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Faisal Alsaif,1 Lina Neel,2 Saleh Almuaiqel,1 Abdulaziz Almuhanna,1 Jude Feda,3 Nouf Alrumaihi,4 Omar Alanazi,3 Mohammed Almansour,3 Majda Fuad Saeed,3 Mona Soliman3 1College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; 3Medical Education Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 4Saudi Commission of Health Specialties, College of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Mona Soliman, Head of Medical Education Department, Professor of Medical Education and Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia, Tel +966505468581, Email msoliman1@ksu.edu.saBackground: COVID-19 pandemic has resulted in a sudden shift to online education. PBL was one of the components that was transformed to online. The aim of the present study was to investigate the impact of the sudden shift to virtual PBL during COVID-19 pandemic in achieving the intended learning objectives of the PBL and to explore the students’ perception of the virtual versus traditional PBL.Methods: This is a retrospective study that was conducted in the college of medicine, King Saud University. We compared the perception of third year students who participated in traditional face-to-face PBL in 2019– 2020 and in the virtual PBL in 2020– 2021. We compared the performance of the students in the traditional face-to-face and in virtual PBL. An online survey was distributed from October to December 2021. The survey contained 7 sections. Each section included several questions comparing virtual and traditional PBL in that aspect.Results: Out of 284 third year medical students, 124 students responded with a response rate of 43.66%. More than half of the students (n = 77, 63%) felt significantly motivated to actively participate in PBL sessions in a virtual learning environment, motivated to learn and support group work and gained critical thinking skills (mean = 3.54 ± 0.12 versus 3.59 ± 0.14, p < 0.001). The majority of students (n = 82, 66%) felt significantly more satisfied about their learning during the virtual PBL versus traditional PBL (mean = 3.48 ± 0.42 versus 3.91 ± 0.59, p < 0.001). There was no significant difference in the students’ performance in traditional versus virtual PBL (mean = 4.77 ± 0.22 versus 4.79 ± 0.29, p = 0.2).Conclusion: The results of this study showed that students were significantly more satisfied with the experience in the virtual versus traditional PBL. Medical students’ performances in virtual PBL were comparable to the traditional face-to-face approach.Keywords: COVID-19, problem-based learning, PBL, traditional, virtual, learning, medical students

Khalid Mubarak Bindayna, Ahmed Qareeballa, Ronni Mol Joji, Ali Al Mahmeed, Hicham Ezzat, Abdulrahman Yousif Ismaeel, Khaled S Tabbara Microbiology, Immunology and Infectious Diseases Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of BahrainCorrespondence: Khalid Mubarak Bindayna Microbiology, Immunology, and Infectious Diseases Department, College of Medicine and Medical SciencesArabian Gulf University, Manama, Kingdom of BahrainEmail bindayna@agu.edu.bhIntroduction: The curriculum at medical school at Arabian Gulf University is centered on small group learning and real-life problems provided to students and guiding students to learn actively. In microbiology, laboratory skills are taught in an innovative manner using mini cases and different lab sessions and are integrated with other basic sciences. This article describes the format and pattern of laboratory skills sessions conducted using PBL methods at Arabian Gulf University and discusses the perception of students towards PBL in laboratory skill learning and way forward for the same.Methods: The study sample size was 110. The students’ perception of the laboratory skills teaching methods was assessed through an exit survey at the end of each session. A semi-structured self-administered survey instrument was prepared, and the questions were arranged in two sessions and focused on identifying the relevance, timing, strengths, and weaknesses of the teaching method and recommendations to improve the same.Results: We observed that more than 50% of the participants agreed or strongly agreed that the time given for PBL was adequate, topics discussed were relevant, presentations were clear, pre-session briefing and Case-Based Studies (team-based learning (TBL)) helped in their learning. The participants identified the demonstration of experiments and hands-on experience provided in the laboratory were most helpful. When enquired about the difficulty, among 48% of the participants, 80% observed that the slides used in the learning/teaching were lengthy.Conclusion: The use of PBL in a lab setting promotes active learning. In the heart of PBL, TBL is a powerful tool in the educational process offering the students deep comprehension and allowing them to gain practical and intellectual skills.Keywords: PBL, microbiology, laboratory skill learning

Ihab Shafek Atta,1,2 Ali Hendi Alghamdi3 1Pathology Department, Faculty of Medicine, Assuit Branch, Al-Azhar University, Cairo, Egypt; 2Pathology Department, Faculty of Medicine, Albaha University, Albaha, Saudi Arabia; 3Department of Surgery, Faculty of Medicine, Albaha University, Albaha, Saudi Arabia Introduction: Self-directed learning (SDL) and problem-based learning (PBL) are fundamental tools to achieve lifelong learning in an integrated medical curriculum. However, the efficacy of SDL in some clinical courses is debated.Aim: The aim of the study was to measure the effectiveness of SDL for an ophthalmology course in comparison with PBL.Methods: A cross-sectional study was conducted with fifth-year medical students enrolled in an ophthalmology course. SDL comprised four case-based scenarios guided by several questions. PBL comprised three sessions. An ear, nose, and throat (ENT) course was selected for comparison as a control. At the end of the course, 30 multiple-choice questions (MCQs) for both SDL and PBL were assessed and analyzed against their counterparts in the ENT course by an independent t-test.Results: For the SDL component of the ophthalmology course, the number and percentages of students attaining high (n = 6/60, 10%) and moderate (n = 15/60, 28.3%) scores on an MCQs written exam were evaluated. For the PBL component, high scores were seen for 23.3% (n = 14/60), and moderate scores for 33.3% (n = 20/60) of the participants. For the SDL component of the ENT course, the number and percentages of students attaining high (n = 14/60, 23.3%) and moderate (n = 17/60, 28.3%) scores were recorded. For the PBL component, high (16/60, 26.6%) and moderate (17/60, 28%) scores were recorded. Significant p-values were obtained between the results for SDL and PBL in the ophthalmology course (p = 0.009), as well as between SDL results for both courses (p = 0.0308). Moreover, differences between the SDL results of ophthalmology and the PBL results of ENT (p = 0.0372) were significant.Conclusion: SDL appears to be less valuable for promotion of self-readiness. Periodic discussions in small groups or by panel discussion are strongly recommended for students to enhance readiness with SDL. Keywords: SDL, PBL, ophthalmology, ENT, lifelong learning, teaching tools

Ram Lochan Yadav,1 Rano Mal Piryani,2 Gopendra Prasad Deo,3 Dev Kumar Shah,1 Laxmi Kumari Yadav,4 Md Nazrul Islam1 1Department of Physiology, Chitwan Medical College, Bharatpur, Nepal; 2Department of Internal Medicine and Health Professional Educational Research Center (HPERC), Chitwan Medical College, Bharatpur, Nepal; 3Department of Anaesthesiology and Critical Care, Chitwan Medical College, Bharatpur, Nepal; 4Department of Microbiology, Chitwan Medical College, Bharatpur, Nepal Background: Problem-based learning (PBL) was introduced into Basic Medical Sciences early in the 1980s at Tribhuvan University (TU), Nepal, followed by other universities where didactic lecture method was still followed as the main teaching strategy. Despite gaining its popularity worldwide as integrated teaching learning method, PBL is not given importance in Nepal. This study aimed to assess the attitude and perceptions of undergraduate medical students regarding learning outcomes of PBL and to know their views about role and qualities of effective tutors for its successful implementation.Methods: This descriptive study was based on a self-administered questionnaire. The first part of the questionnaire measured students’ perception and attitude toward benefits of PBL and the second part measured students’ perception about role of PBL tutor. Bachelor of Medicine and Bachelor of Surgery (MBBS) first year (2014/2015 academic year) students at Chitwan Medical College, TU, were asked to express their opinions about the importance of learning outcomes by rating each statement on a five-point Likert scale and the responses were combined into three categorical variables: “agree” (strongly agree plus agree), “neutral”, and “disagree” (strongly disagree plus disagree). Data were analyzed using SPSS version 21.0.Results: Approximately 85.5% participants agreed that PBL is an interesting method of teaching learning. Most of them (86.7%) accepted that PBL is an interactive and a mutual learning method and improves self-directed learning (83.2%). Although 78% had recommended it better than lecture, many (54.2%) pointed it out as a time-consuming method. The participants were also highly rated (80.5%) to the statement - the tutor’s role in enhancing the constructive active learning and maintaining good intra-personal behavior.Conclusion: Student’s attitude toward PBL was positive. They highly appreciated the roles of a tutor as facilitators and motivators for proper activities in PBL session. PBL sessions were considered effective in improving students professional knowledge and refining problem-solving and self-directed learning skills along with enriching teamwork experience. Keywords: PBL, student’s perception, role of tutor, teaching learning method

Lucélio B Couto, Gustavo S Romão, Reinaldo B Bestetti Department of Medicine, University of Ribeirão Preto, Ribeirão Preto, Brazil We have read with great interest the paper by Kassab et al, who have essentially shown that good teachers will be good tutors in a problem-based learning (PBL) environment. We have been facing great difficulties to select tutors because there has been no tradition in PBL in our region in the preuniversity teaching. Furthermore, the majority of our teachers have been formed in a discipline-based medical curriculum. Therefore, it is reassuring to learn from the work by Kassab et al that subject-matter mastery is the powerful independent predictor of tutoring skills. View the original paper by Kassab and colleagues.

Salah Eldin Kassab,1 Nahla Hassan,1 Marwan F Abu-Hijleh,2 Reginald P Sequeira3 1Department of Medical Education, Faculty of Medicine, Suez Canal University, Ismailia, Egypt; 2College of Medicine, Qatar University, Doha, Qatar; 3College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain Purpose: Recruitment of tutors to work in problem-based learning (PBL) programs is challenging, especially in that most of them are graduated from discipline-based programs. Therefore, this study aims at examining whether lecturing skills of faculty could predict their PBL tutoring skills. Methods: This study included evaluation of faculty (n=69) who participated in both tutoring and lecturing within particular PBL units at the College of Medicine and Medical Sciences (CMMS), Arabian Gulf University, Bahrain. Each faculty was evaluated by medical students (n=45±8 for lecturing and 8±2 for PBL tutoring) using structured evaluation forms based on a Likert-type scale (poor to excellent). The prediction of tutoring skills using lecturing skills was statistically analyzed using stepwise linear regression. Results: Among the parameters used to judge lecturing skills, the most important predictor for tutoring skills was subject matter mastery in the lecture by explaining difficult concepts and responding effectively to students' questions. Subject matter mastery in the lecture positively predicted five tutoring skills and accounted for 25% of the variance in overall effectiveness of the PBL tutors (F=22.39, P=0.000). Other important predictors for tutoring skills were providing a relaxed class atmosphere and effective use of audiovisual aids in the lecture. Conclusion: Predicting the tutoring skills based on lecturing skills could have implications for recruiting tutors in PBL medical programs and for tutor training initiatives. Keywords: PBL, tutor, tutoring skills, lecturing skills

Background: Massive open online courses (MOOCs) is a new teaching technology based on a network platform, which can provide more students with the possibility of systematic and repeated learning. Due to the complexity of transesophageal echocardiography (TEE), the wide range of knowledge involved, and many knowledge points being difficult to understand, it is difficult to meet the teaching needs of this content with the traditional teaching mode. This study aimed to discuss the application of lecture based learning (LBL) and problem based learning (PBL) in the training of perioperative TEE in the context of MOOCs., Methods: Sixty residents were randomly divided into two groups to participate in a 5-day perioperative TEE training program. The web-based PBL mode was used in the observation group and the LBL mode was used in the control group, with 30 residents in each group. The teaching effect of the web-based PBL mode was compared with the LBL mode by basic theory test, practice examination, image interpretation and questionnaire., Results: The image interpretation score and the total test score were higher in the observation group than in the control group with statistically significant differences ( P <0.001). The results of the questionnaire show that the residents were more satisfied with the web-based PBL mode than the LBL mode ( P <0.001)., Conclusion: The web-based PBL method has obvious advantages over the LBL mode in the training of perioperative TEE., Competing Interests: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article., (© 2020 Dong et al.)

Purpose: The development of clinical problem-solving skills evolves over time and requires structured training and background knowledge. Computer-based case simulations (CCS) have been used for teaching and assessment of clinical reasoning skills. However, previous studies examining the psychometric properties of CCS as an assessment tool have been controversial. Furthermore, studies reporting the integration of CCS into problem-based medical curricula have been limited., Methods: This study examined the psychometric properties of using CCS software (DxR Clinician) for assessment of medical students (n=130) studying in a problem-based, integrated multisystem module (Unit IX) during the academic year 2011-2012. Internal consistency reliability of CCS scores was calculated using Cronbach's alpha statistics. The relationships between students' scores in CCS components (clinical reasoning, diagnostic performance, and patient management) and their scores in other examination tools at the end of the unit including multiple-choice questions, short-answer questions, objective structured clinical examination (OSCE), and real patient encounters were analyzed using stepwise hierarchical linear regression., Results: Internal consistency reliability of CCS scores was high (α=0.862). Inter-item correlations between students' scores in different CCS components and their scores in CCS and other test items were statistically significant. Regression analysis indicated that OSCE scores predicted 32.7% and 35.1% of the variance in clinical reasoning and patient management scores, respectively (P<0.01). Multiple-choice question scores, however, predicted only 15.4% of the variance in diagnostic performance scores (P<0.01), while students' scores in real patient encounters did not predict any of the CCS scores., Conclusion: Students' scores in OSCE are the most important predictors of their scores in clinical reasoning and patient management using CCS. However, real patient encounter assessment does not appear to test a construct similar to what is tested in CCS.