Dialog About Psychosocial Issues in Problem-Based Learning Sessions in Medical Education

Open Access
Adams, Nancy Ellen
Graduate Program:
Adult Education
Doctor of Education
Document Type:
Date of Defense:
October 05, 2016
Committee Members:
  • Elizabeth Jean Tisdell, Dissertation Advisor
  • Elizabeth Jean Tisdell, Committee Chair
  • Edward W Taylor, Committee Member
  • Carol Whitfield, Committee Member
  • Gregory Alan Crawford, Outside Member
  • problem-based learning (PBL)
  • psychosocial aspects of health care
  • cultural-historical activity theory (CHAT)
  • dialog
  • medical students
The purpose of this qualitative case study was two-fold: to investigate the dialog about psychosocial aspects of health care in problem based learning (PBL) groups in a single medical school; and to describe the factors that learners and PBL facilitators identify as influencing dialog about these issues in PBL groups. Medical education is a specific form of adult education practice and this study is grounded in the fact that medical students must learn not only about the scientific and clinical aspects of health care but about psychosocial aspects as well. PBL is a widely used modality in medical schools where small groups of learners discuss open-ended, case-based scenarios, identify their own knowledge gaps and then gather information and engage in group dialog to meet their learning objectives. The study aimed to examine how students discussed psychosocial issues in PBL sessions. The theoretical frameworks informing this study was cultural historical activity theory (CHAT) and the PBL literature. Data were collected through the observation and recording of dialog in the selected PBL groups, and through individual interviews with selected learners and facilitators about the factors they saw influencing dialog about psychosocial issues. Findings in regard to PBL group dialog about psychosocial issues indicate that in general, episodes of psychosocial dialog were observed to occur much less frequently, and were of much shorter duration, than dialog about scientific and clinical aspects of the case. Patient behaviors were the most frequently discussed psychosocial domain. Learners most often framed sociocultural issues as direct determinants of health care outcomes rather than asking critical questions about how these social and cultural factors, such as race and ethnicity, were linked to underlying differences in access to health care. There was also a lack of reference to external information resources about psychosocial topics; further, learners often reacted to initiation of psychosocial dialog with laughter that indicated dismissive attitudes towards psychosocial topics. Findings in regard to participants’ views on factors that influence psychosocial dialog focused on the need for “high yield” topics for PBL dialog that would relate to national high stakes exams; concerns for vulnerability and trust in groups around psychosocial issues that are sometimes perceived as controversial; the role of the facilitator, and learners’ prior life and clinical experiences. The findings are discussed and interpreted through the lens of CHAT, and suggestions and implications for medical education and adult education theory, practice, and further research are considered.