TUTORIAL DALAM PBL

Rahmatina B. Herman
Fakultas Kedokteran Universitas Andalas
 What is PBL?
PBL is a learning method on principle of using
problems as a starting point for the acquisition
and integration of new knowledge (Barrows,
1982)
In PBL students work on the problem which is
explicitly used to get students themselves to
identify and search for the knowledge that they
need to obtain in order to approach the
problem (Ross, 1991).
 The Objective of PBL

The acquisition of an integrated body

of knowledge related to the problem
and the develop or application of
problem-solving skills
 Philosophy of Learning in PBL
Student-Centered
Problem-Based
Integrated
Community-Oriented
Early Clinical Exposure
Self-Directed/ Selective with Core
 tutor

Tutorial
group
process

problem students

Three elements of the learning process in PBL

 1. Tutorial
Tutorial PBL context:
As heart of PBL
Active learning process in small group discussion (10
11 students / group)
Stimulated by a problem (scenario)
Activate prior knowledge
Facilitated by tutor
Moderated by a student
Assisted by secretary (ies)
Structured activity: seven-jump
 ..1. Tutorial

What is Small Group?

Small group work is characterized by student
participation and interaction (Crosby 1996)
The Goals of Small Group Learning:
- The development of communication skills
- The development of intellectual and professional
competencies
- The development of presentation skills
- The personal growth of students (and perhaps the
tutor)
 ..1. Tutorial
Process in Small Group Learning
INCREASING
DEGREE GOAL
ACTIVE ROLE OPTIMUM GROUP
OF THE TEACHER GROWTH AND
INDIVIDUAL
GROWTH
C.I
INDIVIDUAL C.I
GROWTH AND
EXPECTATIONS
C.I
GROUP C.I C.INORMING MOURNING
GROWTH FORMING
TIME
STORMING PERFORMING
C.I = CRITICAL INCIDENT
 ..1. Tutorial
Effective tutorial group:
cohesive
high motivation
mutual helps among individuals
have a high motivation to learning together
respect the opinion of others, but remain critical
Discussion cooperatively, not competitively
actively participate
not having personal stress
All members understand the tasks that must be completed
and trying to complete it with high spirit
(Sefton, 2001)
Encourage Teamwork
 ..1. Tutorial

Guidance at the first meeting of tutorial

Introducing the purpose of the block
Ground rules/ethics:
Punctuality
One person speak at a time
Respect for each other
Time-out
Regulation of institution (Peraturan Akademik,
Peraturan Kemahasiswaan)
Feedback at the end of each tutorial
 ..1. Tutorial
Seven Jump
1. Clarifying unfamiliar terms
2. Defining problems
3. Brainstorming possible hypotheses or explanations
4. Arranging explanations into a tentative solution
5. Defining learning objectives
6. Gathering information
7. Sharing the results of information gathering and
private study
Step 1. Clarifying unfamiliar terms

Process
Students identify any words whose meaning is unclear
- other group members may provide definitions.
Reason
Unfamiliar terms act as an obstacle to understanding.
Clarification of even half - understood terms may start
learning process.
Written output
Words or names on which the group cannot agree a
meaning should be listed as learning objectives.
 Step 2. Defining problems
Process
This is an open session when students are encouraged
to contribute their view of the problem under discussion
in a fast-moving and wide-ranging analysis.
Reason
It is quite possible for every member of tutorial
group to have a different perspective on a problem
and these views broadens the intellectual horizons
of those involved and defines the task ahead.
Written output
List of issues to be explained
 Step 3. Brainstorming
possible hypotheses or explanations
Process
A continuation of the open session and students try to
formulate, test and compare the hypotheses or
explanations of the problem or case.
Reason
The crucial step that prompts the use of previous
learning and memory and allows students to test /draw
on anothers understanding; links can be formed
between the items. If well handled by group, it pitches
learning at the deeper level of 'understanding.
Written output
List of hypotheses or explanations
Step 4. Arranging explanations into
a tentative solution
Process
The problem is scrutinized in fine detail and compared
against the proposed hypotheses/explanations, to see
how they will match and further exploration if needed.
This starts the process of defining learning objectives.
Reason
Actively processes and restructures existing
knowledge and identifies gaps in understanding.
Written output
Explanations for problems, schematically, to link new
ideas with each other; a visual output of relationships
between different pieces of information and facilities
storage of information in long-term memory.
Step 5. Defining learning objectives
Process
The group agrees a core set of learning objectives that
all students will study; it must be focused, not too
broad or superficial and achievable within the time
available; some students may have objectives because
of their own personal learning needs or interests
Reason
The process of consensus uses the expertise of the
entire tutorial group to synthesize the foregoing
discussion into appropriate learning objectives; pulls
the group together and concludes the discussion.
Written output
Learning objectives
Skenario (BLOK HEMATOLIMFOPOEITIK)
MENGAPA HARUS DINA?
Dina, 12 tahun, dibawa ibunya ke IGD RSUD setelah tertabrak motor
sepulang dari sekolah. Dari pemeriksaan ditemukan fraktur tulang
radius. Dokter merencanakan tindakan reposisi dibawah anestesi
dan meminta paramedis untuk melakukan pemeriksaan darah rutin
pasien. Ketika hasil pemeriksaan siap, dokter sangat terkejut karena
Hb Dina 5,6 gr%, padahal tidak ada perdarahan luar maupun dalam
akibat kecelakaan tersebut. Ketika dokter bertanya pada ibunya, ibu
Dina mengatakan bahwa anaknya menderita epilepsi dan sejak usia
6 tahun rutin minum obat. Dina juga termasuk anak yang susah
makan, tidak suka minum susu dan makan daging. Akhirnya dokter
meminta untuk dilakukan pemeriksaan darah lengkap serta pungsi
lumbal. Ibu Dina jadi bertanya-tanya, mengapa perlu dilakukan
pemeriksaan tersebut pada anaknya? Bagaimana anda
menerangkan permasalahan ini pada ibu Dina?
 Step 1. Clarifying unfamiliar terms
1. IGD: .
2. RSUD: ..................................
3. fraktur: .
4. tulang radius: .
5. reposisi : ..
6. Anestesi:
7. Hb: .
8. Epilepsi: ..
9. pungsi lumbal: .
 Step 2. Defining problems
1. Mengapa Dina dibawa ke IGD RSUD?
2. Mengapa dokter merencanakan reposisi?
3. Mengapa dokter meminta melakukan pemeriksaan
darah rutin?
4. Apa artinya Hb 5,6 gr%?
5. Mengapa dokter menanyakan riwayat kesehatan
Dina masa lalu?
6. Apa artinya minum obat rutin selama 6 tahun
terakhir?
7. Apa artinya susah makan, tidak suka susu dan
daging?
8. Mengapa dokter memutuskan pemeriksaan darah
lengkap dan pungsi lumbal?
Step 3. Brainstorming possible hypotheses or
explanations (prior knowledge)
1. Dina dibawa ke IGD RSUD karena kecelakaan
2. Dokter merencanakan reposisi karena fraktur
3. Pemeriksaan darah rutin karena Dina akan dianestesi
4. Hb 5,6 gr% artinya anemia berat
5. Riwayat kesehatan masa lalu (anamnesis) untuk
menelusuri penyebab anemia pada Dina
6. Minum obat secara rutin bisa menekan (depresi)
hematopoetik
7. Susah makan, tidak suka susu dan daging menyebabkan
defisiensi nutrisi termasuk bahan untuk produksi darah
8. Pemeriksaan darah lengkap dan pungsi lumbal
(pemeriksaan penunjang) untuk diagnosis pasti kondisi
hematopoetik dan penatalaksanaannya
 Step 4. Arranging explanations into
a tentative solution
Kecelakaan

Fraktur Reposisi Anestesi

Anemia Darah Rutin

Obat Susah makan

Depresi Defisiensi
hematopoetik
Anamnesis, Pemeriksaan
fisik, penunjang

Anemia aplastik Anemia defisiensi

Tatalaksana
 Step 5. Defining Learning Objectives (LO)
Mahasiswa mampu:
1. Menjelaskan pengertian dan jenis-jenis anemia
2. Menjelaskan aspek epidemiologi dan faktor-faktor yang
mempengaruhi terjadinya anemia defisiensi dan anemia aplastik
3. Menjelaskan patofisiologi terjadinya anemia defisiensi dan aplastik
4. Menjelaskan gejala dan tanda anemia defisiensi dan aplastik
5. Menjelaskan diagnosis dan diagnosis banding anemia defisiensi dan
aplastik (anamnesis, pemeriksaan fisik dan pemeriksaan penunjang)
6. Menjelaskan pemeriksaan laboratorium yang diperlukan untuk
menunjang diagnosis anemia defisiensi dan aplastik
7. Menjelaskan penatalaksanaan anemia defisiensi dan aplastik secara
komprehensif
8. Menjelaskan prognosis anemia defisiensi dan aplastik
9. Menjelaskan kasus anemia defisiensi dan aplastik yang memerlukan
rujukan
Step 6. Gathering information
Process
Finding materials in:
textbooks,
computerized literature search using internet
looking at pathological specimens,
talking to an expert, etc
Reason
Clearly an essential part of the learning process is
gathering and acquisition of new information, which
students do on their own
Written output
Students' individual notes
 Step 7. Sharing the results
of information gathering and private study
Process
- Students begin with their list of learning objectives.
- They identify individual information from private study
and help each other understand and identify areas of
continuing difficulty for further study (or expert help).
- They attempt to undertake and produce a complete
analysis of the problem.
Reason
This synthesizes the work of the group, consolidates
learning and identifies areas of uncertainty, possibly for
further study.
Written output
Students' individual notes
Feedback
 Evaluation in Tutorial
Structured Form:
- Participation
- Communication
- Learning preparation
- Activity in discussion
- Critical thinking
- Group skills
- General comments
 Tell me and I will forget
Show me and I will remember
Involve me and I will understand
Step back and I will act

Chinese proverb