• Explain the basis of Distance education (DE) and Problem based learning (PBL.)
• Enumerate the components of DE and Taxonomy of PBL.
• Use these methodologies within your subject area.

Before we conclude this book, it is time to introduce you to some of the newer methodologies being adopted for Medical education all over the world. The basic reason to look for these alternatives is the dissatisfaction with the conventional mode of education which is losing its relevance in this era of information explosion. Continuing education of health professional poses another challenge which conventional education is unable to meet. There are over 25 different teaching methodologies described but we shall restrict our discussion to only two viz. Distance Education (DE) and Problem based learning (PBL.)

It is difficult to give a precise definition of DE ; depending on which aspect of it is being emphasised, experts have given different definitions. The common points which emerge from perusal of these definitions can be stated as follows. " Ant non conventional learner - centered teaching - learning system which does not rely on face - to face teaching as the primary mode of instruction but which facilitates two way academic dialogue by a variety of media. " You will realise that this definition gives a very wide canvass to DE and does not restrict it to mere printed lessons.

The concept of DE is complimentary to the recent concept of 'New Learner', who prefers a non formal, life long orientation of one's awareness and who is aware of his abilities, needs, strengths and weakness. The system does not bind the learner with constraints of place, time, space, entry requirements and pace of learning - rather it allows the learner and the teacher to work apart without depending on word of mouth as the sole means of communication but uses unorthodox means of communication to continue two - way academic exchange.

We want you to distinctly understand that a distance learner is not a longer - rather he has the support of a large number of subject experts, educationists, psychologists, media experts, academic counsellors and tutors. In this sense, DE permits privatisation of institutional study as well as institutionalisation of private study.

It should be clear to you that while correspondence education tries to impart conventional courses and curricula through print, DE uses non - conventional, learner - centered curricula through multimedia approach. In this way, it compliments rather than replaces conventional education. DE is cost - effective and cost efficient as compared to other modes of education - primarily because it can address a large number of learners at one go. Further, it maintains equality and quality of education. DE can also be used for traditional campus based teaching, thus allowing freedom to teachers to engage themselves in research and other academic pursuits.

• Formulation of curricula

• Production of self instructional materials (SIM)

• Distance teaching

• Evaluation

• Student support services

Let us discuss them one by one.

Formulation of curricula : DE evolved out of learner needs. The curricula for DE are therefore based on real life situations rather than on conventions. Thus, the curricula may relate to continuing education, skill updating, recent advances, growth of professional (eg. management for doctors) or even self enrichment. They evolve out of learner's needs - hence they are better accepted and are able to generate motivation on the part of the learner. We have already discussed this aspect with you in chapter 2 and 21.

Production of SIM : SIMs are the 'heart' of DE. As the name indicates they are self - instructional and therefore act as surrogate teachers. Just like a real teacher, they provide information, they motivate, they inspire, they evaluate, they provide feedback and they guide to further reading. These materials are learner active i.e. they require some activity on the part of the learner and do not lend themselves to passive reading. These materials and do not lend themselves to passive reading. These materials can be in printed from or use other media like audio, video, learning kits, computers etc. For cost considerations, most DE programmes use print as the primary media, supplementing it with others.

You may be wondering, how SIMs differ from a text book. Look at the table below and you will understand.

One of the key characteristics of SIMs is to have a large number of access devices which enable the learners to grasp the material in a better way.

Distance Teaching : As we have already pointed out, SIMs include a lot of activities and assignments. These assignments have to be completed and sent to a tutor. The tutor's job is not merely to assign marks or put a tick here and there but to distance teach. The purpose of distance teaching is to provide an immediate feedback to the student and guide him towards better learning. Distance teaching is done by writing academically useful comments, pointing mistakes and suggesting ways to improve learning. After a student has been graded, the tutor has to write a global comment explaining why a particular grade has to write a global comment explaining why a particular grade was awarded. A provision has to be built for supplemental communication also. In case a learner does not agree with the grades awarded, he can write back to the tutor seeking clarifications.

• In - text questions, meant to stimulate thinking. The answers are provided simultaneously.

• Self - check exercises, given at the end of a complete piece of information. They may require either factual recall or ask the learner to relate a given information to his prior experience. Sometimes a learner may be asked to use this knowledge in a new situation.

• Computer marked assignments, usually given at the end of a block and consist of multiple choice questions, aiming at test of factual knowledge.

• Projectwork, aimed at providing practical hands - on experience to the learner so that he can apply his newly acquired skills to actual life situations.

• Tutor marked assignments consist of short answer questions and structured essay questions to test comprehension and higher level of knowledge.

Students Support Services are an important aspects of DE because there is no peer group. Being physically away from tutors and peers, distance learners require a higher level of motivation. Student support services are generally made available at study centres. Basically these include library facilities, A - Vmedia, peer group interaction, tutor interaction and counselling. All these aim at breaking social isolation of the distance learner.

B. Problem Based Learning (PBL)

Home you ever come across the term problem based learning ? Probably your response will be yes. You will say that you have been always teaching your students, based on problems. You expect them to analyse and synthesise facts that you have taught them, in relation to a particular problem. We are afraid, you are only partly correct - what we referred to just to be called a teaching method.

Problem based learning (PBL), on the other hand, is a totally different educational strategy, where the problem is posed first and learning areas are identified later. Thus, in contrast to problem solving, where the student already has the knowledge, PBL emphasises acquiring new knowledge in the context of the problem. With this brief introduction, let us take you through some of the advantages of adopting PBL as an educational strategy.

The contemporary scenario in medical education is radically different from that prevailing say 20 years back. The pattern of diseases, morbidity and mortality, population explosion, has never been so much as it is now. Every issue of thousands of medical journals brings new discoveries and modalities of treatment. The existing medical curricula is also showing signs of expansion. In the recent years, many subjects have been added to the examination scheme and others are likely to be added, making it very difficult for the student to cope.

The biggest criticism, however, against the traditional medical education is the fragmentary and unintegrated training given by different departments. There is no effort to keep the future requirements of students in mind. Passing the examination becomes the major concern of most students with the results that when students reach clinical years, they have already forgotten the basic sciences. Even in clinical subjects. emphasis is on teaching hi-tech theoretical aspects. Thus, our students can rattle off everything about Pontiac fever or Alzheimer's disease but find it difficult to outline the management of dehydration or pneumonia. Another tragic side of the coin is inability to perform minor procedures like giving an injection. Even if a student has learnt basic procedures, these are under the buffered and protected environment of a tertiary level hospital. When confronted with an actual patient in a practical situation, even the best of students finds himself at a loss.

The basic approach of PBL is learning in context. It puts the learner in a particular and then gives him a task as a source of learning, comparable to an actual task that he may be confronted in his future professional life. The burden of learning is shifted from the college or teacher to the student himself. PBL devotes less attention to filling the mind ; it aims to prepare and develop it.

You may recall at this stage, the taxonomy of learning. PBL uses a slightly different kind of taxonomy which includes structuring the knowledge for use in clinical context (SCC) ; Clinical reasoning process (CRP); Self directed learning (SDL) and motivation to learn (MOL).

The process of PBL begins by identifying local / regional disorders, which are used as a base for problem formulation. It also needs to be identified at this stage as to what is not to be taught. A problem is then presented to the students in the form of an actual clinical case, as illustrated here.

A 25 years old male patient is brought to the emergency with complaints of pain in abdomen.

Once a problem has been stated, trigger areas are identifies by the students themselves under guidance of a tutor. These trigger areas are used to lay down learning objectives. With reference to preceding problem, the trigger areas could be :

• Anatomical and physiological basis of pain in abdomen.

• Anatomical and physiological basis of presenting symptoms.

• Conditions which could mimic this type of presentation.

• Physical findings to conform or refute these conditions and so on.

After the learning areas have been identified, the students discuss with the tutor, from where and how to seek this information. This may include library, skill labs, hospital wards, laboratories, museums or discussion with resource persons. The students collect facts, verify them from various sources, draw conclusions and form judgements. This educational strategy prepares the students to learn even in new situations and become what can be called life long learners.

No two patients with similar features or with textbook symptoms. These are always variations. This requires development of a thinking process for correct diagnosis. By adopting PBL, reasoning and analytic skills of the student develop to a much greater extent. Students develop a tolerance for ambiguity and develop an attitude of accepting a probability rather than a certainty. They develop respect for the views of others and a satisfaction in team work.

Experience has shown that students learning by this strategy acquire relevant facts, retain them better and longer, are ready to learn and accept their mistakes and have a more positive attitude towards self, colleagues and patients.

Did you notice that both the never methodologies which we discussed with you are learner - centered ? In both the situations, teacher is working more as a facilitator rather than a subject expert. Interestingly, you can use this in your classrooms also. Try to give more freedom to the students (of course, academically !) try to be a bit more tolerant for ambiguity and you will find your students more motivated and ready to accept new challenges of learning.