PROBLEM-BASED LEARNING (PBL) CARA BELAJAR di Fakultas Kedokteran Universitas Andalas

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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

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BPK FK UNAND BAKTI 2013/20134

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

(3)

…..Education

Input

Learning

Process

Output

Outcome

(4)

Kemp

Learning

is key

to success of

an education

(5)

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)

(6)

Teaching-Learning Strategy

Teacher-centered (Teaching)

Student-centered (Learning)

(7)

One-way didactic methode (Sefton, 2001)

student student student student student student student Teacher

Teacher-Centered (Teaching)

(8)

……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

(9)

(10)

The Learning Pyramid

Teach each others Lecture Discussion group Demonstration Audiovisual Reading Practice by doing 5% 10% 20% 30% 50% 75% 80% Average Retention Rate

(11)

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

(12)

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

(13)

Novice Expert

Educational Psychology

(14)

Teaching Learning

Teacher centered Knowledge transfer

Reinforces passiveness

Teachers provide answers

Teachers direct students

Student centered

Knowledge acquisition

Reinforces activeness

Teachers ask questions

Teachers guide students Teaching vs Learning

(15)

facilitator student student student student student student student student

Student-Centered (Learning)

(16)

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

(17)

(18)

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

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

(19)

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).

(20)

The

acquisition of an integrated body

of knowledge related to the problem

and the develop or application of

problem-solving skills

(21)

Student-Centered

Problem-Based

Integrated

Community-Oriented

Early Clinical Exposure

Self-Directed/ Selective with Core

(22)

(23)

tutor students problem Tutorial group process

(24)

The problem is

the motor

of the learning

(25)

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

(26)

PELAKSANAAN PBL

DI FK – UNAND

KURIKULUM

(27)

(28)

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

Pengertian Kompetensi

(29)

(30)

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

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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

(32)

KURIKULUM FAKULTAS

BLOK BLOK BLOK BLOK

MODUL MODUL MODUL

SKENARIO

mingguan

SKENARIO mingguan

(33)

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

(34)

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

(35)

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

(36)

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)

(37)

Process in Small Group Learning

INCREASING DEGREE TIME FORMING STORMING NORMING PERFORMING MOURNING n n n n C.I nnnn C.I n n n n C.I n n n n C.I nnnn C.I w w w w ACTIVE ROLE OF THE TEACHER u u u uINDIVIDUAL GROWTH AND EXPECTATIONS GROUP ₈₈₈₈ GROWTH GOAL OPTIMUM GROUP GROWTH AND INDIVIDUAL GROWTH

(38)

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

(39)

………..menggunakan

problem

untuk

mendorong aktivitas pembelajaran

berdasarkan

a need-to-know basis

(Woods, 1994)

Kunci Tutorial dalam PBL

(40)

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

(41)

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

(42)

……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

(43)

(44)

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

(45)

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.

(46)

..….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.

(47)

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

fast-moving and wide-ranging analysis.

(48)

…..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

(49)

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.

Brainstorming

(50)

……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

(51)

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

Arranging explanations into

a tentative solution

(52)

……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.

(53)

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.

……Arranging explanations into

a tentative solution

(54)

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

(55)

……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

(56)

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

(57)

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?

(58)

Step 3. Brainstorming possible hypotheses or

explanations

(prior knowledge)

1. Dina dibawa ke IGD RSUD karena kecelakaan 2. Dokter merencanakan reposisi karena fraktur

3. Pemeriksaan darah rutin karena Dina akan dianestesi 4. Hb 5,6 gr% artinya anemia berat

5. Untuk menelusuri penyebab anemia pada Dina 6. 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

(59)

Step 4. Arranging explanations into

a tentative solution

Kecelakaan

Fraktur Reposisi Anestesi

Darah Rutin Anemia Obat Depresi hematopoetik Anemia aplastik Susah makan Defisiensi Anemia defisiensi Anamnesis, Pemeriksaan fisik, penunjang

(60)

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

(61)

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.

(62)

……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

(63)

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.

Sharing the results

(64)

……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

(65)

(66)

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

(67)

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

(68)

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

(69)

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

(70)

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

(71)

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

(72)

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

(73)

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

(74)

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

(75)

Penilaian Tutorial

Menggunakan borang terstruktur:

- Partisipasi - Komunikasi - Persiapan - Keaktifan - Critical thinking - Group skills - General comments

(76)

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)