Problem Solving–What’s in the residue?

Consider the following scenario: A group of professionals delivers a set of services. Each of these services requires different types of tasks. Each type of task can only be performed by specialized professionals. In addition, no one can predict the specific task to be performed; tasks only become known during the course of service delivery and only to professionals in some specific hierarchy of the group.

This kind of scenario is familiar to health care services. A patient expresses her needs to a family doctor who translates them into specific clinical tasks. Other professionals then carry out or expand on those tasks during service delivery. The needs the patient expresses and how the professionals translate them into specific tasks can change over time and in most cases no one can tell in advance what specific tasks may be required.

These scenarios highlight two categories of problems: what to do specifically in any given task, and how to manage the dependencies between tasks—assigning the tasks to the right people who will do the right thing, at the right time, with the right resources.

Now consider how complex the required tasks can be when a patient has a chronic illness such as diabetes or multiple sclerosis or HIV/AIDS. In all these cases, interprofessional learning is problem based learning. As professionals learn to coordinate their tasks, they learn to solve a problem that is central to group work, and in the process, may improve collaboration, know more about each other, the tasks each one performs, and how they all fit into a unified whole.

And so would students learn together if we can expose them to opportunities where they can solve problems collectively. This is in essence what D’Eon et al. propose as they extend the merits of Problem Based Learning (PBL) to Interprofessional Education (IPE) in the context of HIV/AIDS management (www.jripe.org/index.php/journal/article/view/28/28). With PBL, students can talk about their thinking and reflect on it, and it is precisely this reflective ability that is their major source of knowledge as they discuss their view of a problem and their own tentative approaches to solving it. In theory, the simulated professional contexts of PBL can help students learn about not only what to do to care for a patient, but also how to do it collaboratively with colleagues who may hold competing viewpoints. But is this what happens in practice?

Not necessarily. D’Eon et al. suggest that students may learn more about the technical content related to HIV/AIDS than about group working: understanding the role of others, developing shared knowledge, coordinating tasks. The authors explain that this may be because students “…directed their attention to the scientific, medical, and technical aspects of the disease and less attention to the interprofessional dimension. This may be neither a good nor a bad phenomenon, but could be judged based on the intended and desired relative values of the two central learning goals.”

I can see three reasons why we need to give learning about group work its fair share of attention as we extend PBL to interprofessional contexts.

First, there is the somewhat troubling notion – brought long ago by John Dewey – that what students learn through problem solving is what remains after they solve problems. If this is true, then how can we maximize the likelihood that this residue is Inter-Professional Education (IPE— defined as learning with, from, and about each other to improve collaboration and care quality) if interprofessional practice is not targeted in students’ learning?

The second reason has to do with costs. The interprofessional PBL module on HIV/AIDS involved seven different health professions programs and 300 students. In addition to much investment in coordinating the module, the authors report that the “module consists of about six hours of small group work and a few hours of independent research and discovery learning, a considerable amount of total time on task.” I doubt that this kind of investment can be friendly to educational policy if interprofessional practice is not both an explicit learning goal and an outcome of problem based learning.

Third, clear IPE goals and content are important from a research point of view. We cannot be sure what students are learning (what’s in the residue) or how effective their IPE learning is, if we are not specific about the IPE content of the problems they solve.

In summary, we must be clear about the kind of problems the students are learning to solve: defining tasks or coordinating them. One can argue that when students face a trade-off between defining tasks from their professional perspective and coordinating multiple professional viewpoints on the same tasks, they tend to choose their own professional perspective because it is more convenient to do so. D’Eon et al.’s preliminary results seem to support this view. Further research may expand on these results for the benefit of collaborative practice and enhanced care quality.

Hassan Soubhi

One thought on “Problem Solving–What’s in the residue?

  1. The HIV/AIDS iPBL module has been successful in many ways but it is not enough. As Hassan has pointed out we want there to be more left over after the problem has been solved! Are there changes in attitudes, dispositions, and habits of behaviour either in the care of persons living with HIV/AIDS or/and the coordination of tasks as in interprofessional collaboration? Great question for further research! I think so but have we driven home our advantage? To complete their education, after the HIV/AIDS module experience, students need more application exercises in slightly different situations to consolidate and refine their initial learning.

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