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 Table of Contents  
CASE STUDY
Year : 2018  |  Volume : 5  |  Issue : 4  |  Page : 302-304

Impact of problem-based learning in dentistry curriculum in Nepal: A self-reflection


1 Department of Oral Medicine and Radiology and Public Health Dentistry, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
2 Department of Pharmacology, Christian Medical College and Hospital, Ludhiana, Punjab, India

Date of Web Publication14-Nov-2018

Correspondence Address:
Jyotsna Rimal
Department of Oral Medicine and Radiology, B. P. Koirala Institute of Health Sciences, Dharan
Nepal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_122_18

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  Abstract 


My project on problem-based learning (PBL) is not new to medical schools but not many dental schools have adopted this approach in their curriculum in South Asian region. This approach not only develops content knowledge and skills but also sharpens the soft skills such as critical thinking, interpersonal, teamwork, presentation, speaking, and communication skills, which are equally needed to become a successful doctor. As a part of fellowship of the Foundation for Advancement on Medical Education and Research, Regional Institute, Christian Medical College, Ludhiana, this approach was tried in 2013 and ultimately incorporated in the curriculum in 2014. This case study describes the journey, challenges, and way forward from initiation of PBL approach in a government dental college of Nepal to its inclusion in national curriculum.

Keywords: Innovative curricula, medical education, problem-based learning, process assessment


How to cite this article:
Rimal J, Shrestha A, Badyal DK. Impact of problem-based learning in dentistry curriculum in Nepal: A self-reflection. CHRISMED J Health Res 2018;5:302-4

How to cite this URL:
Rimal J, Shrestha A, Badyal DK. Impact of problem-based learning in dentistry curriculum in Nepal: A self-reflection. CHRISMED J Health Res [serial online] 2018 [cited 2018 Dec 10];5:302-4. Available from: http://www.cjhr.org/text.asp?2018/5/4/302/245444




  Introduction Top


The World Health Organization has recommended that dental education should be problem based, socially and culturally relevant, and community oriented.[1] Problem-based learning (PBL) is an educational methodology widely used in medical education and is growing in dental education.[2] With the introduction of integration of basic sciences and the clinical subjects, students are expected to be active participants in their learning process.[3] The Foundation for Advancement of International Medical Education and Research (FAIMER) is a nonprofit organization committed to improving global health through health professions education. It concentrates its efforts in low-income regions in Asia, Africa, and Latin America and focuses on three specific strategies: faculty development, targeted research that informs health workforce policy and practice, and development of data that advances educational quality improvement decisions. Nepal is a resource-constraint country. Initiation of new ideas and teaching methods in dental sciences in Nepal would require change in perceptions from the faculty and institute management. FAIMER fellowship contributes in capacity building of human resources in health professions education. Student-centered education is the need of the day, and PBL provides the best outlet to it. As an educator, despite devoting a considerable time to plan, prepare, and teach basic science students, they did not retain much basic science knowledge in further clinical years when they started dealing with patients. The literature, on how to develop long-term memory of the students, clearly prove that PBL is one of the best ways to develop not only long-term memory but also to make students self-directed and life-long learners.[4],[5],[6] The education innovation project entitled “Introduction of Problem Based Learning in Undergraduate Dentistry Program in Nepal” was done for FAIMER fellowship at Christian Medical College Ludhiana-FAIMER, Regional Institute [Figure 1]. The project has set a milestone in dental education in Nepal.[7] B.P Koirala Institute of Health Sciences is a center of excellence in health professions education in Nepal. PBL, though an established student-centered approach in MBBS program, had not seen its day in dentistry. The need for student-centered approach in dentistry was felt for a long time. This case study reflects the initiation and implementation of PBL in dentistry program for the first time in Nepal.
Figure 1: Students at “search-research-discover” session in the library

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  Case Study Top


The experience (What?)

After the incorporation of PBL in the BDS curriculum, the cases were written by a team of experts from different specialties of dentistry. Each case design was done by a core group of faculty of different specialties along with PBL experts. Initial cases took as long as 6 months to design. However, with proper orientation, training, and practice, only 1 month was required in the design of the latest PBL case. The topics for which cases have been designed are as follows: temporomandibular joint, muscles of mastication, occlusion, dental caries, and infection control. The feedback of the sessions, students, and tutors has also been taken using different questionnaires. This has provided us an evidence that students liked the exposure to a new approach of learning and they enthusiastically have embraced this and have also expressed that they would want to continue learning using this methodology.[7] The endeavor, initially as an educational innovation project, was incorporated in the curriculum because students were convinced with the learner-centered approach. The gaps identified in the delivered and written curriculum through the Teaching Program Implementation Committee was bridged by revision of curriculum. Along with other modifications, PBL was included in it. During curriculum revision workshop, it was expressed that PBL is also beneficial in clinical subjects, especially in clinical reasoning and diagnostic analytical skills. Many clinical departments teach the same content/disease and many a times students get confused with the different perspectives of the content/disease. This was thoroughly discussed in the curriculum review workshop and decided to initiate PBL also in the clinical years. Qualitative assessment of the program as a whole has shown that the program has been applauded and appreciated by students and tutors [Figure 2]. These assessments provide the organizers of the PBL with the evidence for scope of improvement and future directions.
Figure 2: Group picture with students, tutors and coordinator after the 5-day problem-based learning session

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Reflective observation (So what?)

PBL is resource intensive in terms of human resource and finances. Unless institutions realize the importance of investing in this student-centered approach, the implementation part suffers. The real challenge started once it was implemented. The educators of BDS program came from traditional curricular model and they had been taught by teacher-centered approach. The infrastructure was inadequate for small group teaching, and there were not enough PBL cases for a routine PBL. It took few motivated, like-minded and convinced faculty members to work toward overcoming these challenges. The department of health professions education organized and conducted faculty training programs on PBL, role of tutors, and case designing. Infrastructure was upgraded at the existing discussion rooms of each department to suit for PBL tutorials. Teams of PBL of different levels were formed which included PBL core group and separate PBL subcommittees for MBBS/BDS/Nursing programs. The PBL core group comprised all the program coordinators, PBL coordinators of each program chaired by the Dean, Academics. The PBL subcommittee for BDS program was formed which included a PBL coordinator and all the BDS program coordinators and deputy coordinators along with representatives from departments as members. This team is also responsible in writing cases. We have so far developed 10 cases and are working on developing at least 25 cases on the most common problems of oral cavity. Process assessment for each PBL block is an important part of the teaching–learning activity. The team has just completed PBL block on “Infection Control Protocol” for 3rd-year BDS students. Students found it beneficial as they are better oriented about each department's infection control protocol and feel more comfortable in working at clinical areas.

The road ahead (What now?)

The initiation of PBL in dentistry program in Nepal has set many milestones. The need to learn the process of PBL is increasing day by day as other universities are initiating PBL in dentistry in Nepal. This need is reinforced by the Nepal Medical Council which mandates all the Medical and Dental Curricula to follow SPICES model.[8]

Despite the success so far, there are challenges in motivating the students to be active learners as they are used to being spoon fed by traditional lectures. For this, PBL team should work on designing good cases and good monitoring by tutors. Assessing the soft skills learned in PBL is another challenge that our team need to work upon. Learning needs to be linked with the assessment as our students are strategic learners. Hence, capacity building of PBL experts is essential if PBL is to be implemented nationally.

PBL study groups may be formed to discuss and learn more about this learning approach. There also has been demand for online course on PBL. Although massive open online course requires a good IT team, it can be started small at the local level, expanding it over time. The PBL process assessment also needs to be more systematic and should be used to improve future PBL process. With the commitment of the university management and the governing council, PBL will benefit the students to develop their critical thinking, self-directed, and life-long learning skills.


  Conclusion Top


There has definitely been a substantial impact of the FAIMER project on PBL in dental curriculum in Nepal. A considerable progress in dental education can be expected in future.

Acknowledgment

The authors would like to thank the tutors, faculty, and students who participated actively in all the group interactions and resource sessions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wang G, Tai B, Huang C, Bian Z, Shang Z, Wang Q, et al. Establishing a multidisciplinary PBL curriculum in the school of stomatology at Wuhan University. J Dent Educ 2008;72:610-5.  Back to cited text no. 1
    
2.
Susarla SM, Bergman AV, Howell TH, Karimbux NY. Problem-based learning and research at the Harvard school of dental medicine: A ten-year follow-up. J Dent Educ 2004;68:71-6.  Back to cited text no. 2
    
3.
Khullar S. Integrated teaching in medical education in India. Int J Basic Appl Physiol 2016;5:6-14.  Back to cited text no. 3
    
4.
Callis AN, McCann AL, Schneiderman ED, Babler WJ, Lacy ES, Hale DS, et al. Application of basic science to clinical problems: Traditional vs. hybrid problem-based learning. J Dent Educ 2010;74:1113-24.  Back to cited text no. 4
    
5.
Alrahlah A. How effective the problem-based learning (PBL) in dental education. A critical review. Saudi Dent J 2016;28:155-61.  Back to cited text no. 5
    
6.
Williams JC, Paltridge DJ. What we think we know about the tutor in problem-based learning. Health Prof Educ 2017;3:26-31.  Back to cited text no. 6
    
7.
Rimal J, Paudel BH, Shrestha A. Introduction of problem-based learning in undergraduate dentistry program in Nepal. Int J Appl Basic Med Res 2015;5:S45-9.  Back to cited text no. 7
    
8.
Accreditation Standards for BDS 2017. Nepal Medical Council. Available from: http://www.nmc.org.np/information/accreditation-standards-for-the-bds-2017.html. [Last accessed on 2018 Oct 01].  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

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