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PBL Curriculum for Critical Care Trainees

This website was designed to provide educational material about a range of topics related to Critical Care Medicine. It includes a series of modules developed in accordance with the objectives of training in Adult Critical Care of the Royal College of Physicians and Surgeons of Canada (RCPSC). Each module presents the journey of a fictional patient in the Intensive Care Unit (ICU), as well as the efforts provided by an ICU team to care for this patient.

The material presented on this website does not include the knowledge content related to each objective, but rather represents a collection of realistic ICU scenarios meant to assist teachers and to guide learners in their review of various ICU-related topics. The scenarios may not always present the best possible diagnostic or management approaches, and you may disagree with the choices made by the protagonists. The problems were purposefully designed to be ambiguous to stimulate small-group discussions and individual critical thinking. In addition, the modules were created with specific learning objectives in mind, which are provided with each case. However, we expect that the users will identify their own objectives during the completion of the modules according to their individual knowledge and learning needs.

How to use this website

There are two ways to use the modules:

1. As a teaching tool

If you are an ICU teacher/educator, you can use the material presented in each module to organize problem based learning (PBL) sessions with your critical care trainees. 

What is PBL?

PBL is an educational approach specifically designed for small-group learning. A series of carefully planned, authentic, and contextualized medical problems are discussed by trainees under the supervision of a facilitator (usually a senior physician). For each problem, the group identifies objectives that are then reviewed individually. Subsequently, trainees' findings are shared and discussed during a follow-up session. Based on concepts such as andragogy (adult learning) and constructivism (knowledge is actively constructed rather than passively transmitted and acquired), PBL curricula share core characteristics: interactive, student-centered, and self-directed.

Why use PBL?

In theory, PBL offers many advantages for medical trainees: deeper learning through cognitive elaboration, re-activation of individual prior knowledge, and development of lifelong learning strategies. However, PBL effectiveness is still a matter of debate in the medical education literature. At the undergraduate level, PBL study findings are inconsistent. PBL appears as good as traditional lecture-based teaching for knowledge development, and is usually perceived as more enjoyable by the students. The role of PBL in postgraduate critical care training has not been studied thus far. In theory, CCM trainees represent an ideal learner population to implement PBL curriculum. Their heterogeneous and rich medical background should generate productive small-group discussions.

Learn more about PBL:

How to organize PBL sessions?

1. Problem Selection
Select a module from the website and print the Tutor document and the Trainee document. The modules can be completed in any order.

2. Problem Introduction
During this first small-group session, distribute a copy of the Trainee document to the trainees. As a group, read the problem, one section at the time. After each section, ask the trainees about their understanding of the scenario and their opinions in terms of management. Some questions are provided for guidance in the Trainee document, as well as the specific objectives addressed in each section. The goals of this session are to identify areas of uncertainties in trainees' knowledge and specific learning objectives, which can then be distributed among trainees. (Suggested session duration: 60-90 minutes)

3. Self-Study
Over the following days/weeks, each trainee is responsible to read about the objective(s) assigned during the first session. (Suggested duration: 2-14 days)

4. Following Sessions: Review of the learning objectives
During the following sessions, each trainee presents to their colleagues the results of their reading. They may summarize the material reviewed, explain how this knowledge applies to the problem initially discussed, and share useful references on the topic. (Suggested session duration: 2-4 sessions of 60-90 minutes)

What is my role as a PBL tutor/facilitator?

The facilitator' biggest challenge is usually to resist the urge of lecturing the trainees on a given topic. We recommend that PBL tutors use their expertise to challenge and question the trainees and to motivate them to find answers to their questions. Tutors can also be helpful in many other ways: planning and organizing the sessions, maintaining positive group dynamics; ensuring equal participation from all trainees, clarifying persistent areas of doubts; managing time; providing constructive feedback to individual trainees.

2. As a learning tool

If you are a critical care trainee, you can use the material presented in each module to guide your readings and to refine your clinical reasoning by reviewing the interactive features included in each scenario.

How to use the interactive modules

To use the interactive modules, select a case by clicking on the title from the menu below. The modules can be completed in any order.

Each case is divided in three sections. Questions and learning objectives are presented at the end of each section. We encourage you to take a moment to identify the problematic issues addressed in the scenario and to mentally commit to a diagnosis or management plan when appropriate. This will help you to identify your knowledge gaps and to select individual learning objectives at the end of the module.

Each module uses a similar format. The case unfolds over a series of slides. At the left of your screen, you will find a sidebar with a picture of the main character involved in this part of the scenario. Below the picture, a navigation panel presents the outline of the case. Use the note tab of the slides called end of section questions to find the learning objectives specific for each section. At the bottom of each slide, you will find a player control that allows you to advance to the next slide.

Most of the slides are text slides that provide you with the content of the case. A few question slides have been inserted throughout the cases to force you to pause and think about what is happening in the scenario. In addition, some cases contain image slides with additional interactive features. Finally, each case ends with a reference slide providing a few helpful references on the main topics covered by the module to guide your readings.

About us

Each module was designed by a team of fully certified critical care physicians working as clinicians and educators in a tertiary academic center in Canada. Numerous critical care trainees have also contributed to the content of this website.

Feedback

We would love to receive feedback regarding the scenarios and the website, and to hear about your personal experience with the website.

Please, send your comments, suggestions or questions to criticalcarePBL@sunnybrook.ca.

Acknowledgements

This project was made possible with funding support from the Royal College of Physicians and Surgeons of Canada through the 2011 Royal College/Associated Medical Services CanMEDS Research and Development Grant.

We would also like to thank Ms. Jennifer Asselstine and the Sunnybrook web communications team for their contributions to the development of this website.

Modules

Case 1

High Speed, High Pressure
Download printable version:

Case 2

When Immunity Fights Back
Download printable version:

Case 3

Blood Losses, Fluid Gains
Download printable version:

Case 4

Dangerous On Its Own...
Download printable version:

Case 5

The Ups and Downs of the Neutrophil Count
Download printable version:

Case 6

Burning Issues
Download printable version:

Case 7

Losing Your Sleep Over Somebody Else's Sleep
Download printable version:

Case 8

Blockage, Leakage, Drainage
Download printable version:

List of abbreviations commonly used in the modules

AC/PC: Assisted Controlled/Pressure Controlled
AC/VC: Assisted Controlled/Volume Controlled
BP: Blood Pressure
CRF: Chronic Renal Failure
CXR: Chest X-Ray
Db/DM: Diabetes
EMS: Emergency Medical Services
ETT: Endotracheal Tube
FFP: Fresh Frozen Plasma
GCS: Glascow Coma Score
Hb: Hemoglobin
HR: Heart Rate
ICP: Intracranial Cerebral Pressure
IHD: Intermittent Hemodialysis
LV/RV: Left / Right Ventricle
NP: Nasal Prong
NS: Normal Saline
Plt: Platelets
PRBC: Packed Red Blood Cells
RL: Ringers Lactate
RR: Respiratory Rate
RRT/CCRT: Critical Care (Rapid) Response Team (aka Outreach Team)
SOB: Shortness of Breath
SpO2: O2 saturation by pulse oximetry
WBC: White blood count