Institute Fellow Nor Azila Mohd Adnan Shares Reflections on Problem-Based Learning at the Universiti Malaya

Nor Azila Mohd Adnan, Ph.D.
Faculty of Medicine
Universiti Malaya
Kuala Lumpur, MALAYSIA

Nor Azila Mohd Adnan, Ph.D., a FAIMER Fellow from the 2002 Institute class, has worked at the Universiti Malaya since 1981 in a number of capacities, including Year I medical course coordinator (1992-1993), deputy dean (1994), Phase I coordinator of the New Integrated Curriculum (NIC) (implemented in 1998), and problem-based learning (PBL) coordinator and chair of the PBL committee (2000-2007) of the Faculty of Medicine. Azila’s education innovation project during her Institute fellowship was to Increase and Improve Implementation of Problem-Based Learning.

Azila says that PBL is not new to the Universiti Malaya. During an e-mail interview, she shared some of the PBL-related stumbling blocks and successes her institution has encountered.

The proposal to introduce PBL as part of the learning approach in the NIC became moot when discussions on curriculum review started in 1996. The decision on curriculum review was based on information obtained from a survey (carried out in 1994) of the evaluation performance of our graduates working as interns in the Ministry of Health hospitals, by the consultants who supervised them. To improve graduate outcomes a curriculum review was done, weaknesses and strengths were identified, and corrective measures were proposed with the results of the survey taken into account. In short, an integrated curriculum was proposed, with three vertical strands: Scientific Basis of Medicine; Personal Professional Development (PPD); and Doctor, Patient, Health and Society (DPHS), identified to ensure a holistic and patient-oriented doctor as the product of our education, with PBL as a feature in the students’ learning approach.

As part of the curriculum review, several staff members served on systems committees that worked toward improving deficiencies of the previous curriculum with the development of the PPD and DPHS strands. However, little attention was given to how PBL should be utilized. For the latter it was more of the “hammer” rather than the “induction-campaign” approach. The decision to introduce PBL as a curricular approach was not fully supported by faculty, although an introduction of some trial PBL tutorials into the second year (Phase II) was allowed. It was left to the Phase II coordinator, with help from a few of us, to introduce the PBL tutorial format in 1999 within the systems module. In 2000 PBL tutorials were introduced in some systems in year 1 (Phase I). Thus, in a way, PBL was used as a tool in teaching-learning rather than a curricular approach and content lectures were given after the cases had been discussed.

In that same year a new Dean and Deputy Dean of Undergraduate programme were appointed. Subsequent to that the PBL committee was formed (in 2000) and I was appointed as chair. Although our committee, with the Phase coordinators, was expected to help maintain running the PBL tutorials, not much authority or mandate was given to progress further in trying to increase the use of PBL within the NIC. We also did not know how PBL should be implemented or what a PBL curriculum should entail.

If the implementation of PBL was to be evaluated in its purist form, where there is “true” independent learning with problems/cases as the trigger to learning as described in the literature, then I would say that our implementation of PBL was not quite successful, since the first two years of the curriculum are still lecture-based, as far as learning of content is involved, and too few cases are used. However, since the cases are discussed before the systems lectures are given, there are positive outcomes seen and some progression in that the students are: showing more independence with the ability to obtain and learn some of the information; becoming more vocal and critical in opinion; showing integration in learning, thus supporting the organ-systems approach; beginning to consider social-behavioural issues; and becoming more patient-oriented. This also helps to strengthen the vertical integration between the preclinical and clinical sciences and integration amongst the preclinical disciplines.

The goal of my FAIMER Institute project was to try to progress further by increasing the number of cases used to trigger learning and to reduce lectures on the related topics with a long-term plan of modifying the curriculum gradually. In one aspect, this was achieved when faculty agreed to a “trial” implementation of a four-week gastrointestinal tract (GIT) module coordinated by a colleague, Professor Cheah Swee Hung, in session 04/05, using the case-based learning (CBL) approach. During the four-week period, students learned by working through two long cases, six short cases, and several self-study cases, with content lectures reduced drastically.

Progress was achieved using the “persuasion/campaign” approach, which I learned from my FAIMER Institute experience. Various strategies such as staff development and sharing ownership were used. The CBL-GIT module was continued in sessions 05/06 and 06/07. However, due to critical staff shortage, the CBL approach was shelved for session 07/08.

My FAIMER Institute experience has had some impact on my career progression. It was and still is a valuable learning experience and has made an impact on my view of and approach to medical education, and the events that occurred in terms of curriculum and staff development. I was able to give better, more knowledgeable input in regards to faculty education and staff development, and became a mentor to many of my younger colleagues. To a certain extent, I am regarded as the resident expert in medical education.

Azila was considered for a position in the Ministry of Education in 2004, but the Dean of the university offered a more senior member of faculty for the position, so that Azila could uphold her tasks as a member of the faculty. In January 2007, she was offered the position of Deputy Director of the revived Universiti Malaya Learning Improvement Centre (UMLIC) for the whole university; however, she declined the offer as it would mean moving away from her faculty, medical education, and FAIMER.

Azila received staff excellence awards conferred by the University in 1998, 2000, 2002, 2004, and 2005. Azila’s plans for the next two to three years, with the help of key staff members and other FAIMER Fellows, are:

• to update and help the New Deputy Dean look into several issues related to the curriculum;
• to help the Deputy Dean reactivate the proposal to establish a medical education unit;
• to increase staff development programmes through various committees and, after the medical education unit is established with core members, ensure that these activities are in place, and that curriculum development and implementation is coordinated and monitored with regular programme evaluation; and
• to reactivate capacity building.

Azila has initiated a research project with her colleagues within the faculty, since her fellowship, and has obtained funding from the Intensified Research Priority Areas (IRPA). The focus of the project is on the development of performance indicators, which includes the development of OSCEs, analysis of the MCQs, and the continued monitoring of the performance of graduates at the 23 general hospitals during their pre-registration house officers (PRHO) period.

Azila is involved in a host of national and international activities and was an invited guest speaker or facilitator at many of them. She was appointed or elected as: Vice-President of the Asia-Pacific Association on PBL in Health Sciences (APA-PHS) from 2006-2008; member of the International Advisory Board for APC-PBL since 2005; country representative in APA-PHS, 2002-2006; and member of the International Survey Team to audit the Aga Khan University Undergraduate Medical Programme according to LCME standards (in December 2006). In 2006, Azila was involved in the national seminar, “Staff-student ratio for Undergraduate Medical Programme,” which was organized by the Ministry of Education.

Azila has become an unofficial recruiter for the FAIMER Institute. She recommends the FAIMER Institute to colleagues and includes a note in her slide presentations about the Institute. She has even requested time at a conference to present information on FAIMER.

Azila remains involved with FAIMER and her Institute fellowship class. In 2005, she was selected as a Fellow in the FAIMER International Fellowship in Medical Education (IFME) program and received full financial support from FAIMER to pursue a master’s degree in health professions education (MHPE). Azila received a postgraduate certificate in medical education from the University of Dundee in March 2006. Azila also co-authored “Accreditation of undergraduate medical training programs: Practices in nine developing countries as compared with the United States,” which appeared in the July 2006 issue of Education for Health. Azila was invited to participate in the 2007 FAIMER Institute as a Global Faculty Discussant (GFD). GFDs provide materials and insight gained from their MHPE programs and other professional experience during the planning and implementation of the Mentoring and Learning Web (ML Web) on-line discussions.

Currently Azila is taking a year’s unpaid leave to provide care for her ailing parents.