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11/11/2017

Current Concepts of
Problem Based Learning and
Curriculum Development
Ahmad Raif
Block 1. 5 Medical Education Management
Master Degree of Biomedical Sciences
Postgraduate School of Universitas Prima
Indonesia
Medan
2017

Problem Based Learning : Continuum


Theoretical Learning

Problem Oriented Learning

Problem Assisted Learning

Problem Solving Learning

Problem Focused Learning

Problem Based Mixed Approach

Problem Initiated Learning

Problem Centered Discovery Learning

Problem Based Learning

Task Based Learning

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Problem Based Learning : Continuum


Theoretical Learning

Rul (Th) Traditional Lecture, Textbook

Problem Oriented Learning

Rul (Pt) Lecture with protocol (guide)

Problem Assisted Learning


Rul  Eg Lecture followed clinical experience

Problem Based Learning : Continuum


Problem Solving Learning

Eg Case Discussion

Problem Focused Learning


Introductory Lecture, Information in
Rul  Eg  Rul
Study Guide

Problem Based Mixed Approach


Combination Information and Problem
Rul  Eg, Eg  Rul
Based Approach

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Problem Based Learning : Continuum


Problem Initiated Learning
(Eg)  Rul Patient management

Problem Centered Discovery Learning


Student derive Specific Principle from
Eg  Rul (Sp)
Literature

Problem Based Learning


Ex : Investigation of Thyrotoxicosis, student
Eg  Rul (G)
understand General T4 function test

Problem Based Learning : Continuum

Task Based Learning


A set of Task by a healthcare
Eg (T)  Rul professional  basis for the
problem presented to the student

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VISION & MISSION


MEDICAL FACULTY

Micro Curriculum
Macro Curriculum
PBL
CBC
Problem Meso Curriculum &
KKNI
Micro Curriculum
Learning
Objective Learning Outcome
(Learning Issues)
Profile of Medical Doctor

LEVELS OF COMPETENCE
PREREQUISITES KNOWLEDGE SKILLS ATTITUDES

COMPONENT
ABILITIES

COMPOSITE

COMPETENCE

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Correspondence

Kurikulum
Makro

Accumulation

Kurikulum
Connection Meso

Integration

Kurikulum
Comprehensiveness Mikro

Correspondence

Curriculum
Coordinator

Accumulation

Year
Connection Coordinator

Integration

Block
Comprehensiveness Coordinator

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PENYUSUNAN KURIKULUM MAKRO


Perumusan Kompetensi Dokter

Penentuan Tema Tahun/Fase Blok


Kurikulum
Pemetaan Hasil Belajar / Learning
Outcome pada Tema Fase / Tahun Blok
Kurikulum
Penentuan Tema Blok Kurikulum

PETA KURIKULUM (CURRICULUM MAP)

CURRICULUM MAP

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CURRICULUM MAP

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CURRICULUM MAP

CURRICULUM MAP

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PENYUSUNAN KURIKULUM MESO


Mendistribusikan Learning Outcome ke
tema blok, dari tema fase/tahun ke
dalam masing tema blok kurikulum

Mendistribusikan daftar masalah, daftar


penyakit, daftar ketrampilan ke dalam
masing blok kurikulum

SILABUS/ RANCANGAN GARIS BESAR


PEMBELAJARAN BLOK (GBPB) DAN
SATUAN ACARA PEMBELAJARAN (SAP)

PENYUSUNAN KURIKULUM MIKRO


Analisis dan diskusi mendalam
terhadap cetak biru (kurikulum meso)
yang telah dibuat.

Membuat daftar berbagai bidang


ilmu/ pokok bahasan terkait yang
relevan dengan tema blok.

Merancang kerangka teori yang


sesuai dengan tema blok.

BUKU BLOK (STUDY GUIDES)

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ISI KURIKULUM MIKRO (BUKU BLOK)

BLOCK

MODUL MODUL

LEARNING LEARNING LEARNING LEARNING


UNIT UNIT UNIT UNIT

TUTORIAL
PBL

PRACTICAL SELF
SGD LECTURES
SESSION STUDY

Competency is …

• A complex set of behaviour built on the


components of knowledge, skills and
attitudes

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Discipline-based Education

Assessment

Doctor’s
Curriculum Competences

Discipline as starting point

Titi Savitri Prihatiningsih,


(2006)

Competency-based
Education
Assessment

Doctor’s
Curriculum Competences

Integrated
Student-centred learning
Problem-based
Problem as starting point

Titi Savitri Prihatiningsih,


(2006)

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What are Learning Outcomes?


• Are broad statements of what is achieved
and assessed at the end of a course of study.

• Can be used easily in curriculum planning, in


teaching and learning and in assessment.

What are Learning Outcomes?


• Recognize the authentic interaction and
integration in clinical practice of knowledge,
skills and attitudes

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Weakness of
Instructional Objectives
• Rigid
• Long list (Contoh KIPDI II hampir 1000, KIPDI I
– lebih dari 1000 halaman)
• Time consuming
• Difficult to integrate between domains
• Difficult to prepare
• Difficult to implement

What are the differences


between Learning Outcome and
Instructional Objectives?

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1. Details of Specification
• Instructional objectives • Learning outcomes can
are extensive and be describe
detailed • Implication—They
• Implication—They are provide an intuitive,
difficult and time userfriendly and
consuming to use transparent framework
forcurriculum planning,
teaching and learning
and assessment

2. Level of Specification for Emphasis


• Instructional objectives • Learning outcomes
emphasize specification of emphasize a broad
instructional intent at a overview with a design-
lower and more detailed down approach to a more
level detailed specification
• Implication—This may • Implication—Key areas of
trivialize and fragment and learning are emphasized
make it difficult to get
agreement

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3. The Classification Adopted and


Interrelationship
• Instructional objectives are • Interrelationship of
classified into discrete learning outcomes with
areas: knowledge, skills nesting of outcomes,
and attitude knowledge embedded and
metacompetences
• Implication—This ignores recognized
the complexities of medical • Implication—This reflects
practice and the behaviour expected of
interrelationships a doctor and encourages
application of theory to
practice and a holistic
integrated approach to
patient care

Titi Savitri Prihatiningsih

4.Intent or Observable Result


• Statement of aims and • Learning outcomes are
instructional objectives guaranteed
are perceived as achievements
intentions • Implication—They are
• Implication— They may institutionalized and
be ignored in incorporated into
practice as unrealistic practice

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5. Ownership
• Aims and objectives are • The development and use
owned by the curriculum of learning outcomes can
developer and reflect a engage teaching staff and
more teacher-centred reflect a more student-
approach to the curriculum centred approach
• Implication—They are • Implication—Teachers
perceived as prescriptive identify with the outcomes
and threatening to the and students take more
teacher and student. It is responsibility for their own
more difficult for the learning
student to identify with
them

Domains of Learning

Cognitive

Affective

Psychomotor

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What is Taxonomy?
• Taxonomy is a tool for classifying
instructional objectives
• Taxonomy is hierarchical – levels increase in
difficulty or sophistication
• Taxonomy is cumulative – each level builds
on and subsumes the ones below

Bloom’s Cognitive Objectives


1. Recall LEVEL 1
2. Comprehension RECALL
3. Application LEVEL 2
4. Analysis INTERPRETATION
5. Synthesis LEVEL 3
6. Evaluation PROBLEM SOLVING

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Bloom’s Cognitive Objectives

(Benjamin Bloom, 1950) (Lorin Anderson, 1990)

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Two Dimensional Framework of


Bloom’s Cognitive Objectives

Anderson, Krathwohl, et. al. (2003)

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Affective Objectives
1. Receiving
2. Responding
3. Valuing
4. Organization
5. Characterization by a value or value complex

Harrow’s
Psychomotor Objectives
1. Reflex movements
2. Basic-fundamental movements (locomotor, non-
locomotor)
3. Perceptual abilities (visual, auditory, tactile)
4. Physical abilities (endurance, strengths)
5. Skilled movements (simple, compound and
complex skills)
6. Non-discursive communication

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Simpson’s
Psychomotor Objectives
1. Perception
2. Set
3. Guided Response
4. Mechanism
5. Complex overt response
6. Adaptation
7. Origination

Levels Of
(Increasing) Competence "Kirkpatrick Model“

UnConscious
Competence

Conscious Competence

Conscious InCompetence

UnConscious
InCompetence

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REFERENCES
• Davis, M.H. & Harden, R.M. (1998). AMEE Guide no. 15: Problem based
learning: a practical guide. Medical Teacher, 21 (2). 130-40.
• Davis, M.H. & Harden, R.M. (1995). AMEE Guide no. 5: The core
curriculum with options or special study modules. Medical Teacher, 17 (2).
• Dent J.A. & Harden, R.M. (2005). A Practical Guide For Medical Teacher.
Second Edition. Elsevier Churchill Livingstone.
• Harden, R.M. (2001). AMEE Guide no. 21: Curriculum mapping: a tool for
transparent and authentic teaching and learning. Medical Teacher, 23 (2).
123-37.
• KKI, (2012). Standar Kompetensi Dokter Indonesia. Konsil Kedokteran
Indonesia. Jakarta.
• Papa, F.J & Harasym, P.H. (1999). Medical curriculum reform in North
America, 1975 to the present : a cognitive science perspective. Academia
Medicine. 74 (2).
• Prihatiningsih TS.( 2008). Principles of Curriculum Development. (Power
point presentations).[Unpublished].

(Exercise)
Identification of Learning
Outcome dan Subject Matter
Ahmad Raif
Block 1. 5 Medical Education Management
Master Degree of Biomedical Sciences
Postgraduate School of
Universitas Prima Indonesia
Medan
2017

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Learning Outcome (1)


A. The student will identify correctly all white
cells on a differential.
B. To increase the student’s ability to visually
identify white cells on a differential.

Learning Outcome (2)


A. The student will gain knowledge of
automated chemistry tests.
B. The student will state the principle for each
automated chemistry test listed.

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Learning Outcome (3)


A. The student will be familiar with red blood
cell maturation in the bone marrow.
B. The student will diagram the maturation of
red blood cells.

Learning Outcome (4)


A. The student will understand the
interpretation of hemoglobin electrophoresis
patterns.
B. Given several electrophoretic scans, the
student will correctly diagnose each normal
or abnormal pattern.

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Case ‘Hemolytic Anemias’


After attending the lecture, reading the assignment,
and performing the tests in the laboratory,
the student will:
1. Define the term hemolytic anemia. (………………..)
2. Classify the major hemolytic anemias by their
intrinsic or extrinsic causes. (………………..)
3. Summarize each disease discussed in lecture
including distinguishing characteristics, clinical
manifestations, laboratory findings, pathology,
and treatment. (……………………..)

Case ‘Hemolytic Anemias’


After attending the lecture, reading the assignment,
and performing the tests in the laboratory,
the student will:
4. For each disease discussed in lecture, determine
the appropriate tests to resolve the problem.
Include the principle and mechanism of each
test in the evaluation.(…………………..)
5. Given a set of laboratory data and patient
history, correctly diagnose the disease.
(………………………….)

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Case ‘Hemolytic Anemias’


After attending the lecture, reading the assignment,
and performing the tests in the laboratory,
the student will:
6. Work independently and with others under time
constraints. (…………………………..)#
7. Apply knowledge, skills, and values learned from
course work and life experiences to new
situations (…………………..)
8. Project an image of professionalism including
appearance, dress, and confidence.
(…………………..)

Case ‘Hemolytic Anemias’


Upon completion of the laboratory exercise the
student will:
1. Correctly perform the electrophoretic procedure
and obtain a satisfactory pattern that could be
accurately interpreted by both the student and
the faculty member.
2. Interpret normal and abnormal electrophoretic
patterns with 100% accuracy as compared with
patterns interpreted by the CLS.
3. Using a densitometer, obtain the concentration
of each protein fraction within 10% of faculty
member’s results

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Clinical Learning Skills


In Medical Education

Ahmad Raif
Block 1. 5 Medical Education Management
Master Degree of Biomedical Sciences
Postgraduate School of Universitas Prima
Indonesia
Medan
2017

Clinical Skills is as a Complex Learning


• Integrate: knowledge, skills & attitudes
• Coordinate qualitatively different constituent
skills
– Problem solving and reasoning aspects
– Routine aspects
• Aim at transfer of learning

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Four Characteristics of the


Complex Learning

Constituent skills

Goal-directedness

Simultaneous learning
processes

Lengthy and effortful process

Lengthy & Effortful Process

 At least 100 hours to reach basic level of


Proficiency
 May take thousands of hours of practice to
become a “real” expert
 Learners have to invest large amounts of
effort in acquiring the skill
 Cognitive capacity constraints

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Learning Processes and


the Four Components

Learning
Induction tasks
Schema
construction Supportive
Elaboration
information

Knowledge Procedural
Schema compilation information
automation Part-task
Strengthening
practice

Skill Training Program must be Attended :

• Simple to complex
• Iterated
• Feedback
• Learning material: (Simulated patient and
standardized patient)
• Link with theory and relevant with profession
• Previously trained skills
• Isolated to integrated
• Assessment

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REFERENCES
• Dent J.A. & Harden, R.M. (2005). A Practical Guide For
Medical Teacher. Second Edition. Elsevier Churchill
Livingstone.
• KKI, (2012). Standar Kompetensi Dokter Indonesia. Konsil
Kedokteran Indonesia. Jakarta.
• Prihatiningsih TS.( 2008). Principles of Curriculum
Development. (Power point presentations).[Unpublished].

Student Assessment
In Medical Education

Ahmad Raif
Block 1. 5 Medical Education Management
Master Degree of Biomedical Sciences
Postgraduate School of
Universitas Prima Indonesia
Medan
2017

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Role of Test
To get general information (descriptive)
To evaluate performance (poor, fair, good,
excellent)
 To evaluate a policy (successful, failed)
 To give a feed back
 Planning

Some Senteces of Student Assessment

I believe that teaching without testing is cooking


without tasting.
Try to use more than one assessment instrument and
more than one assessor especially if you are looking
at skill and attitudes.
Gather as much data on the candidate as it is feasible
If you want your student to read  “MCQ”
If you want your student to show competence 
Examination in these skills

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Types of test (Formats)


1. Oral Exam (Lisan)
2. Written Test
 Subjective test (Essay Cerita,)
 Multiple Choice Question, MCQ (Pilihan ganda)
 Simple True and False Choice (Pilihan benar-salah
sederhana)
 Multiple True and False Choice (Pilihan benar-salah ganda)
 Short Answer Test (Jawaban pendek) seperti , fill in dan
completion test
3. Skill Competence Test (Ujian kompetensi ketrampilan
(Checklist/rating scale )
4. Task/ project

TYPE OF TEST (Objective)


1. Placement Test
2. Diagnostic Test
3. Formative Test
4. Summative Test
5. Screening Test

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Climbing the pyramid......

Performance assessment in vivo:


Does
Does Masked SPs, Video, Audits…..
Performance assessment in vitro:
Shows how
Shows how OSCE, Simulated Task-based test…
(Clinical/task) Context based tests:
Knows how
Knows how MCQ, essay type, oral…..

Knows
Knows Factual tests:
MCQ, essay type, oral…..

REFERENCES
• Davis, M.H. & Harden, R.M. (1998). AMEE Guide
no. 15: Problem based learning: a practical
guide. Medical Teacher, 21 (2). 130-40.
• Dent J.A. & Harden, R.M. (2005). A Practical
Guide For Medical Teacher. Second Edition.
Elsevier Churchill Livingstone.
• KKI, (2012). Standar Kompetensi Dokter
Indonesia. Konsil Kedokteran Indonesia. Jakarta.
• Harsono.( 2008). Principles of Student
Assessment. (Power point presentations).
[Unpublished].

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STANDAR KOMPETENSI
DOKTER INDONESIA

Ahmad Raif
Block 1. 5 Medical Education Management
Master Degree of Biomedical Sciences
Postgraduate School of Universitas Prima
Indonesia
Medan
2017

Daftar Kompetensi Klinik

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Keterangan Level Kompetensi Kasus


1) Tingkat Kemampuan 1  Mengenali penyakit ketika membaca literatur 
Dokter segera merujuk.

2) Tingkat Kemampuan 2  Mampu membuat diagnosis klinik  Merujuk


secepatnya ke spesialis yang relevan dan mampu menindaklanjuti
sesudahnya.

3) Tingkat Kemampuan 3 ;
3A. Mampu membuat diagnosis klinik  Memutuskan dan memberi
terapi pendahuluan, serta merujuk ke spesialis yang relevan (bukan
kasus gawat darurat).
3B. Sama seperti 3a (untuk kasus gawat darurat).

4) Tingkat Kemampuan 4  Mampu membuat diagnosis klinik  Dokter


mampu menangani problem itu secara mandiri hingga tuntas. 73

Keterangan Level Kompetensi Skills

• Mengetahui dan dapat menjelaskan


1

• Pernah melihat atau pernah didemonstrasikan


2

• Pernah melakukan atau pernah menerapkan di


3 bawah supervisi

• Mampu melakukan secara mandiri.


4
74

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