Problem based learning is used in many medical schools in the United Kingdom and worldwide. This article describes this method of learning and teaching in small groups and explains why it has had an important impact on medical education.

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The group learning process: acquiring desirable learning skills

In problem based learning (PBL) students use “triggers” from the problem case or scenario to define their own learning objectives. Subsequently they do independent, self directed study before returning to the group to discuss and refine their acquired knowledge. Thus, PBL is not about problem solving per se, but rather it uses appropriate problems to increase knowledge and understanding. The process is clearly defined, and the several variations that exist all follow a similar series of steps.

#### Generic skills and attitudes

Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes, such as communication skills, teamwork, problem solving, independent responsibility for learning, sharing information, and respect for others. PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes. Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice.

However, when PBL is introduced into a curriculum, several other issues for curriculum design and implementation need to be tackled. PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences. It has implications for staffing and learning resources and demands a different approach to timetabling, workload, and assessment. PBL is often used to deliver core material in non-clinical parts of the …

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https://www.cc-seas.columbia.edu/sites/dsa/files/what_is_PBL.pdf

Problem based learning

Effects of problem-based learning: a meta- analysis

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Problem-Based Learning: An Approach to Medical Education

The idiopathic hypereosinophilic syndrome

This meta-analysis investigated the influence of assessment on the reported effects of problem-based learning (PBL) by applying Sugrue’s (1995) model of cognitive components of problem solving. Three levels of the knowledge structure that can be targeted by assessment of problem solving are used as the main independent variables: (a) understanding of concepts, (b) understanding of the principles that link concepts, and (c) linking of concepts and principles to conditions and procedures for application. PBL had the most positive effects when the focal constructs being assessed were at the level of understanding principles that link concepts. The results suggest that the implications of assessment must be considered in examining the effects of problem-based learning and probably in all comparative education research.

Effects of Problem-Based Learning: A Meta-Analysis From the Angle of Assessment:

OBJECTIVE: To provide physicians and allied health care professionals with guidelines for the diagnosis and management of migraine in clinical practice. OPTIONS: The full range and quality of diagnostic and therapeutic methods available for the management of migraine. OUTCOMES: Improvement in the diagnosis and treatment of migraine, which will lead to a reduction in suffering, increased productivity and decreased economic burden. EVIDENCE AND VALUES: The creation of the guidelines followed a needs assessment by members of the Canadian Headache Society and included a statement of objectives; development of guidelines by multidisciplinary working groups using information from literature reviews and other resources; comparison of alternative clinical pathways and description of how published data were analysed; definition of the level of evidence for data in each case; evaluation and revision of the guidelines at a consensus conference held in Ottawa on Oct. 27-29, 1995; redrafting and insertion of tables showing key variables and data from various studies and tables of data with recommendations; and reassessment by all conference participants. BENEFITS, HARMS AND COSTS: Accuracy in diagnosis is a major factor in improving therapeutic effectiveness. Improvement in the precise diagnosis of migraine, coupled with a rational plan for the treatment of acute attacks and for prophylactic therapy, is likely to lead to substantial benefits in both human and economic terms. RECOMMENDATIONS: The diagnosis of migraine can be improved by using modified criteria of the International Headache Society as well as a semistructured patient interview technique. Appropriate treatment of symptoms should take into account the severity of the migraine attack, since most patients will have attacks of differing severity and can learn to use medication appropriate for each attack. When headaches are frequent or particularly severe, prophylactic therapy should be considered. Both the avoidance of migraine trigger factors and the application of nonpharmacological therapies play important roles in overall migraine management and will be addressed at a later date. VALIDATION: The guidelines are based on consensus of Canadian experts in neurology, emergency medicine, psychiatry, psychology, family medicine and pharmacology, and consumers. Previous guidelines did not exist. Field testing of the guidelines is in progress.

/pdf/guidelines-for-the-diagnosis-and-management-of-migraine-in-260q91o97k.pdf

Guidelines for the diagnosis and management of migraine in clinical practice

We report a case of a young man with intractable seizures and migraine who underwent vagal nerve stimulation (VNS) as a treatment for his seizure disorder without success but with a rather striking reduction in his migraine attacks. The case is presented in detail and discussed in light of the current understanding of the putative mechanisms by which VNS reduces seizures and possibly benefits migraine.

Vagal Nerve Stimulation Aborts Migraine in Patient with Intractable Epilepsy

The purpose of the study was to compare the impact of continuing medical education for primary care physicians in Halifax, Nova Scotia, Canada, delivered through a problem-based learning (PBL) format with that of a lecture-based format, in the clinical area of headache diagnosis and management. From January to June 1995, 38 physicians participated in three problem-based learning sessions, and 49 in a lecture-based session in the clinical area of headache. Pre- and posttest assessments of knowledge were made of each group before and immediately after the educational sessions. A second evaluation using Key Features Problems (KFP) to measure clinical reasoning was administered to both groups 3 months later. Analysis of covariance between groups on the post-test, using the pre-test result as covariate, showed significantly greater knowledge in the PBL group. Mean post-test KFP scores also were significantly higher for the PBL group. The PBL group's satisfaction with several programme dimensions was significantly higher than that of the lecture group. These results must be viewed in the context of differing amounts of exposure for the two groups. Problem-based learning in continuing medical education in the area of headache management was associated with greater knowledge acquisition and with greater improvement in clinical reasoning skills than in a lecture-based approach. Problem-based learning also was preferred by family physicians. However, the cost-benefit of this approach was questioned, since the PBL group had more exposure. Several factors limit the generalizability of this study, e.g. the impossibility of randomly composing the two experimental groups. Further research is required to determine if the results are generalizable and whether a PBL approach results in change in practice behaviour.

Comparison of problem‐based learning and lecture format in continuing medical education on headache diagnosis and management

OBJECTIVE: To provide physicians and allied health care professionals with guidelines for the nonpharmacologic management of migraine in clinical practice. OPTIONS: The full range and quality of nonpharmacologic therapies available for the management of migraine. OUTCOMES: Improvement in the nonpharmacologic management of migraine. EVIDENCE AND VALUES: The creation of the guidelines followed a needs assessment by members of the Canadian Headache Society and included a statement of objectives; development of guidelines by multidisciplinary working groups using information from literature reviews and other resources; comparison of alternative clinical pathways and description of how published data were analysed; definition of the level of evidence for data in each case; evaluation and revision of the guidelines at a consensus conference held in Ottawa on Oct. 27-29, 1995; redrafting and insertion of tables showing key variables and data from various studies and tables of data with recommendations; and reassessment by all conference participants. BENEFITS, HARMS AND COSTS: Augmentation of the use of nonpharmacologic therapies for the acute and prophylactic management of migraine is likely to lead to substantial benefits in both human and economic terms. RECOMMENDATIONS: Both the avoidance of migraine trigger factors and the use of nonpharmacologic therapies have a part to play in overall migraine management. VALIDATION: The guidelines are based on consensus of Canadian experts in neurology, emergency medicine, psychiatry, psychology and family medicine, and consumers. Previous guidelines did not exist. Field testing of the guidelines is in progress.

/pdf/guidelines-for-the-nonpharmacologic-management-of-migraine-4rhxvbnvyg.pdf

Guidelines for the nonpharmacologic management of migraine in clinical practice

Although beneficial in allergic and parasitic disease, eosinophils exert nonspecific toxic effects upon host tissues, especially the central and peripheral nervous systems. Eosinophil-induced neurotoxicity is characterized by axonal neuropathy, cerebral infarction, and dementia. Eosinophil-derived cytotoxic proteins are fundamental to the pathogenesis of this disorder.

RA Purdy

Papers

Guidelines for the diagnosis and management of migraine in clinical practice

Vagal Nerve Stimulation Aborts Migraine in Patient with Intractable Epilepsy

Comparison of problem‐based learning and lecture format in continuing medical education on headache diagnosis and management

Guidelines for the nonpharmacologic management of migraine in clinical practice

Eosinophil‐induced neurotoxicity Axonal neuropathy, cerebral infarction, and dementia