An approach towards problem-based learning in virtual space.

Problem-based learning (PBL) is an established and efficient approach to sustainable teaching. Here, we describe translation of PBL into the virtual classroom thereby offering novel teaching aspects in the field of Nuclear Medicine. Our teaching approach is implemented on a "moodle" platform and consists of 2 modules: complementary seminar teaching materials and a virtual PBL-classroom, which can be attended via Skype.Over the course of 4 semesters 539 students have accessed our teaching platform. 21 students have participated in the PBL seminar (module 2). After resolving some minor technical difficulties our virtual seminars have evolved into a forum of intense studies, whereby the participating students have learned to become more independent along the workup of the teaching cases. This was reflected in the results of the intra-group presentations and discussions.Quantitative and qualitative evaluation of our moodle-based PBL platform indicates an increasing level of acceptance and enthusiasm by the students. This has initiated discussions about opening our PBL concept to a wider audience within the university and beyond the Nuclear Medicine specialty.

Introduction

The idea of problem-oriented learning (POL) is to promote self-managed, discovering and cross-disciplinary learning and to enable a self-evaluation. Participants should learn to analyse a topic, to research and evaluate the literature and eventually to compare, select and implement solutions. In recent decades this teaching method has proven to be more effective than the “traditional chalk and talk” [1], [2] and is gaining, especially in the context of medical education and especially in the first phase of training - in importance [3], [4], [5]. Nuclear medicine is a so-called “small” subject and therefore has relatively little presence in everyday medical teaching. This means that many students have little contact with the content and possibilities of the subject. With a multi-media seminar [6], this can be changed. Moreover, as an imaging subject, nuclear medicine offers itself to media-based teaching/learning methods [7], [8]. This approach in a way allows the simulation of medical activities. The student gets a better insight into the possibilities and limitations of the procedures. In addition, media supported teaching/learning methods that go beyond the traditional methodological approach of lectures and seminars are a useful supplement to study provision [1], [9], [10], [11]. Against this background, we made attempted to supplement “traditional” nuclear medicine teaching with a multi-media POL-seminar teaching project, which transfers the POL concept into virtual space.

Overall Teaching Goal

The aim of the course is present nuclear medicine as a clinical specialisation, to demonstrate the basic principles of nuclear medical activities and to open up awareness of functional imaging and molecular treatments. It is a special concern to us to communicate the fascination and methodological elegance that is inherent to the analysis of physical features with no relevant intervention in the metabolic processes. In addition to the teaching of subject-specific knowledge, it is important to also relate the subject to clinical practice in order to raise awareness of the future workplace reality for students, something which usually lies outwith nuclear medicine.

Teaching Project

The teaching project based on the learning platform used at the University of Duisburg-Essen, “moodle” (http://www.moodle.de/), (http://moodle.uni-duisburg-essen.de/course/category.php?id=101) consists of two parts:

the nuclear medicine moodle pages accompanying the seminar

the POL area of nuclear medicine.

The first part allows students to reproduce the nuclear medicine seminars, the films used, and useful references and links are provided. In the second part of interested students can participate in a voluntary online-POL seminar and deepen their knowledge. The first part allows students to revise the nuclear medicine seminars by providing the slides, sources and further references. In the second part interested students can participate in a voluntary online POL seminar and deepen their knowledge. This part of the offer was - because it is teaching project - deliberately designed to be passive; except for a forum and feedback tools there are no plans for interactive teaching at this level. The concept plans that moodle pages accompanying the seminar draw attention to the “active offer” (the POL area) and serve as a “lure”.

Therefore, the method of problem-oriented learning is described at the bottom of the page and the first POL case is made available on this page. Students interested in working on this POL case in a virtual seminar are asked to register by email to receive more information. Once there are at least 4 people interested in working on a POL case, a small group is formed. To conduct a virtual POL seminar, some basic technical knowledge or preparation is required from each participant. Due to the costs, a deliberate decision was made not to use virtual classrooms or a similar platforms. In our context the online communication software Skype (http://www.skype.com) and the word processing application Google Docs (http://www.google.com/google-d-s/intl/de/tour1.html) were used. Both programs available free of charge and are already used by many people in everyday life. While Skype provides the basis for the online meetings with conference calls, the application Google Docs has the advantage that a multitude of documents can be edited by different people, simultaneously or one-at-a-time, so simple synchronous and asynchronous online collaboration is possible. For this purpose the tutors create an account and provide login information for the students. The case process is inspired by the classic POL principle, which means the starting point for the students is a real case study from nuclear medicine. To date, three cases have been completed dealing with thyroid diagnosis, oncological positron emission tomography (PET) and myocardial scintigraphy. As an example, the POL module “Energised” on thyroid diagnosis and treatment, including the background information for students and tutors, the intended learning goals and guidelines for online presentation is shown in the appendix . The case is worked upon - following the classical POL model [12] - in seven steps, which are carried virtually for the most part (online):

The steps to clarify basic questions of understanding, defining the problem, the collection of ideas and approaches, the systematic ordering of ideas and approaches are made online in a Skype conference call under the moderation of a tutor (a specialist in nuclear medicine or a medical physics expert, each with at least 5 years of teaching experience but without dedicated training), which ends in the formulation of learning objectives. Subsequently, students work on their own or in groups to develop the learning content and compile the results in a document (text or slides).

In this phase, slated to last up to three weeks maximum, the tutor is available by email or by telephone on weekdays to answer questions and problems and responds to questions/comments within 24 hours. Finally, the synthesis and discussion of the group results on the basis of the documents takes place online as well. A feedback session concludes the case discussion.

Experiences and Evaluation

The educational project “Molecular Imaging”" was conducted in summer 2008 for the first time. It was found that the “passive” part of the offer was well received in the last four semesters. A total of 539 students used the slides for revising the seminars. The “active part”, which expects a lot of participation from the students, was viewed by 21 students from the 2nd (n=11), 3rd (n=8) and 5th clinical semester (n=2) in five POL groups of 4-5 students each. Except for two students all participants have completed the relevant course. Both drop-outs indicated that the course was too effort-intensive and one student complained that the technical conditions are inadequate. The technical difficulties consisted of initial problems with the Skype conference, causing the start of the first POL-event to be delayed by 30 minutes. Amongst the other 19 participants, the seminars became a very active forum in which the students became increasingly independent. This was reflected, among other things, in the activity of the tutor who only had to intervene in one seminar on myocardial scintigraphy when the group wanted to place its main focus on coronary angiography rather than put nuclear medical diagnostics. Otherwise, the tutor essentially only had to carry out moderating duties. Working through the cases on average took 6 to 7 weeks and in respect to the intended learning goal, the factual results were positive. Due to the (so far) relatively small number of participants, no valid comparison between the “classic face-to-face POL seminars” can be made. From the perspective of the tutors it can be said, however, that both the results of the students' work and the subsequent discussion were at a very high level.

The virtual POL seminar had the character of a teaching project, so far with only relatively few participants. Accordingly, our evaluation interest was not only quantitative but also qualitative. The starting point of this approach was the social scientific criticism of the quantitative survey with questionnaires, which allow mathematisation of the results presentation and reproducibility but with results that often remain superficial due to the suppression of factors or that may produce a false picture [13]. In the context of a complex teaching-learning situation a of lack of proximity to the problem and a lack of practical relevance can be the result. With a qualitative survey, however, we chose an open results approach, which highlights the teaching-learning situation in its inner argumentative and practical structure. This is important because the views of the relevant stakeholders will be reflected systematically.

Against this background, the evaluation of the course was carried out both in a feedback session at the end of the course and via a brief online questionnaire (moodle), in which students graded four aspects of the course (from 1 “very good” to 6 “bad fail”). 17 of the 21 students evaluated the event (see Figure 1 (Fig. 1)) and gave mostly positive assessments. It is striking that the technical implementation of the course, especially the first POL groups, received the worst assessment which can also be ascribed to initial problems of the tutors. In the feedback session all participants stated that they benefited from the seminar. A virtual seminar was uncharted territory for most participants and this is reflected in statements that the format of the seminar takes some getting used to. There was also consensus that a restriction of communication to the linguistic level is difficult because the non-verbal element is important, particularly in group work. It is therefore not surprising that four of the five small groups met in face-to-face during the working stage to discuss the case. From the perspective of teachers and the clinic too, the seminar was instructive, even labour intensive compared to the classical “chalk and talk” approach, with an average of 11 hours (6 hours in total in the online phase, 3 hours for evaluating the results and feedback to students and 2 hours for tutoring support).

Figure 1

Results of the written evaluation of the virtual POL course from 2008 summer to 2009/2010 winter semester (n=17 questioned, gradings (1 “very good” to 6 “bad fail”), absolute frequencies)

Discussion and Outlook

In summary, in our view, the transfer of the POL principle to virtual reality is possible and we judge the first results as a success for the students, teachers and the subject of nuclear medicine overall. Although the POL approach is time-intensive, in particular for teachers and students and created technical problems initially, the described concept has the potential for wider communication of basic knowledge in nuclear medicine. However, it seems difficult, especially in the group phase, to operate purely on virtual interaction between the students as the limitations of this communication form were felt to be difficult, so that in four of the five seminars face-to-face meetings of the students also took place. It remains to be seen whether this can be overcome by the growing online socialisation of students or whether the seminar consequently will be limited to the study site to continue to enable personal contact. Nevertheless, we view virtual POL seminars as an interesting addition to teaching which make it possible to interest motivated students in the subject of nuclear medicine and in the medium, perhaps to win over [14].

To achieve this, it must be discussed in the following how the widest possible involvement of students can be achieved. In the pilot courses conducted by us, which were primarily about the feasibility of virtual POL and first experiences, the seminar was completely voluntary and, in comparison to the number of students who access the moodle site, relatively little used. This experience is consistent with those of the working group on “Computer-assisted teaching and learning systems in medicine” in of the German Society for Medical Computer Science, Biometry and Epidemiology (GMDS), which reports that only about 5% of students took advantage of the available e-learning systems as part of their self-studies [quoted from [15]]. A study on the case-based CASUS system points out that a main reason for the lack of student use of e-learning is linked to the lack of relevance to the students. In the Munich study, cases were worked upon by all students as soon as this was linked to “credit points” and thus relevant for the students’ exams. In case of pure self-study, where no credits were awarded, this occurred with only 10% of students [16]. It is likely that these conclusions also apply to virtual POL.

In the coming semesters an attempt will be therefore to anchor the POL seminar in teaching more strongly, for example by approaching interested students in the presence seminars or on the moodle course “Molecular Imaging” already. In the longer term, we are considering the introduction of structural changes by integrating the course in the curriculum and extending it beyond the specialist subject of nuclear medicine to the full range of diagnostic imaging, in particular radiology. In doing so, the course would not only become more attractive to students but for the teaching staff it could become a focal point for new approaches to teaching that go beyond one’s own subject.

Limitations of the Study

Although the experiences with the virtual POL that were described were generally positive, in our view it must be clearly stated that this was limited to an educational project only and that this must be further optimised. This applies to both to the virtual POL itself by further developing the seminar content (improving the cases), technical aspects (smooth flow) and to organisational aspects (approaching students more actively) or further linking with other courses (for example using a student wiki [17]).

As experience with the project increases and an increasing number of students, the project focus must lie in further evaluation. This needs to be extended and standardised to create a representative baseline in the medium term that will allow us to compare the intended learning outcomes of classic POL with our virtual POL. Only if the results achieved are at least comparable, long-term implementation of the virtual POL would make sense.

Competing Interests

The authors declare that they have no competing interests.