gms | German Medical Science

GMS Journal for Medical Education

Gesellschaft für Medizinische Ausbildung (GMA)

ISSN 2366-5017

Student evaluation of problem-based learning in a dental orthodontic curriculum – A Pilot study

research article dentristry

  • corresponding author Anja Ratzmann - University Medicine Greifswald, Outpatient Department of Orthodontics, Greifswald, Germany
  • U. Wiesmann - University Medicine Greifswald, Institute for Medical Psychology, Greifswald, Germany
  • P. Proff - University Medicine Greifswald, Outpatient Department of Orthodontics, Greifswald, Germany
  • Bernd Kordaß - University Medicine Greifswald, Department of Dental Medical Propedeutics, Community Dentistry, Greifswald, Germany
  • T. Gedrange - University Medicine Greifswald, Outpatient Department of Orthodontics, Greifswald, Germany

GMS Z Med Ausbild 2013;30(3):Doc34

doi: 10.3205/zma000877, urn:nbn:de:0183-zma0008771

This is the English version of the article.
The German version can be found at: http://www.egms.de/de/journals/zma/2013-30/zma000877.shtml

Received: November 9, 2012
Revised: March 7, 2013
Accepted: April 7, 2013
Published: August 15, 2013

© 2013 Ratzmann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Abstract

Objective: The present questionnaire survey investigated student reception of problem-based learning (PBL) in the orthodontic curriculum with regard to acceptance, sense of purpose and motivation, knowledge and understanding, as well as tutorial support.

Methods: Over a period of two terms, we compared two different didactic methods (PBL and short presentations) by randomizing the participants of a course on orthodontic diagnostics into two different groups, who inversed methods after the first term.

Results: The two student groups did not show any significant differences with regard to assessments or examination performance. Therefore, acceptance of the PBL concept seems to be mainly associated with the motivation of individuals to use this method. The higher the motivation, the more positive is the attitude towards the PBL concept. Students seem to work more constructively and efficiently with PBL if they can judge the concept meaningful for themselves.

Conclusion: In consideration of the relevant literature and the present results, PBL can be principally integrated into the dental curriculum as a method of learning. However, student motivation is vital to learning success.

Keywords: dentistry, orthodontic education, problem-based learning, conventional didactic lecture


Introduction

Examples of PBL implementation into medical and dental curricula

In the search for student-centered forms of learning, problem-based learning (PBL) has become more and more established in medical education. Medical and dental studies in Germany are divided into preclinical and clinical phases. In contrast to medical degree courses, dental degree courses already include practical teaching units, and clinical treatment steps are simulated and practiced by means of simulator heads even during the preclinical phase. During the clinical phase, patients are treated on an interdisciplinary basis, which facilitates the linking of individual facts with complex problems, thus resulting in comprehensive dental treatment. Because this procedure corresponds to the PBL concept in its wider sense, PBL appears to be particularly suitable for the dental curriculum.

Over the past few years, problem-based curricula have been developed worldwide according to the role model of the McMaster University [1], particularly for medical degree courses. Famous examples are the Harvard Medical School in Boston [2], the University of New Mexico [3], and the University of Newcastle in Australia [4]. In Europe, the most prominent example of having converted the entire medical curriculum is the University of Maastricht [5]. By now, several medical faculties in Germany teach clinical subjects [6], [7], [8], [9], [10]] by means of the PBL concept, and the Universities of Berlin [11], [12] and Witten-Herdecke [13] offer reformed medical study programmes that are entirely based on this concept.

In dental studies, the Malmö Dental School [8] completey chanced its curriculum in favor of a student-centered PBL concept in 1990. The University of Dresden introduced PBL-based block courses in each clinical term of the dental curriculum as part of the reform-curriculum DIPOL® [http://tu-dresden.de/die_tu_dresden/fakultaeten/medizinische_fakultaet/studium/stuverz/index_html], a hybrid curriculum consisting of new and traditional elements. Lectures are maintained but to a lesser extent, whereas the number of courses, traineeships, as well as practical training sessions with patients has increased. New elements are small group tuition, special case discussions, self-studies, modern forms of teaching and learning, such as multimedia, interdisciplinary education, and new examination formats [http://tu-dresden.de/die_tu_dresden/fakultaeten/medizinische_fakultaet/studium/stuverz/index_html].

Autonomous, problem-based, and media-supported learning are essential aims of the project ‘Heicudent’ at the University of Heidelberg [http://www.klinikum.uni-heidelberg.de/Zahnmedizin.118579.0.html]. As part of the reform of the dental curriculum, PBL-based seminars have been implemented into the course ‘Diagnostics and Planning 1‘ for 4-year students.

Student acceptance of PBL
1. Investigative instruments

The relevant literature shows that the term ‘student acceptance’ involves rather different aspects. A common denominator of the majority of trials is their use of questionnaires as investigative instruments [14], [15], [16], [17], [18], [19], [20]. The essential content of these questionnaires is the subjective self-evaluation of students with regard to professional competence including clinical skills, the level of knowledge, and communicative competency. Further topics to be assessed are motivation and satisfaction with the PBL concept. Student acceptance was analyzed by dividing participants into two groups. One group was taught according to the PBL concept and the other group by means of traditional learning methods. Furthermore, PBL-based curricula were subjected to numerous evaluations.

2. Comparison of PBL with traditional learning methods

A retrospective analysis of dental graduates from the Harvard University did not show any significant differences between the two methods with regard to professional competence and clinical skills [14]. In contrast, medical graduates at the University of Maastricht taught according to the PBL concept showed better self-assessments with regard to expert knowledge and subject-specific competency than their traditionally educated peer group [16]. A retrospective trial at the University of Dalhousie investigated medical students who had been prepared for hospital internship either according to the PBL concept or by traditional learning methods. The subsequent analysis showed significantly better self-assessments for the PBL-trained group with regard to learning environment and the curriculum [15].

Every trial showed higher values for graduates in the PBL-trained groups with regard to communicative competency, critical thinking skills, small group tuition, team work, and self-assessment of own strengths and weaknesses. The reform-curriculum DIPOL® was evaluated by means of a multi-level concept [21], [22] that included questions on acceptance of this new form of learning and its transferability (expected usefulness of the gained knowledge on the part of the participants). Furthermore, learning achievement was assessed, and the PBL concept was compared with traditional learning methods used simultaneously in other subjects. Student assessments showed positive ratings for the PBL concept with regard to acceptance and motivation but also minor advantages of traditional learning methods with regard to the acquisition of specialist knowledge and transfer expectation [22].

The same group of authors also evaluated the PBL concept for the dental curriculum by analyzing the feedback from students and tutors according to Kirkpatrick’s 3-level model [23]. The results showed good student acceptance of the PBL concept as well as considerable improvements in autonomous learning as well as in cooperative and communicative skills [23].

The PBL-based block training ‘Social Medicine’ at the Medical University of Hannover showed higher student ratings with regard to learning achievement and higher success in transferring than traditional learning methods [8]. According to the findings of a randomized comparison of the two learning methods conducted at the University of Cologne, students clearly considered the PBL concept to be better than traditional learning methods [24].

In a retrospective evaluation of the PBL concept and traditional learning methods in the field of surgery at the University of Maastrich, medical graduates taught according to the PBL concept showed significantly higher ratings with regard to learning motivation [17].

3. Evaluation trials on PBL

PBL-based curricula were not only analyzed within the comparative trials described above but also within evaluation trials. The results of a Swedish trial [25] indicated a high level of satisfaction of the graduates with their PBL-based preclinical education in view of their later medical work. As part of the reform of the dental curriculum, the course ‘Internal Medicine’ at the University of Nijmegen was converted according to the PBL concept [18]. The majority of participants (73%) not only considered PBL a useful method of learning but preferred it over traditional learning methods. Small group tuition was viewed as the preferable method of learning by 75% of the participants. Small group tuition enables students to do better in seminars and to identify themselves with the subject matter. The PBL-based curricula at the University of Malmö and the Dental School of Southern California are generally held in high regard and are preferred over traditional learning methods with regard to didactics [19]. The convertion of the orthodontic curriculum to the PBL concept at the University of Manchester has resulted in high student satisfaction with the course (organization of modules, quality of the PBL-based cases, course material, etc.) [20].

Student motivation and cooperation were necessary criteria for the success of the PBL concept, and good group dynamics were essential for the cooperation within small groups [26], [27]. Lack of motivation and dissatisfaction with the tutor had a negative influence on achieving the learning targets in seminars [28], [29], [30]. The influence of tutor behavior on the patterns of group interactions and learning achievements of the PBL concept were investigated in a master’s thesis at the Goethe University Frankfurt [31]. The authoress could show that directive tutors have a significant positive influence on the learning process of their students. Students at the University of Muenster favorably assessed the integration of a problem-based e-learning system (ePBL) into the orthodontic treatment courses I and II in the clinical part of the curriculum [32].


Aim of the evaluation

This literature survey shows that, in German-speaking countries, only a few trials have evaluated the PBL concept within the dental curriculum from a student point of view. Therefore, our trial conducted at the University of Greifswald investigated student acceptance of PBL as an active form of learning within the orthodontic curriculum (dental curriculum) by means of selected criteria (acceptance, sense of purpose and motivation, knowledge and understanding, and tutorial support). In a second step, the extent of the interrelation of these criteria was analyzed for the first time. The following hypotheses were tested in the context of this trial:

1.
Student acceptance of PBL does not change even after a certain amount of time has passed since the evaluation.
2.
In general, students rate the PBL concept as positive, meaning that , they develop a clear idea about the learning method of PBL (knowledge and understanding), judge the concept to be purposeful , are motivated during their PBL-based course (meaningfulness and motivation), and consider their experiences with the PBL concept positive (acceptance).
3.
Assessment of acceptance is positively connected with the assessment of meaningfulness as well as that of knowledge and understanding.

Methods

Study participants and study design

Two different didactic methods (PBL and short presentations) were compared within a course on orthodontic diagnostics in the fifth academic year. This course runs for two terms, beginning in the winter term and finishing in the subsequent summer term.

Because of the absence of a national catalogue of learning objectives, we developed our own catalogue of learning objectives for the subject ‘Orthodontics’. This catalogue was based on the guidelines for the formulation of learning objectives according to Bloom [33] and constituted the basis of the seminar contents. For the fifth academic year in the orthodondic curriuculum, the catalogue of learning objectives includes the topic ‘Diagnostics and Therapy of Orthodontic Diseases’. Tuition should cover the diagnostic and therapeutic procedures of all relevant orthodontic anomalies according to the leading symptoms described by Klink-Heckmann [30]. The overall curriculum of the fifth academic year includes 26 required lecture hours per week during the winter term, of which 16 hours are allocated to the integrated course ‘Dental Prothodontics and Prothetics II' and 8 hours to the course ‘Orthodontic Diagnostics I’. During the summer term, the total number of weekly lecture hours required is 31hours, of which 16 hours are allocated to the integrated course, 4 hours to certificate-based lectures, and 11 hours to the course ‘Orthodontic Diagnostics II’. Since all students had already been taught according to the PBL concept during the preclinical phase [34], extensive experience with PBL was already available prior to our trial. To test the medium-term evaluations of the PBL concept, four randomized student groups in the course ‘orthodontic diagnostics’ were taught according to the PBL concept as well as - with a delay in time - by traditional teaching methods. Group allocation (randomization) was carried out in an alternating process by means of the matriculation number. The 34 students (13 men and 21 women with an average age of 25.8 years) participating in the investigation were regular students in their fifth academic year, meaning that none of them was a repeater. Inclusion criteria were regular enrolment in dental studies as well as eligibility to participate in the course of orthodontic diagnostics according to the study regulation and the specific course regulations. The exclusion criteria resulted from these pre-conditions.

Each student group was supervised by two specifically trained research associates (tutors) of the Department of Orthodontics. As qualification, the tutors had participated in a certified multiply-day training course on problem-based learning according to the University of Harvard approach. Every student in a seminar group had to give a short presentation on a predeterminant seminar topic. The seminar sessions lasted 1.5 hours each and took place every Wednesday morning at weekly intervals. During the winter term, group 1 and 2 were taught according to the PBL concept and group 3 and 4 by means of short presentations. In the summer term, the didactic methods were exchanged (group 1 and 2 had short presentations, and group 3 and 4 had PBL-based seminar sessions). For the PBL-based seminar sessions, the tutors formulated ‘paper cases’ according to the respective leading symptoms of orthodontics. Every seminar session included the presentation of one patient case including clinical symptoms that had been prepared according to the seven jump method. Overall, 10 patient cases were discussed according to the PBL concept. The seminar series was evaluated at the end of the second term.

Investigative instrument

This evaluation was conducted by means of an in-house questionnaire (Greifswald evaluation questionnaire on student acceptance of problem-oriented learning [GreifPBL]) containing 17 items on the PBL concept (see Figure 1 [Fig. 1]). Content-wise, the items covered didatic knowledge, meaningfulness, acceptance, didactic preferences for the acquisition of knowledge, as well as tutorial support. The evaluation was practice-oriented meaning that, it focused on assessing the project [33]. Answers were based on a five-point Likert scale (1 represented the least and 5 the highest degree of accordance), and the response rate was 100%.

Data analysis

Data was evaluated with the statistical software program PASW 18 [35]. We calculated descriptive (central tendencies and distributions) and inferential parametric statistics (Pearson’s r for correlations between variables, one-sample t-tests for testing deviations from average ratings and independent one-sample t-tests for testing differences between two groups). In the context of our total survey, the inferential statistical tests have to be interpreted with care because of the low sample size. Additionally, we assessed the examination performance of all seminar groups. The examination performance included the results of an identical multiple choice test that all seminar groups had to answer on completion of the two-term orthodontic course as well as the results of the oral orthodontic examination within the framework of the State Examination in Dentistry that takes place after the fifth academic year. Moreover, our evaluation included the overall final grade of the State Examination in Dentistry encompassing all dental subjects.


Results

Group differences (hypothesis 1)

No differences could be found between group 1 and 2 (PBL followed by short presentations) and group 3 and 4 (short presentations followed by PBL) with regard to the assessment of their examination performance (t-tests for independent samples were not significant). Also, no gender differences could be found (t-tests were not significant). The statistical tests have an estimated power of 0.79 if large systemic differences are to be excluded (d=1, α=.05, two-sided). These results facilitated an overall analysis of the student sample.

Appraisals of the PBL concept (hypothesis 2)

Figure 1 shows the mean values of the 17 items (N = 34). For a better illustration of student preferences, the center point of the rating scale (scale value 3) was chosen as a starting point of the graphical representation. The students agreed that they understood the concept of PBL (item 1) and had worked out how to process a patient case according to the PBL concept (item 3). Students were able to participate in the course in a constructive manner (item 12) and rated their tutorial supervision and support as good (items 14a and 14b, 15a and 15b). Only items 5 and 8 (PBL as a favorite method of learning) as well as item 9 (learning efficiency) were assessed negatively.

The inferential statistical analyses showed significant differences between the assessment of the items 1, 3, 5, 8, 9, 12, 14a and 14b, and 15a and 15b and the center point of the rating scale (3) (|3.10|<ts(33)<|11.20|,005>ps>.0001). For these items, a high concordance for PBL was found amongst the students. In contrast, the mean values of the items 2 and 10 (sense of purpose and motivation), 4 (knowledge), 6 and 7 (retention of the learned material), and 11 and 13 (acceptance) approximately corresponded to the center point of the rating scale (3). Thus, one sample t-tests were not significant (ps>.05).

Contextual analyses (hypothesis 3)

We investigated the extent to which the subjective student acceptance of PBL (items 5, 8, 9, 11, 12, and 13) is connected with the meaningfulness and motivation (items 2 and 10) as well as knowledge and understanding (items 1, 3, and 4). Table 1 [Tab. 1] shows the Pearson correlations. The relation pattern showed a highly significant correlation between the acceptance of PBL and the individual motivation to use PBL, but an insignificant or less significant correlation with regard to cognitive understanding of the method. The higher the motivation, the more positive was the attitude (values for correlation strength were partly about .60 and higher). In contrast, acceptance of PBL is less dependent on the knowledge of the method (the majority of correlation coefficients was not significant). Only the clarity of the concept (item 1) has a significant association with the willingness to constructive cooperation (item 12) (r=.49, p<.01). The intention to use PBL in future (item 5) is probably only realized if the respective person has an idea of how to process a patient case in a problem-oriented manner (item 3) (r=.35, p<.05). Furthermore, the experienced meaningfulness (item 2) is positively associated with cognitive clarity (1) as well as with the understanding of the process (3), whereas motivation (10) is connected to clarity (1) but not to the understanding of the process (3). According to our analysis, the students also recognized for themselves a link between the method of learning and the retention of the learned material (the retention of the learned material is higher if students do self-guided study).


Discussion

Although more publications are available on learning achievement and learning performance of the PBL concept than on traditional learning methods, only a few studies in German-speaking countries focus on student acceptance of PBL in the orthodontic curriculum. Despite its rather small sample size, the present trial provides interesting insights into this topic. The strengh of our analysis is that it includes students of one complete year.

Effects of order (hypothesis 1)

As expected, we did not find any order effects, for instance, we could not find any differences between group 1 and 2 (PBL followed by short presentations) and group 3 and 4 (short presentations followed by PBL). Because students were randomized into two groups from the very beginning, both groups started in effect with the same prerequisites (learning performance, a priori preference of the learning method, etc.). Therefore, the fact that one group had used PBL in the previous term did not cause any distortion effects. Students were neither more prejudiced nor did they have a more positive or a more negative attitude after PBL-based seminars. Based on these results, we considered it legitimate to combine the two sub-samples.

Evaluation of the PBL concept (hypothesis 2)

The present trial showed a rather reserved assessment of PBL with regard to meaningfulness, retention of the learned material, motivation, and attitude towards the PBL concept. The students agreed that they understood this concept of learning and had worked out how to process a patient case according to the PBL concept. The students were able to participate in the course in a constructive manner. PBL was evaluated negatively with regard to favorite method of learning and learning efficiency. The implementation of a problem-based learning concept is difficult when other subjects have to be learned by means of traditional learning methods [36]. The described orthodontic course takes place in the last year of the dental curriculum. Thus, because all students had used traditional learning methods during their entire study period, they might have not been able to use PBL to full advantage. Therefore, our results did not show any significant preference of students for the PBL concept.

In contrast, when comparing the two learning methods, other authors found a positive feedback if the entire curriculum had been converted to PBL [20], [18], [37], [19]. Students at the University of Manchester generally gave a positive assessment of the conversion of the orthodontic curriculum to the PBL concept [20], and a comparison of PBL with traditional learning methods at the University of Nijmegen showed a strong preference of the students for the PBL concept [18]. Similar to our investigation, the existing curriculum was complemented by a PBL module. Students rated the PBL concept as more efficient because its case-based seminars facilitated better retention of the learned material.

The results of a British trial showed that the PBL concept improves team work as well as the presentation of learning contents [37]. Students of the reformed medical curriculum DIPOL evaluated the PBL concept positively with regard to student acceptance and motivation. Small effect differences were found for traditional learning methods with regard to acquisition of specialist knowledge and transferibility [22]. However, the DIPOL curriculum is a reformed study program in which the majority of clinical subjects are taught by means of the PBL concept. In our trial, the orthodontic curriculum was taught according to PBL but all other subjects by means of traditional teaching methods. In contrast to DIPOL, the PBL-based block training ‘Social Medicine’ at the Medical University of Hannover showed higher student ratings with regard to learning achievement and higher success in transferring than traditional learning methods [8]. Further comparisons of the two learning methods also showed a strong preference for the PBL concept [24], [17].

However, in each of the listed trials, the PBL concept was implemented into the curriculum in a different form and at a different point in time. Evalutions were done by means of questionnaires that had been designed in different forms according to the respective course of study. Our trial also differs from the described trials with regard to the statistical analysis. Most comparative trials show purely descriptive analyses of the percentage frequencies or mean values of the individual response options [15], [20], [38], [18], [37], [19], [17], whereas our trial involves descriptive and inferential parametric statistics.

Our investigation also showed that students recognize a correlation between the method of learning and the retention of the learned material; meaning that students are able to memorize more when learning on self-guided studies (item 6), which indicates a preference of students for this method of learning. Thus, the method of learning could not be changed by implementing PBL-based seminars. This finding is in line with the results of other investigations [39].

Contextual analyses (hypothesis 3)

In accordance with the results by Regan [40], we could show that acceptance of the PBL concept is mainly linked to individual motivation to use this method of learning. Students seem to work more constructively and efficiently with the PBL concept if they can associate this method with meaningfulness for themselves. The results of different investigations of medical studies show that the success of the PBL concept largely depends on the motivation and cooperation of the respective student [26-30]. One major advantage of the PBL concept is undoubtedly small group learning [41], [42], because this form of learning enables students perform better in seminars and to identify themselves with the subject matter, which often significantly increases student motivation [19], [43], [44], [45].

Our analysis also showed similar results. We found that improved group atmosphere and the high degree of constructive cooperation in PBL-based seminars as well as the perceivably more efficient way of learning connected with the PBL concept was associated with an increase in motivation and meaninfulness. In contrast, students of other subjects made the experience that performance reviews require an associative memory from the beginning. Thus, approaches to interactive learning in small groups does not yield any practical benefits [46].

Limitations of our trial

With regard to possible criticism of our methodological aspects, we would like to point out that the selected study design did not allow for testing of differential effects of the two learning methods, because such testing would have required a crossover design with a randomized intermediary factor (order of didactics) and a within-subject factor (survey after the first and second term). At the end of each the first and the second term, every group should assess their respective method of learning (PBL vs. traditional teaching methods) according to different criteria (subjective learning achievement, learning efficiency, group atmosphere, cooperation within the group, motivation, own contribution, etc.) as well as objective parameters of learning achievement.

Therefore, we only analyzed the subjective student assessment of PBL as a method of learning but not the actual knowledge of students on the PBL concept.

Due to the small sample size, we did not analyze the psychometric properties of the questionnaire. For example, a principal component analysis of an instrument consisting of 17 items and 34 participants to test dimensionality or even a construct validation is of little use.

Future trials could combine students of different years of study to facilitate the analysis of psychometric properties.


Conclusion

In consideration of the relevant literature and the present results, the PBL concept can be principally integrated into the dental curriculum as a method of learning. However, student motivation is vital to learning success.


Competing interests

The authors declare that they have no compting interests.


References

1.
Donner RS, Bickley H. Problem-based learning in American medical education: an overview. Bull Med Libr Assoc. 1993;81(3):294-298.
2.
Feletti GI, Armstrong EC. Problem-based education at Harvard Medical School - a short report on the new pathway to general medical education. Meducs. 1989;2(2):36-39.
3.
Kaufmann DM. Implementing problem- based learning in medical education:Lessons from successful innovations. New York: Springer; 1985.
4.
Clarke RM, Feletti GI, Engel CE. Student perceptions of the learning environment in a new medical school. Med Educ. 1984;18(5):321-325. DOI: 10.1111/j.1365-2923.1984.tb01276.x External link
5.
van der Vleuten CP, Wijnen WH. Problem-based learning: Perspectives from the Maastricht experience. Amsterdam: Universität Amsterdam; 1990.
6.
Berdel WE, Zuhlsdorf M, Nippert RP, Marschall B, Wilhelm MJ, Stümpel F, Herbst H, Kliesch S, Ramsthaler F,Domschke W. Problem-based learning--interdisciplinary tumor medicine: an integrated model of the Munster University. Onkologie. 2001;24(6):587-594. DOI: 10.1159/000055148 External link
7.
Mandl H, Bruckmoser S, Konschak J. Problemorientiertes Lernen im Münchner Modell der Medizinerausbildung. Evaluation des Kardiovaskulären Kurses. (Forschungsbericht Nr. 105). München: LMU München; 1999. Zugänglich unter/available from: http://epub.ub.uni-muenchen.de/213/ External link
8.
Busse R. Problem-based learning in a social medicine course--a concept for improving learning achievement and practice r elevance. Gesundheitswes. 1996;58(7):406-410.
9.
Dieter PE. A Faculty Development Program can result in an improvement of the quality and output in medical education, basic sciences and clinical research and patient care. Med Teach. 2009;31(7):655-659. DOI: 10.1080/01421590802520972 External link
10.
Kadmon G, Schmidt J, De Cono N, Kadmon M. A Model for Persistent Improvement of Medical Education as Illustrated by the Surgical Reform Curriculum HeiCuMed. GMS Z Med Ausbild. 2011;28(2):Doc29. DOI: 10.3205/zma000741 External link
11.
Schäfer M, Georg W, Mühlinghaus I, Fröhmel A, Rolle D, Pruskil S, Heinz A, Burger W. Experience with new teaching methods and testing in psychiatric training. Nervenarzt. 2007;78(3):283-284, 287-290, 292-293. DOI: 10.1007/s00115-005-2048-9 External link
12.
Rudiger M, Muller S, Neuwirth A, Kordonouri O, Guthmann F. Integrating problem-based learning into traditional medical courses: the PBL approach to Pediatrics in Berlin. Z Arztl Fortbild Qualitatssich. 2003 Jul;97(4-5):339-341.
13.
Koneczny N, Hick C, Siebachmayer M, Floer B, Vollmar HC, Butzlaff M. Evidence-based medicine in professional training and education in practice? The integrated evidence-based medicine curriculum at the Medical School at the University of Witten/Herdecke. Z Arztl Fortbild Qualitatssich. 2003;97(4-5):295-300.
14.
Thammasitboon K, Sukotjo C, Howell H, Karimbux N. Problem-based learning at the Harvard School of Dental Medicine: self-assessment of performance in postdoctoral training. J Dent Educ. 2007;71(8):1080-1089.
15.
Kaufman DM, Holmes DB. Tutoring in problem-based learning: perceptions of teachers and students. Med Educ. 1996;30(5):371-377. DOI: 10.1111/j.1365-2923.1996.tb00850.x External link
16.
Prince KJ, van Eijs PW, Boshuizen HP, van der Vleuten CP, Scherpbier AJ. General competencies of problem-based learning (PBL) and non-PBL graduates. Med Educ. 2005;39(4):394-401. DOI: 10.1111/j.1365-2929.2005.02107.x External link
17.
Langelotz C, Junghans T, Gunther N, Schwenk W. Problem-based learning for surgery. Increased motivation with less teaching personnel? Chirurg. 2005;76(5):481-486. DOI: 10.1007/s00104-004-0987-5 External link
18.
Tack CJ, Plasschaert AJ. Student evaluation of a problem-oriented module of clinical medicine within a revised dental curriculum. Eur J Dent Educ. 2006;10(2):96-102. DOI: 10.1111/j.1600-0579.2006.00403.x External link
19.
Haghparast N, Sedghizadeh PP, Shuler CF, Ferati D, Christersson C. Evaluation of student and faculty perceptions of the PBL curriculum at two dental schools from a student perspective: a cross-sectional survey. Eur J Dent Educ. 2007;11(1):14-22. DOI: 10.1111/j.1600-0579.2007.00423.x External link
20.
Chadwick SM, Bearn DR, Jack AC, O'Brien KD. Orthodontic undergraduate education: developments in a modern curriculum. Eur J Dent Educ. 2002;6(2):57-63. DOI: 10.1034/j.1600-0579.2002.60203.x External link
21.
Bergmann B, Eisfeldt D, Lanadio S. Messwiederholungspläne als Instrumente einer vergleichenden Evaluation von problemorientierter und traditioneller Lehre an der Medizinischen Fakultät der TU Dresden. Z Eval. 2004;1:7-20.
22.
Bergmann B, Dieter P, Nitsche I. Evaluation des Dresdner Modells DIPOL (Dresdner integratives problemorientiertes Lernen) des reformierten Medizinstudiums. Gesundheitswesen (Suppl Med Ausbild). 2002;19:44-49.
23.
Eisfeldt D. Evaluation des Problemorientierten Lernens im Studiengang Zahnmedizin der Medizinischen Fakultät der TU Dresden. Diplomarbeit. Dresden: Technische Universität; 2002.
24.
Antepohl W, Herzig S. Problem-based learning versus lecture-based learning in a course of basic pharmacology: a controlled, randomized study. Med Educ. 1999;33(2):106-113. DOI: 10.1046/j.1365-2923.1999.00289.x External link
25.
Antepohl W, Domeij E, Forsberg P, Ludvigsson J. A follow-up of medical graduates of a problem-based learning curriculum. Med Educ. 2003;37(2):155-162. DOI: 10.1046/j.1365-2923.2003.01401.x External link
26.
Hitchcock M. Dealing with dysfunctionel tutorial groups. Teach Lern Med. 1997;9:19-24. DOI: 10.1080/10401339709539808 External link
27.
Hendry GD, Ryan G, Harris J. Group problems in problem-based learning. Med Teach. 2003;25(6):609-616. DOI: 10.1080/0142159031000137427 External link
28.
van Mook WN, de Grave WS, Huijssen-Huisman E, de Witt-Luth M, Dolmans DH, Muijtjens AM, Schuwirth LW, van der Vleuten CP. Factors inhibiting assessment of students' professional behaviour in the tutorial group during problem-based learning. Med Educ. 2007;41(9):849-856. DOI: 10.1111/j.1365-2923.2007.02849.x External link
29.
Gerhardt-Szep S. Der Einfluss direkt und nondirektiv ausgerichteten Tutorenverhaltens auf die Lernmotivation, Tutoreneffektivität, Gruppeninteraktionsmuster und den Lernerfolg im POL- Unterricht für Zahnmediziner innerhalb eines Hybridcurriculums. Masterthesis. Frankfurt am Main: J. W. Goethe- Universität; 2010.
30.
Ziebura TJ. Etablierung und Evaluation der kieferorthopädischen digitalen Falldokumentation in der Lehre als problembasiertes eLearningsystem (ePBL). Inaugural- Dissertation. Münster: Westfälische Wilhelms- Universität; 2007.
31.
Krathwohl DR. A Revision of Bloom's Taxonomy: An Overview. Theor Prac. 2002;41(4):212-218. DOI: 10.1207/s15430421tip4104_2 External link
32.
Ratzmann A, Wiesmann U, Gedrange T, Kordass B. Early patient contact in undergraduate dental education in Germany -'The Greifswald Model'. Eur J Dent Educ. 2007;11(2):93-98. DOI: 10.1111/j.1600-0579.2007.00429.x External link
33.
Norusis MJ. Inc. S. PASW Statistics 18 Advanced Procudures. New Jersey: Prentice Hall; 2010.
34.
Jones A, McArdle PJ, O'Neill PA. Perceptions of how well graduates are prepared for the role of pre-registration house officer: a comparison of outcomes from a traditional and an integrated PBL curriculum. Med Educ. 2002;36(1):16-25. DOI: 10.1046/j.1365-2923.2002.01105.x External link
35.
Pau AK, Collinson S, Croucher R. Dental students' evaluation of 2 community-oriented PBL modules. Eur J Dent Educ. 1999;3(4):159-166. DOI: 10.1111/j.1600-0579.1999.tb00086.x External link
36.
Lieberman SA, Stroup-Benham CA, Peel JL, Camp MG. Medical student perception of the academic environment: a prospective comparison of traditional and problem-based curricula. Acad Med. 1997;72(10 Suppl 1):S13-15. DOI: 10.1097/00001888-199710001-00005 External link
37.
McParland M, Noble LM, Livingston G. The effectiveness of problem-based learning compared to traditional teaching in undergraduate psychiatry. Med Educ. 2004;38(8):859-867. DOI: 10.1111/j.1365-2929.2004.01818.x External link
38.
Regan JA. Motivating students towards self-directed learning. Nurse Educ Today. 2003;23(8):593-599. DOI: 10.1016/S0260-6917(03)00099-6 External link
39.
de Grave WS, Dolmans DH, van Der Vleuten CP. Student perceptions about the occurrence of critical incidents in tutorial groups. Med Teach. 2001;23(1):49-54. DOI: 10.1080/0142159002005596 External link
40.
Dolmans DH, Wolfhagen IH, van der Vleuten CP, Wijnen WH. Solving problems with group work in problem-based learning: hold on to the philosophy. Med Educ. 2001;35(9):884-889. DOI: 10.1046/j.1365-2923.2001.00915.x External link
41.
De Grave WS, Boshuizen HP, Schmidt HG. Effects of problem- based discussion on studying a subsequent text: a randomized trial among first year medical students. Instruc Sci. 2001;29:33-44. DOI: 10.1023/A:1026571615672 External link
42.
O'Neill PA, Willis SC, Jones A. A model of how students link problem-based learning with clinical experience through "elaboration". Acad Med. 2002;77(6):552-561. DOI: 10.1097/00001888-200206000-00015 External link
43.
Brunton PA, Morrow LA, Hoad-Reddick G, McCord JF, Wilson NH. Students' perceptions of seminar and lecture-based teaching in restorative dentistry. Eur J Dent Educ. 2000;4(3):108-111. DOI: 10.1034/j.1600-0579.2000.040303.x External link
44.
Steinert Y. Student perceptions of effective small group teaching. Med Educ. 2004;38(3):286-293. DOI: 10.1046/j.1365-2923.2004.01772.x External link
45.
Tipping J, Freeman RF, Rachlis AR. Using faculty and student perceptions of group dynamics to develop recommendations for PBL training. Acad Med. 1995;70(11):1050-1052. DOI: 10.1097/00001888-199511000-00028 External link
46.
Harter C, Schellberg D, Mölter A, Kadmon M. Frontalunterricht oder interaktive Gruppenarbeit? Ein Vergleich des Lernerfolges und der studentischen Evaluation für das Fach Biochemie. GMS Z Med Ausbild. 2009;26(2):Doc23. DOI: 10.3205/zma000615 External link