Idea Generation
The second step in the process of investigating a PBL problem is the generation of Ideas/Hypotheses that could explain the Signs and Symptoms exhibited by the patient in the PBL case. In a clinical situation this would be equivalent to generating the list of Differential Diagnoses. This “thinking” step is the most critical in learning using PBL. This process revolves around the question “What do we think?” about the processes and causes underlying the Facts of the case. Idea generation does not begin until the group has reached a consensus on the Facts. The group should generate Ideas that encompass or link each of the significant Facts previously identified. The group should spend a significant portion of each session generating ideas and testing these ideas based on what they already know or have learned. A typical approach is to generate an idea with the format; I think this is an example of XXX because of the Facts YYY we have identified and our previous learning ZZZ. The group should continue to generate Ideas until a consensus is reached that the relevant Facts have been considered. Only then should the group advance to the Learning Need Determination step.
How it is done:
The Idea generation phase is a key step in the process as it represents the group’s ability to critically think about the problem. The facilitator may start the generation of Ideas by asking, “What do you think is going on with this patient?” The students will then begin to generate hypotheses to explain the identified Facts, and the scribe will record these hypotheses or “Ideas”. In generating Ideas, students will draw upon prior knowledge acquired from previous parts of the case, from previous cases in the curriculum, or from other sources. The reasoning behind an Idea should be clear to others in the group. To make Ideas clear a student should explain how their knowledge and the Facts are related. As one example, a student working on a case featuring a patient with bleeding gums and a host of clinical findings, including blood values, might say, “I think the patient’s bleeding ‘gums’ are related to his low platelet count because platelets are needed for proper clotting.”
An idea should also be testable, meaning that the group could learn additional information to determine whether this idea is in fact reasonable and could possibly explain some aspect of the patients signs and symptoms. As long as the Idea is testable and grounded upon the Facts of the case it should be included in the group’s list, unless the member of the group objecting to the idea can supply solid data showing that the Idea would not be possible. |
It is more likely that an idea could be further elaborated upon to make it clearer. As such, the group members should be encouraged to help one another refine and build upon Ideas that do not initially meet these criteria, rather than dismissing them as “bad Ideas.” It is to the group’s advantage to generate as many Ideas as they reasonably can to explain the patient’s presentation since this ensures complete coverage of the content and concepts involved in the case. As a group, students will likely have different backgrounds and this can be beneficial to creating a wider perspective for examining the patient case.
It is important that all of the previously identified Facts be potentially explained by or included in one or more of the Ideas generated. In addition, the students should try to generate Ideas that link sets of Facts together into a more global analysis of the problem. When the students have exhausted their Ideas , they should then group their ideas into a bigger theme and assign priorities to the ideas. Grouping the Ideas into categories such as “More Likely” and “Less Likely” will begin to focus the investigation of the case and provide the group with a sense of progress. The group should only move onto the next phase of the PBL Process when it agrees it has:
Why it is done:
Having a diversity of ideas about the origin of the patient’s signs and symptoms can broaden the group’s perspective on generating creative solutions to problems. The Idea generation phase is similar to “brainstorming”. This stage of the process asks students to reveal their collective prior knowledge and experience and connect it to new information presented in the case. During this stage the students have to regularly exercise their reasoning skills and practice articulating their thinking to other members of the group. The Idea Generation phase is the most important phase of the PBL process and should always be given a significant segment of the time allotted to any facilitated session.
The Idea generation phase is analogous in some ways to the generation of a Differential Diagnosis phase in a clinical situation during which a broad set of potential diagnoses is considered to insure that a potential outcome is not excluded without sufficient clinical rationale. Part of what the group does in applying the PBL process to a case is to develop a broad list of possible explanations. Subsequent learning will allow them to refine the list of Ideas to those most likely to explain the patient’s problem. The Idea generation step is critical in developing the students’ ability to take a more inclusive view of patient diagnosis on first presentation. Definitive diagnoses for patients are often only possible after the generation of additional facts through the completion of specific investigations. Thus the second phase of PBL case investigation replicates the approach to patient care that is desired in an expert clinician.
Learning Need Determination ->
