What makes PBL inclusive?
Problem based learning (PBL) is a learning tool that sees students working collaboratively in groups to solve clinical problems. At St George’s, healthcare courses, such as medicine, use PBL to challenge students’ concepts on taught information and get them to apply it in simulated patient cases.
In my own personal experience, I have personally found PBL a worthwhile experience that has allowed me to put into practise my clinical knowledge. PBL also provides the opportunity to work collaboratively with peers and to see cases from others’ perspectives. Not only on diagnosing and treating patient characters but also aspects of their social lives and how that might impact how they access care. However, in some discussions around the cases, we also spoke about apparent stereotypes of some of the characters.
Research has already been carried out by staff and students on stereotyping in Case Based Learning (CBL) already (1). However, it differs slightly from PBL as it doesn’t require students to pick options to progress through the case but rather begins helping students to understand why certain decisions were undertaken. A staff and student partnership group undertook a qualitative study into humanising cased-based discussion. They found that some cases lacked diversity in terms of ethnicity (specifically patient characters of Black British and Eastern European descent) and contained stereotypes, this included not only patients but also the healthcare professionals featured within the cases.
To combat this the team formed groups of staff, student and interprofessional case writers, provided diversity teaching and staff workshop and online writing resources.
They then followed up with 16 medical students to identify the effect, if any, on the newly written cases. Several themes were investigated, but specifically for diversity, students expressed they were now ‘no concerns about stereotyping’ and that patients were from a range of backgrounds. It also found the use of diverse names in the cases helpful, as they would now know how to pronounce them in the future.
The study did identify some limitations, including the number of students interviewed, not having students from a LGBT+ and neurologically diverse backgrounds as part of the feedback process. Additionally, as students were recruited in 2 cohorts, the time that had elapsed between CBL session and data collection were different which may have affected student recall.
So how can this be applied to inclusion in PBL?
• Obtain feedback on the current PBL cases to identify any inclusivity-related issues.
• Recruiting and involving students and staff from various backgrounds into the case writing process.
• Train case writers to write diverse and inclusive cases.
• Review the newly written cases with students, using a form instead of a MS Teams interview to increase the engagement in providing feedback.
• Regularly review cases to make sure they continue to represent the diverse population that is found within the St George’s and the surrounding communities.
Overall, diversity and inclusivity within PBL would allow students to gain a better understanding of what it’s like for people from a range of different backgrounds to access and experience healthcare services. Therefore, enabling students to better diagnose patients from all walks of life, therefore helping them become well-rounded inclusive clinicians in the future.
References:
(1) Humanising Case-Based Learning: A Qualitative study | Dr S Baig, Dr R Al-Bedaery, Y Khare, J Sullivan-Mchale