Our Experiences in Conducting PBL Session at Universal College of Medical Sciences (UCMS) Bhairahawa Nepal

Problem-based learning (PBL) is an educational strategy first introduced in McMaster University Canada fifty years back. In Nepal, it was first introduced in Tribhuvan University (TU) Institute of Medicine (IOM) early 1980s for sometimes. Subsequently, PBL implemented in B P Koirala Institute of Health Sciences (1998), Kathmandu University (KU) Medical School (2001), KU affiliated medical colleges (2011) and Patan Academy of Health Sciences (2010-2011). It has also been experimented in two medical colleges KIST Medical College (2011) and Chitwan Medical College (2015) affiliated to TU-IOM. The PBL as an educational strategy is just mentioned in TU-IOM MBBS curriculum (2008) and BDS curriculum (1999) but not practiced. Universal College of Medical Sciences (UCMS) Bhairahawa, Nepal established in 1998 is affiliated with TU-IOM. UCMS conducted one PBL session for first year MBBS / BDS for six-days June 16-21, 2019. Prior to implementation, one-day “Workshop on PBL for Tutors” was conducted for tutors for understanding PBL process and recognizing the role of tutor in conducting PBL. One PBL package was developed including scenario, 4-triggers and tutor guide. After workshop, implementation plan for session was developed.Students were oriented on first day for one-hour. Tutorials were conducted for two-hours (11.00-13.00) for first five-days with supervised self-directed learning (SDL) for two-hours in afternoon (14.00-16.00) with SDL continued at hostel. During tutorials students encountered patient’s problem comprised of four-triggers; they identified cues, established learning needs and developed learning objectives followed by discussion. Seminar was arranged on last day for four-hours. Feedback from students was obtained on structured questionnaire and students received feedback individually from respective tutor in afternoon of last day. Students presentations in seminar were orderly, logical, and delivered proficiently. Tutors communicated that students were motivated, satisfied, participated actively, they acquired optimal knowledge and their communication, analytical and problem-solving skills enhanced. Students feedback was positive and constructive.


TU-IOM runs its medical school named Maharajganj Medical
Campus and seven private medical colleges and seven dental colleges are affiliated with it. All medical colleges have been implementing undergraduate curriculum for medicine (MBBS) revised in 2008 and all dental colleges have been implementing undergraduate curriculum for dentistry (BDS) revised in 1999. The undergraduate MBBS curriculum is students centered, information oriented, uniform, systematic, community oriented and horizontally integrated while undergraduate BDS curriculum is students centered, information oriented, uniform, systematic, hospital based and horizontally integrated. The problem-based learning strategy is just mentioned in both curriculums but not practiced [6,7]. TU-IOM is in process of revising both undergraduate medicine and dentistry curriculums.

Tribhuvan University Institute of Medicine Kathmandu in Nepal in
1978-1980 as a teaching learning strategy [8,9]. It was implemented for sometimes. B P Koirala Institute of Health Sciences (BPKIHS), Dharan Nepal introduced PBL in 1998 [8]. Kathmandu University

Universal College of Medical Sciences (UCMS)
Universal College of Medical Sciences (UCMS) Bhairahawa Nepal established in 1998 is affiliated with Tribhuvan University Institute of Medicine (TU-IOM). It runs undergraduate and postgraduate courses in medicine, dentistry, nursing and allied sciences [11].
It implements undergraduate curriculum for medicine (MBBS) revised in 2008 and undergraduate curriculum for dentistry (BDS) revised in 1999 [6,7].

Health Professions Training Committee of UCMS
With the purpose to strengthen the capacity and competence

Before PBL session
After workshop, plan for implementation of one PBL session for students of first year MBBS and BDS was developed. The date for session was scheduled in third week of June 16-21, 2019 and notified a week prior to implementation. Orientation for students was planned for first day for one hour 10.00-11.00am. Tutorials were timetabled for two hours 11.00-13.00 hours for first five days June (16-20,2019) with supervised self-directed learning (SDL) for 2 hours in the afternoon 14.00-16.00 hours with SDL continued at hostel. The seminar was scheduled on last day of session June 21, 2019 (see Table 1). Students (No140) of first year MBBS/BDS were divided into 10 groups randomly, notified and informed to the students. Each group comprised of 14 students,10 from MBBS and 4 from BDS. Places for 10 tutorial rooms with

Observation of tutorial: HPTC chief coordinator and PBL
coordinator observed the tutorial process.

PBL implementation committee meet: Members briefed to HPTC
Chief coordinator about proceedings of days' activities.
Day two: tutorial two: Students reached the tutorial room on time and did discussion on identified learning objectives of trigger one for one hour. After discussion new scriber and leader was selected. Then tutor shared trigger 2; students after interaction identified clues, developed learning needs and learning objectives.
Tutor facilitated their learning and kept them on track. Students dispersed for lunch at 13.00-hour and assembled again at14.00hour for SDL which was supervised by respective tutor. Respective tutor took attendance twice in day.

Observation of tutorial: HPTC chief coordinator and PBL
coordinator observed the tutorial process.

Observation of tutorial: HPTC chief coordinator and PBL
coordinator observed the tutorial process.

PBL implementation committee meet: Members briefed to HPTC
Chief coordinator about proceedings of days activities.

Conclusion
Overall PBL session was well planned, organized, conducted and executed. The PBL process and tutorial proceedings were satisfactorily facilitated by tutors and reasonably managed by PBL coordinator and HPTC chief coordinator. Students participations were commendable. They were gratified, updated their communication skills, learnt about self-directed learning process, small group activity process, use of learning resources, analytical skills, problem solving skills and interpersonal development.