PROBLEM-BASED LEARNING (PBL) CARA BELAJAR di Fakultas Kedokteran Universitas Andalas Rahmatina B. Herman Bagian Pendidikan Kedokteran (BPK) Fakultas Kedokteran – Universitas Andalas Bimbingan Aktivitas Kemahasiswaan dan Tradisi Ilmiah (BAKTI) Fakultas Kedokteran Universitas Andalas Tahun Akademik 2013/2014
Education Purpose of Education “….provide assistance to learners that enables them to achieve levels of development (and efficiency) that they would not be able to achieve by themselves Tiffin and Rajasingham BPK FK UNAND
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…..Education Input Learning Process
Output Outcome BPK FK UNAND
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How to succeed an education?
Learning is key to success of an education Kemp BPK FK UNAND
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What is Learning? Learning is a change in human capability, which can be retained, and not due to the process of growth (Gagne) Learning is a change in behavior as a result of experience (Haggard) Learning is a process by which behavior is changed, shaped, or controlled (Tiffin and Rajasingham) BPK FK UNAND
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Teaching-Learning Strategy
Teacher-centered (Teaching) Student-centered (Learning)
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Teacher-Centered (Teaching) Teacher
student
student
student
student
student
student
student
student
One-way didactic methode (Sefton, 2001) BPK FK UNAND
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……Teacher-Centered (Teaching) Teacher is solely responsible for what the student is expected to learn Teacher decides what information and skills the student should to learn in what sequence and at what pace
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Teacher Centered
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The Learning Pyramid Average Retention Rate
Lecture
5%
Reading Audiovisual
10%
Demonstration
30%
Discussion group Practice by doing
50%
Teach each others
80%
20%
75%
National Training Laboratories, Bethel, Maine, USA BPK FK UNAND
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Constructivism Theory Knowledge is constructed from experience Learning is a personal interpretation of the world Learning is an active process in which meaning is developed on the basis of experience Conceptual growths comes from the negotiation of meaning, the sharing of multiple perspectives and the changing of our internal representations through collaborative learning Learning should be situated in realistic settings; testing should be integrated with the task and not a separate activity BPK FK UNAND
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Adult Learning Theory (Malcolm Knowles)
Adults are autonomous and self-directed Adults have accumulated a foundation of life experiences and knowledge Adults are practical Adults are relevancy-oriented Adults are goal-oriented Adults need to be shown respect BPK FK UNAND
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Educational Psychology
Novice BPK FK UNAND
Expert
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Teaching
Learning
Teaching vs Learning
Teacher centered Knowledge transfer Reinforces passiveness Teachers provide answers Teachers direct students BPK FK UNAND
Student centered Knowledge acquisition Reinforces activeness Teachers ask questions Teachers guide students BAKTI 2013/20134
Student-Centered (Learning) student student
student
student
student
student
student student
facilitator
Interpersonal communication, complex interaction - facilitated by a tutor (Sefton, 2001) BPK FK UNAND
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Student-Centered (Learning) The student learn to determine what he needs to know Teacher responsibility in the beginning by providing the student experience and guidance It is expected that student will eventually take full responsibility for his own learning. Active acquisition of information and skills by student BPK FK UNAND
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Enjoyable BPK FK UNAND
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Student-Centered Learning Strategy Active learning Collaborative learning Inquiry-based learning Cooperative learning
Problem-based learning Peer led team learning Team-based learning Peer instruction Inquiry guided learning Just-in-time teaching Small group learning Project-based learning Question directed instruction BPK FK UNAND
Independent learning Adult learning Self-directed learning Autonomous learning Discovery learning Think-pair share Experiential learning Performance-based learning Task-based learning Work-based learning Competence-based learning Case-based learning Etc BAKTI 2013/20134
What is PBL? PBL is a learning method on principle of using problems as a starting point for the acquisition and integration of new knowledge (Barrows, 1982) In PBL students work on the problem which is explicitly used to get students themselves to identify and search for the knowledge that they need to obtain in order to approach the problem (Ross, 1991). BPK FK UNAND
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The Objective of PBL The acquisition of an integrated body of knowledge related to the problem and the develop or application of problem-solving skills
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Philosophy of Learning in PBL Student-Centered Problem-Based Integrated Community-Oriented Early Clinical Exposure Self-Directed/ Selective with Core BPK FK UNAND
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PROBLEM
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tutor
Tutorial group process problem
students
Three elements of the tutorial process in PBL BPK FK UNAND
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The Role of Problems
The problem is the motor of the learning
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……The Role of Problems New information is better processed and retained Problem solving skills are enhanced Integration of basic science and behavioral science knowledge is stimulated Students learn how to learn Student are stimulated to undertake self-directed activities Student motivation is enhanced Integration of knowledge from different discipline is fostered BPK FK UNAND
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PELAKSANAAN PBL DI FK – UNAND KURIKULUM BERBASIS KOMPETENSI (KBK)
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Pengertian Kompetensi Seperangkat tindakan cerdas dan penuh tanggung jawab yang dimiliki seseorang sebagai syarat untuk dianggap mampu oleh masyarakat dalam melaksanakan tugas-tugas di bidang pekerjaan tertentu SK Mendiknas No. 045/U/2002
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Tahap Pendidikan Dokter Pendidikan Dokter di Indonesia mengacu kepada Standar Pendidikan Profesi Dokter dan Standar Kompetensi Dokter yang disahkan oleh Konsil Kedokteran Indonesia (KKI) Pendidikan Dokter Layanan Primer terdiri atas dua tahap: > Tahap Akademik : S.Ked > Tahap Profesi (Tahap Klinik): Dokter Internship dan Uji Kompetensi untuk memperoleh Sertifikat Kompetensi dari KKI BPK FK UNAND
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Strategi Implementasi Tahap Akademik Kurikulum fakultas disusun kedalam blok Menyusun matriks blok dan kompetensi Menetapkan kordinator blok dan kordinator tahap Menyusun kurikulum blok Menyusun modul dan skenario setiap blok Menyusun strategi implementasi PBL untuk setiap blok BPK FK UNAND
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KURIKULUM FAKULTAS
BLOK
BLOK
MODUL
SKENARIO mingguan BPK FK UNAND
MODUL
BLOK
BLOK
MODUL
SKENARIO mingguan BAKTI 2013/20134
Pembelajaran Ekstra-Blok Dilaksanakan setiap hari Sabtu Student-Centered Learning Tahun I
: Mata Kuliah Wajib Universitas Agama, Bahasa Inggris, Kewarganegaraan
Tahun II : Family Oriented Medicine (FOME) Tahun III : Metodologi Riset, Skripsi Tahun IV : Preclerkship BPK FK UNAND
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Strategi Pembelajaran 1. Tutorial dengan konsep “7 jump” 2. Belajar mandiri 3. Praktikum skills lab 4. Kuliah pengantar 5. Praktikum ilmu dasar 6. Diskusi pleno 7. Clerkship (co-schaap) 8. Internship BPK FK UNAND
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Strategi Implementasi PBL Mahasiswa dibagi kedalam kelompok kecil (10 – 11 mahasiswa / kelompok) Kordinator blok bertanggung jawab terhadap implementasi kurikulum blok termasuk: - Menyusun “Study Guide” - Menyusun Skenario (dari bank skenario) - Menjalankan semua aktivitas akademik di blok Kordinator Tahun bertanggung jawab terhadap implementasi kurikulum pada tahun yang dikordinirnya Kordinator Tahap bertanggung jawab terhadap implementasi kurikulum pada tahap yang dikordinirnya BPK FK UNAND
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What is Small Group? Small group work is characterized by student participation and interaction (Crosby 1996) The Goals of Small Group Learning: - The development of communication skills - The development of intellectual and professional competencies - The development of presentation skills - The personal growth of students (and perhaps the tutor) BPK FK UNAND
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Process in Small Group Learning INCREASING DEGREE
GOAL OPTIMUM GROUP GROWTH AND INDIVIDUAL GROWTH
w ACTIVE ROLE OF THE TEACHER
n C.I
uINDIVIDUAL GROWTH AND EXPECTATIONS
n C.I
n C.I GROUP 8 GROWTH
n C.I n C.I
NORMING
FORMING
STORMING
MOURNING
TIME
PERFORMING
C.I = CRITICAL INCIDENT BPK FK UNAND
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1. Tutorial Tutorial dalam konteks PBL adalah: suatu active learning process di dalam diskusi kelompok kecil distimulasi oleh suatu problem (skenario) mengaktifkan prior knowledge mahasiswa difasilitasi oleh seorang tutor dipimpin oleh seorang mahasiswa yang terpilih dibantu oleh seorang sekretaris yang terpilih Untuk mencapai tujuan belajar melalui aktivitas terstruktur yang disebut seven-jump BPK FK UNAND
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Kunci Tutorial dalam PBL ………..menggunakan problem untuk mendorong aktivitas pembelajaran berdasarkan a need-to-know basis (Woods, 1994)
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Peran tutorial dalam PBL Tutorial adalah “jantung” PBL Bentuk dan ukuran “jantung” merupakan gambaran tujuan belajar yang spesifik Setiap denyut “jantung” memberi / menyediakan informasi baru / lebih maju “Jantung” yang sehat akan menjamin pencapaian tujuan belajar BPK FK UNAND
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Effective Tutorial Characteristics of an effective tutorial group: ♦ cohesive ♦ high motivation ♦ mutual helps among individuals ♦ have a high motivation to learning together All members understand the tasks that must be completed and at the same time trying to complete the task with high spirit (Sefton, 2001) BPK FK UNAND
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……Effective Tutorial Each member of the group respect the opinion of others, but remain critical Discussion conducted cooperatively, not competitively The quiet member to be encouraged to actively participate, the dominant member to be asked to reduce its dominance Each member has to be helped to not having personal stress (Sefton, 2001) BPK FK UNAND
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Encourage Teamwork BPK FK UNAND
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Seven Jump 1. Clarifying unfamiliar terms 2. Defining problems 3. Brainstorming possible hypotheses or explanations 4. Arranging explanations into a tentative solution 5. Defining learning objectives 6. Gathering information 7. Sharing the results of information gathering and private study BPK FK UNAND
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Clarifying unfamiliar terms Process - Students identify any words whose meaning is unclear - other group members may be able to provide definitions. - Students should be made to feel safe, enabling them to be honest about anything they do not understand. BPK FK UNAND
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..….Clarifying unfamiliar terms Reason Unfamiliar terms act as an obstacle to understanding. Clarification of even half - understood terms may start the process of learning.
Written output Words or names on which the group cannot agree a meaning should be listed as learning objectives. BPK FK UNAND
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Defining problems Process - This is an open session when students are encouraged to contribute their view of the problem under discussion. - The tutor may need to encourage them all to contribute to a fastmoving and wide-ranging analysis. BPK FK UNAND
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…..Defining problems Reason It is quite possible for every member of tutorial group to have a different perspective, on a problem. Comparing and pooling these views broadens the intellectual horizons of those involved and defines the task ahead.
Written output List of issues to be explained BPK FK UNAND
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Brainstorming possible hypotheses or explanations Process - A continuation of the open session - but students now try to formulate, test and compare the relative merits of their hypotheses or explanations of the problem or case.
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……Brainstorming possible hypotheses or explanations Reason This is a crucial step, that prompts the use of previous learning and memory and allows students to test or draw on another’s understanding; Links can be formed between the items if incomplete knowledge that exist within the group. If well handled by the tutor and group, it pitches learning at the deeper level of 'understanding' rather than the superficial level of 'facts'.
Written output List of hypotheses or explanations BPK FK UNAND
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Arranging explanations into a tentative solution Process - Students will have thought of as many different explanations as possible of what is occurring. - The problem is scrutinized in fine detail and compared against the proposed hypotheses, or explanations, to see how they will match and if further exploration is needed. - This starts the process of defining learning objectives, although it is inadvisable for them to be recorded in writing too soon BPK FK UNAND
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……Arranging explanations into a tentative solution Reason - This stage actively processes and restructures existing knowledge and identifies gaps in understanding. - Making written records of learning objectives too soon hinders thinking and short-circuits the intellectual process, resulting in objectives that are too broad and superficial. BPK FK UNAND
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……Arranging explanations into a tentative solution Written output - This involves organizing explanations for problems, representing them schematically, trying to link new ideas with each other, with existing knowledge and with different contexts. - This process provides a visual output of the relationships between different pieces of information and facilities storage of information in long-term memory. BPK FK UNAND
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Defining learning objectives Process - The group agrees a core set of learning objectives that all students will study. - The tutor encourages them to be focused, not too broad or superficial and achievable within the time available. Some students may have objectives that are not shared by the whole group because of their own personal learning needs or interests BPK FK UNAND
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……Defining learning objectives Reason - The process of consensus uses the expertise of the entire tutorial group (and tutor) to synthesize the foregoing discussion into appropriate and attainable learning objectives. - This not only defines the learning objectives but also pulls the group together and concludes the discussion.
Written output Learning objectives BPK FK UNAND
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BLOK HEMATOLIMFOPOEITIK
MENGAPA HARUS DINA? Dina, 12 tahun, dibawa ibunya ke IGD RSUD setelah tertabrak motor sepulang dari sekolah. Dari pemeriksaan ditemukan fraktur tulang radius. Dokter merencanakan tindakan reposisi dibawah anestesi dan meminta paramedis untuk melakukan pemeriksaan darah rutin pasien. Ketika hasil pemeriksaan siap, dokter sangat terkejut karena Hb Dina 5,6 gr%, padahal tidak ada perdarahan luar maupun dalam akibat kecelakaan tersebut. Ketika dokter bertanya pada ibunya, ibu Dina mengatakan bahwa anaknya menderita epilepsi dan sejak usia 6 tahun rutin minum obat. Dina juga termasuk anak yang susah makan, tidak suka minum susu dan makan daging. Akhirnya dokter meminta untuk dilakukan pemeriksaan darah lengkap serta pungsi lumbal. Ibu Dina jadi bertanya-tanya, mengapa perlu dilakukan pemeriksaan tersebut pada anaknya? Bagaimana anda menerangkan permasalahan ini pada ibu Dina? BPK FK UNAND
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Step 2. Defining problems 1. Mengapa Dina dibawa ke IGD RSUD? 2. Mengapa dokter merencanakan reposisi? 3. Mengapa dokter meminta melakukan pemeriksaan darah rutin? 4. Apa artinya Hb 5,6 gr%?
5. Mengapa dokter menanyakan riwayat kesehatan Dina masa lalu? 6. Apa artinya minum obat rutin selama 6 tahun terakhir? 7. Apa artinya susah makan, tidak suka susu dan daging? 8. Mengapa dokter memutuskan pemeriksaan darah lengkap dan pungsi lumbal? BPK FK UNAND
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Step 3. Brainstorming possible hypotheses or explanations (prior knowledge) 1. 2. 3. 4. 5. 6.
Dina dibawa ke IGD RSUD karena kecelakaan Dokter merencanakan reposisi karena fraktur Pemeriksaan darah rutin karena Dina akan dianestesi Hb 5,6 gr% artinya anemia berat Untuk menelusuri penyebab anemia pada Dina Minum obat secara rutin bisa menekan (depresi) hematopoetik 7. Susah makan, tidak suka susu dan daging menyebabkan defisiensi nutrisi termasuk bahan untuk produksi darah 8. Pemeriksaan darah lengkap dan pungsi lumbal untuk diagnosis pasti kondisi hematopoetik dan penatalaksanaannya BPK FK UNAND
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Step 4. Arranging explanations into a tentative solution Kecelakaan Reposisi
Fraktur Anemia
Anestesi Darah Rutin
Obat
Susah makan
Depresi hematopoetik
Defisiensi Anamnesis, Pemeriksaan fisik, penunjang
Anemia defisiensi
Anemia aplastik BPK FK UNAND
Tatalaksana
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Step 5. Defining Learning Objectives (LO) 1. Menjelaskan pengertian dan jenis-jenis anemia 2. Menjelaskan aspek epidemiologi dan faktor-faktor yang mempengaruhi terjadinya anemia defisiensi dan anemia aplastik 3. Menjelaskan patofisiologi terjadinya anemia defisiensi dan aplastik 4. Menjelaskan gejala dan tanda anemia defisiensi dan aplastik 5. Menjelaskan diagnosis dan diagnosis banding anemia defisiensi dan aplastik (anamnesis, pemeriksaan fisik dan pemeriksaan penunjang) 6. Menjelaskan pemeriksaan laboratorium yang diperlukan untuk menunjang diagnosis anemia defisiensi dan aplastik 7. Menjelaskan penatalaksanaan anemia defisiensi dan aplastik secara komprehensif 8. Menjelaskan prognosis anemia defisiensi dan aplastik 9. Menjelaskan kasus anemia defisiensi dan aplastik yang memerlukan rujukan BPK FK UNAND
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Gathering information Process This could include - finding material in textbooks, - carrying out a computerized literature search using the Internet looking at pathological specimens, - talking to an expert, and - anything else that will help provide the information the student is seeking. BPK FK UNAND
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……Gathering information Reason Clearly an essential part of the learning process is gathering and acquisition of new information, which students do on their own Written output Students' individual notes
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Sharing the results of information gathering and private study Process - Students begin by returning to their list of learning objectives. - They first identify their individual sources of information, pool their information from private study and help each other understand and identify areas of continuing difficulty for further study (or expert help). - After this, they attempt to undertake and produce a complete analysis of the problem. BPK FK UNAND
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……Sharing the results of information gathering and private study Reason This synthesizes the work of the group, consolidates learning and identifies areas of uncertainty, possibly for further study. Written output Students' individual notes BPK FK UNAND
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Feedback BPK FK UNAND
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2. Kuliah Pengantar Tujuan: “mengantarkan” mahasiswa untuk pembahasan modul/ skenario setiap minggu Bukan bertujuan untuk transfer of knowledge Karena itu Kuliah Pengantar harus dilaksanakan pada minggu pelaksanaan modul/ skenario yang bersangkutan Dilaksanakan selama 50 menit/ topik kuliah
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3. Belajar Mandiri Belajar mandiri dilaksanakan di kampus/ perpustakaan Sumber pembelajaran: - Printed material: Buku ajar (textbook), jurnal ilmiah - Internet: situs (website) yang dapat dipertanggungjawabkan keilmiahannya - Pakar: staf pengajar/ dosen, pakar lainnya Hasil Belajar Mandiri harus diserahkan ke Dosen Pembimbing dan bila perlu bisa didiskusikan
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4. Praktikum Ilmu Dasar Tujuan praktikum: membantu pemahaman teori Dilaksanakan di laboratorium ilmu dasar yang bersangkutan Pelaksanaan selama 2 jam per topik praktikum per kelompok praktikum Dilaksanakan di bawah bimbingan instruktur dari staf pengajar/ dosen ilmu dasar yang bersangkutan
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5. Praktikum Skills Lab Tujuan praktikum: mahasiswa memperoleh keterampilan yang berkaitan dengan profesi dokter Dilaksanakan di laboratorium sklills lab Pelaksanaan selama 2 jam per topik praktikum per kelompok praktikum Dilaksanakan di bawah bimbingan instruktur yang ditetapkan oleh Kordinator Blok
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6. Diskusi Pleno Tujuan Diskusi Pleno: sharing antar kelompok tutorial Dilaksanakan setelah selesai tutorial untuk setiap modul/ skenario, yaitu selesai tutorial hari kedua Wajib diikuti oleh semua kelompok mahasiswa pada Blok yang bersangkutan Dua kelompok tutorial menyajikan hasil tutorial mereka, kelompok lain wajib menyimak dan memberi masukan/ sharing hasil tutorial masing-masing kelompok BPK FK UNAND
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6. Diskusi Pleno….. Diskusi dipimpin oleh staf Blok yang bersangkutan dan dihadiri oleh dosen pemberi Kuliah Pengantar pada modul yang bersangkutan Tidak dibenarkan mengajukan pertanyaan yang bersifat menguji atau untuk mencari solusi masalah yang tidak terpecahkan sewaktu tutorial, karena semua masalah harus dapat dicarikan solusinya pada tutorial kedua dari setiap modul/ skenario Dilaksanakan selama dua jam
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7. Clerkship (Co-schaap) Merupakan proses pembelajaran pada Tahap Profesi (Tahap Klinik) Tahap pertama dilaksanakan di Rumah Sakit Pendidikan dan jejaringnya berupa rotasi pada setiap Bagian Klinik dengan durasi waktu yang telah ditentukan untuk setiap bagian dan diakhiri dengan ujian Tahap kedua: dilaksanakan di Puskesmas/ Layanan Primer
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8. Internship Internship bertujuan untuk memandirikan Dokter yang baru lulus Dilaksanakan di wahana internship yang telah ditetapkan Pelaksanaan internship tidak lagi di bawah tanggung jawab Fakultas Kedokteran
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Evaluasi di Tahap Akademik 1. Evaluasi mahasiswa (ujian) ● Ujian/ penilaian blok - Observasi oleh Tutor (Penilaian tutorial) - Ujian tulis - Skills lab: CEP (Checklist Evaluation of live Performance) - Ujian praktikum ● Ujian tahunan dan ujian akhir (komprehensif): - Ujian tulis (progress test) - Skills lab: OSCE (Objective Structure Clinical Evaluation)
2. Evaluasi tutor 3. Evaluasi program BPK FK UNAND
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Penilaian Tutorial Menggunakan borang terstruktur: - Partisipasi - Komunikasi - Persiapan - Keaktifan - Critical thinking - Group skills - General comments
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Tanggung Jawab Mahasiswa Mengikuti semua proses pembelajaran Peraturan Akademik: - Menghadiri semua kegiatan akademik - Tidak hadir harus dengan alasan yang dapat diterima pimpinan - Sanksi: tidak diizinkan mengikuti ujian blok Mematuhi semua peraturan yang berlaku di Institusi (Universitas dan Fakultas) Attitude/ Prilaku BPK FK UNAND
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Sarana Pendukung Ruang tutorial Ruang kuliah Library ICT Laboratorium: - ilmu kedokteran dasar - skills lab Ruang diskusi pleno Rumah-sakit pendidikan BPK FK UNAND
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Efisiensi dan Produktivitas Menetapkan kredit (sks) per blok Aktivitas akademik di dalam setiap blok didasarkan pada sks per blok Indeks Prestasi (IP) / Student‘s Academic Performance Penasihat Akademik / counselor
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Tell me and I will forget Show me and I will remember Involve me and I will understand Step back and I will act Chinese proverb
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Creating Awareness
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A safe and exciting flight
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