase to PBL. In addition to the new educational process, achieving a grasp of both complex medical concepts and related vocabulary is another considerations for planning more time. Also, the faculty stated the importance of becoming involved with guiding the students early in the program. It was presented that if these measures were not taken, extended time would be required in their initial PBL group work. With additional time already factored into a new class, having students extend an already long day might lead to both student and faculty fatigue. Preparation of the students for their new educational role lays a supported foundation for success for both learners and new faculty members.

In the preparation for an upcoming group session, all 7 facilitators approached the task in the same manner. They reviewed material that coincided with the subject taught by reviewing text books, up-to-date web sites (MD Consult was the favorite), and other references. In addition to these resources, one facilitator used a word-target-list which she synthesized from the same web sites.

There is a lack of published information concerning physician assistant PBL programs. This study sought to resolve some specific issues centered on facilitator preparation in these programs. The data gathered resulted in themes related to facilitator's outlook towards PBL, experiences which helped faculty better transition into their teaching position, and identification of various resources that assisted in preparing faculty and students.

REFERENCES

(1.) Marzano RJ, Pickering DJ, Pollock JE. Classroom Instruction that Works: Research-based Strategies for Increasing Student Achievement. Alexandria, VA: Association for Supervision and Curriculum Development. 2001.

(2.) Freire P. Pedagogy of the Oppressed. 3rd ed. New York, NY: Continuum Publishing Company; 1994.

(3.) Leung W. Why is evidence from ethnographic and discourse research needed in medical education: the case of problem-based learning. Med Teach. 2002;24 (2):169-172.

(4.) Azer SA. Problem-based learning challenges barriers and outcome issues. Saudi Med J. 2001;22(5):389 397.

(5.) Groves M, Rego P, ORourke P. Tutoring in problem-based learning medical curricula: the influence of tutor background and style on effectiveness. BMC MedEduc. 2005;5:20.

(6.) Lieblich A, Tuval-Mashiach R, Zilber T. Narrative Research: Reading, Analysis, and Interpretation. Thousand Oaks, CA: Sage Publications; 1998.

(7.) Hitchcock G, Hughes D. Research and the Teacher: A Qualitative Introduction to School-Based Research. 92nd ed. New York, NY: Routledge; 1995.

(8.) Creswell JW. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. 2nd ed. Thousand Oaks, California: Sage Publishing; 2003:150.

(9.) Strauss AL, Corbin J. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. London: Sage; 1990.

(10.) Fontana A, Frey JH. Interviewing: the art of science. In: Denzin D, Lincoln Y, eds. Handbook of Qualitative Research. Thousand Oaks, California: Sage Publishing; 1994:361-376.

(11.) Duch BJ, Groh SE, Allen DE. Why problem based learning? A case study of institutional change in undergraduate education. In: Duch BJ, Groh SE, Allen DE, eds. The Power of Problem-Based Learning. Sterling, Virginia: Stylus Publishing, LLC; 2001:3-11.

(12.) Blessing JD. Introduction to problem-based learning. In: Blessing JD, ed. Clinical Problem Solving for Physician Assistants. Philadelphia, PA: F.A. Davis Company; 2002:1-6.

(13.) Van Rhee JA, Wardley S, Hutchinson CA, Applegate B, Vangsnes EH, Meyer JM, Grinwis BA, Fenn WH. Problem-based learning in physician assistant education: establishing a basis for a comparative study. Perspect Physician Assist Educ. 2003 ;14(4):242-248.

(14.) Wood DF. ABC of learning and teaching in medicine: problem based learning. Br Med J. 2003;326(7384):328-333.

MAJ George S. Midla, SP, USA

Joellen E. Coryell, PhD

* http://www.mdconsult.com/php/217887812-2/homepage

MAJ Midla is a physician assistant at the Brooke Army Medical Center and an adjunct professor at the Interservice Physician Assistant Program, Army Medical Department Center and School, Fort Sam Houston, Texas.

Dr Coryell is an Assistant Professor of Adult Learning and Teaching at the University of Texas San Antonio.
Profiles of study participants by demographics and medical and
teaching experience.

Gender              Female   Female   Female   Female   Female

Age                   52       43       41       55       39

Ethnicity           White    White    White    White    White

Years teaching in     6        7       1.8       9       1.5
PA programs

Years in current      6        7        1        9       1.5
position

Years teaching        6        13       1        9       1.5
with PBL

Years teaching in     0        0       0.8       3        1
lecture format

PBL hours per         90       60       12       12       80
month

Topics of PA         All      All      All      All      All
instruction

Gender                    Male               Male

Age                        54                 38

Ethnicity                White               White

Years teaching in         1.5                 1.5
PA programs

Years in current          1.5                 1.5
position

Years teaching            1.5                 1.5
with PBL

Years teaching in          0                   0
lecture format

PBL hours per              12                 80
month

Topics of PA        Physiology         Electrocardiogram
instruction         Pharmacy           Evidence-based
                    Clinical             medicine
                      procedures       Advanced Cardiac
                    Gastrointestinal     Life Support
                    Cardiology         Basic procedures
                                       Antibiotics


Figure 1. Format of interview questions to determine the
demographic makeup of study participants.

I would like to ask you some demographic questions. Your
participation in answering them will help in this study. The data
collected from demographics may uncover information specific
to certain groups of individuals, which can later function in the
designing of a PBL program that caters to these differences.

1. What is your ethnicity?

2. What is your age?

3. How long have you been teaching physician assistants?

4. How long have you been teaching in your current
position?

5. How long have you been a facilitator for PBL?

6. Did you ever teach at a PA program where you used a
lecture based format?

7. How many hours per month do you work as a facilitator

for PBL?

8. What topics of instruction are you responsible for as a
facilitator?


I think the program is very effective.
   I think it's terrific.
   I think it is an excellent way for teaching PAs and in
   teaching medicine in general.


So my feelings are very strongly positive, because we
   learn in the way that we need to know it as a clinician.
   PBL is structured so that it closely mimics what
   students will ultimately face once in practice.


I think that general practice or family practice would be
   helpful just because it depends on what you tutor. Our
   program is set up and our units are on specific
   disciplines, so if you're an expert on that topic it will be
   very easy for you. If you get stuck teaching neurology
   and you are not experienced in it, then it will be more
   difficult for you.


Figure 2. Format of interview questions to determine the
teaching and medical experiences of study participants.

The following questions I am going to ask you have been
designed so that knowledge can be gathered to help answer 2
broader issues concerning problem-based learning (PBL). These
issues are:

* In what ways do current physician assistant instructors
specifically prepare themselves to implement problem-based
learning in their program?

* What are the perceptions of current physician assistant
facilitators in terms of their programs preparing the curricula
and logistical issues of making a change to problem-based
learning, which directly or indirectly support instructor
transition?

1. PBL education can mean a variety of things to people.
Can you explain your definition of PBL?

2. Could you tell me about your feelings regarding PBL
and its effectiveness in instructing PAs?

3. Could you tell me about your feelings regarding PBL
and its effectiveness in instructing PAs?

4. Were there facilitator preparation topics you wish you

had more insight into that could have better prepared
you for your new teaching role?

5. What   should   a   preparation   program   for new
facilitators look like?

6. We already discussed some of the possible topics that

would have better prepared you for this new teaching
role, but do you have any other comments on topics
that might help other instructors?

7. How do you  now plan/prepare for an upcoming
course or class?

8. Have you identified any academic resources that are
needed for a facilitator? If so, please explain.

9. How do you prepare your students for their role in a
problem-based learning group?

10. How is time managed in your classes?

11. How do you achieve a proper balance between
individual and group work?

12. What other insights have we not discussed that you
can offer future PA facilitators using PBL?


In our opinion, someone who has been through PBL
   adjusts to it more smoothly than those who only have
   previous work experience. Graduates who come back to
   our program or they have had some PBL previously and
   at least understand what it is usually adapt easily. However,
   someone who comes from a background of primarily
   receiving lectures usually they fall back into that
   teaching mode. In PBL that is not done; we must hold
   ourselves back and let the students do self learning.


The typical program states that anyone is capable of
   doing PBL, so I think you need to eradicate that form of
   program and be more practical.


The group would correct themselves if we were in there
   for 20 hours, but that is not possible. So the main thing
   for facilitators is to not fool themselves. They must be
   clinicians to be effective tutors in PA education.


We do a very nice job. We do role playing, which I
   think is the best thing to do besides being dumped in as
   a tutor and see what happens.


I think the biggest thing is mentoring. The other thing
   we do is once we get a new person who comes in we
   have someone go in with them at least the first few
   times they are tutoring.


I review the learning issues sheet and then go to
   resources to review for the case even if I have taught it
   before. Then I go back to the learning issues sheet and
   make notes like little word targets that I'm going to look
   for and hopefully they [the students] will bring me back
   through their learning issues. I will then spring off of
   that learning issue and point some of those out, to track
   them and puzzle weave them into the learning issues.


When they [the students] interview, we do a mock PBL
   so they already have an idea. Our website talks about
   PBL but we encourage them all to be aware of PBL
   before they ever come to the program.


Staff may feel uncertain about facilitating a PBL
   tutorial for a subject in which they do not themselves
   specialise. Subject specialists may, however, be poor
   PBL facilitators as they are more likely to interrupt the
   process and revert to lecturing.
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