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Problem-Based Learning (PBL): A Review of the Current Literature
Problem-Based Learning (PBL) is a relatively new teaching strategy that has revolutionized the teaching and learning processes in multiple parts of the world, and in different fields of knowledge.
This teaching method was conceived and implemented at McMaster University School of Medicine in Hamilton, Ontario, Canada around 1969 both as a teaching strategy and as part of a new curricular design. American neurologist and medical educator, Dr. Howard S. Barrows (Oak Park, Illinois, 1928 – 2011) was the pioneer of this endeavor. Today, after forty six years of its creation and put into practice, PBL has experienced modifications within its fundamentals of conceptualization, practice guidelines, implementation, adaptation improvements, subject to research studies, and extensive debate carried out by numerous academic institutions, as well as the creation of indexed journals that compile all this information serving as the main mechanism of knowledge release. Furthermore, its impact has been such that it has grown at an exponential level, expanding across all continents until, in 2013, it landed in the Dominican Republic. It was the School of Medicine of Universidad Dominicana O&M (O&Med) the first academic institution to incorporate Problem-Based Learning (PBL) in its curriculum and throughout the entire 6-year career program.
The traditional teaching methology, is the one in which the center of attention, for knowledge delivery, is the teacher (Teacher-Centered learning). The teacher comprises the active part of the student-teacher binomial following the traditional format, known and implemented for centuries, of conveying knowledge to a student group or audience so they are able to learn. So, how do we accomplish this task using the traditional teaching strategy? Taking notes, asking questions, reading from different sources like textbooks or journals. In this fashion, one learns about the taught subject to, ultimately, be assessed with exams, papers or practical work that may, in turn, be passed or failed. This is why this traditional methodology is called Teacher-Centered learning2. In contrast, students are the passive component in the context of the binomial relationship and, in spite that the vast majority of people have been educated in this fashion, it is not necessarily the one that promotes the development of some specific and key skills, aptitudes and competences in the students that will eventually complement the acquired knowledge.
In Problem-Based Learning, the building of knowledge relies in the fact that, to solve a problem or case that is presented by the teacher, students must be guided through the process of discussion, research and practical application of knowledge to actually obtain the expected outcome; solve the problem. All this occurs integrating the load of information of almost all courses taken alongside during an academic term and applying newly-acquired knowledge to the “case”. In general, Problem-Based Learning claims that solutions are obtained on the basis of collaborative work among students, working in groups with the support and guidance of the facilitator.
PBL argues that problem-solving through real cases’ discussions requires being knowledgeable in a field; however, blending this information does not take place nor remains as a merely act of rote, but rather as part of a critical-thinking process and practical application of learned material. Teachers exposed to this methodology shares knowledge, provide guidance, follows the case’s learning objectives and afterwards assesses students with a classical exam, but also establishes the unsolved problem so learners are prompted to apply information to different contexts – and approach it from different perspectives – through deliberation, reflection and deep analysis, developing and strengthening clear and organized reasoning and creativity, among other skills.
PBL focuses in learning, research and reflection by students related to a topic, where the teachers perform as facilitators and guides toward problem-solving but not as an absolute authority that only conveys information on the subject matter. The facilitators’ role is not limited to the sole transmission of information but to the orientation and monitoring of students to guarantee the compliance of the case’s Learning objectives, promoting the gain and development of transferable skills – defined previously – that will couple with the conceptual baggage to achieve the final product: a graduate or postgraduate with developed unparalleled cognitive and learning skills and competences. This array of teaching-learning features enables students and graduates to be positioned in selected strata of both academic and professional excellence, and it stimulates them to be highly competitive within the global markets context. Hence, graduates will be enabled and trained with useful tools which, in turn, will enhance self-confidence and competitiveness to pursue further academic training, employment or entrepreneurship.
In problem-based learning students’ performance and progress are evaluated based on two major measurable assessment aspects:
- Quantitative, and
Quantitative assessment encompasses three measurable subsets: 1) active group participation during every session, 2) self-directed study or independent work, and 3) preparation and presentation of the solved case in a plenary session. All these subcategories are graded as a percentage of a more complex assessment process. Besides, students also sit for both a mid-term and a final exam in every academic term. This evaluation process helps teachers (facilitators) better assess the objective aspects of the methodology. The complete evaluation process takes place once the groups have already presented more than 2 cases, sometimes just one depending on the length and complexity of the problems. Both exams are also assigned a percentage of the total grade.
In contrast, the qualitative evaluation focuses more on the level of acquisition and improvement of transferable skills and competences, which I have already mentioned previously. They will be discussed in more detail ahead. Before I proceed to break down these concepts I would like to define upfront what transferable skills stand for. They are nothing but the capacities and abilities, inherent to all human beings, that are firstly identified, developed and later on shaped in such a way that the bearer may, eventually, practically apply, transfer or extrapolate to any environment or field of knowledge which they may find themselves. These skills are not just called “transferable” for the sole fact that students copy them from others, but rather because of their extrapolarity to similar or different areas beyond healthcare. These skills are also applicable to non-professional environments, i.e. household activities, family-related encounters, sports, politics, etc. and they can very effectively contribute to one’s achievement of any goal.
To cite examples of these so-called transferable skills that I mention, and that students develop through problem-based learning (PBL), we find:
o Critical thinking
o Time management
o Decision making
o Problem solving
o Team work, both as team leaders and as team players
o Inter- and intraprofessional communication
o Public speaking
o Analysis and synthesis
o Capacity of interdisciplinary integration of knowledge
Both types of evaluations are made throughout the academic term and results are monitored accordingly. Afterwards, there is a feedback time allocated for active discussion, between facilitators and students, to share the reports on their outcomes in each subset of assessment. The combination of all these evaluations and results are parameters which provide us with a more objective, concurrent and quasi predictable idea of our desired graduates’ profile’s and trajectory forecasting.
In 1994, and again later in 1996, Howard S. Barrows acknowledged that, in the medical field, the act of diagnosing a patient – which is part of a physician’s duty – rested in a combination of processes of hypothetical-deductive thinking and expert knowledge in different domains. To teach specific contents of a discipline (i.e. anatomy, neurology, pharmacology, psychology, etc.) as clearly separate subjects and applying the traditional teaching technique contributed very little in providing the students with a “context”.
Problem-Based Learning (PBL) along with its positive outcomes, as innovative and multifaceted as it is, provides to both students and academic institutions the necessary capabilities that enable graduates to blend within the community as professionals with high levels of integrity, in order to play their roles as leaders, decision makers and opinion formers in any given field. This also exerts its effects on other high-level institutions or people contributing to enhance health promotion and disease prevention, or timely interventions as appropriate. These characteristics grant professionals the opportunity to impact at the individual, community, national and global levels.
Many articles from all corners of the planet have been published on research in the context of PBL, and many authors agree that there is still a lot to investigate and to innovate. Among the existent relevant research studies on PBL I shall mention those of Juri Valtanen (Finland, 2014) about Question-asking patterns in PBL tutorials; the array of publications made by Hmelo-Silver & Barrows et. al.; Catherine Coelho in Facilitating facilitators to facilitate; Constance Bowe & Thomas Aretz on PBL during pre-clinical years of medical school, and many more.
Most researchers coincide with the still-existing lack of more investigations, particularly outlining the following specific areas of PBL: 1) establishing a clear and objective guideline on the principles and fundamentals of PBL, 2) set out conceptual improvements in the role of facilitators, 3) long-term monitoring of question-asking patterns that arise during tutorial sessions, 4) targeting quantitative and qualitative assessments of questions and answers arising during PBL tutorials focusing on both facilitators and students to establish a long-lasting point of balance, 5) promoting the strategy that most of the questions come from students, encouraging debate and discussion, and not from the facilitators. These are the more prevalent concerns in the literature but the recommendations for further research are not limited to them.
My personal position is that, in a matter of five to ten years – hopefully less – when problem-based learning becomes a more widespread, tested and defined both the educator’s and researchers’ communities will report much better, more accurate and well-defined outcomes in general terms, so there will be a greater understanding and acceptance of PBL in most curricula. So much so that I insist in believing there will not be one field of knowledge (medicine, law, engineering, nursing, accounting, economy, IT technology, architecture, etc) that will not have an experience applying problem-based learning as a useful methodology.
Those of you – like me – to whom education is a basic pillar to people’s and society’s growth and development, face a great challenge as to what curricular innovation and better learning outcomes concerns. I am certain it is timely to ponder on where are we right now, where are we heading to and whether we want to go there, to really focus on our teaching and learning objectives in the twenty-first century. World expert’s work shows that active learning – through PBL – is key to achieve academic success, especially in times when open access to information is easily reachable by all kinds of students from everywhere; making these whole processes – of self-directed and active learning – an easier and more fruitful one.
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