roblem-Based Learning Discussions (PBLDs) have been an integral part of the ASA Annual Meeting since 1992. The open call for, and blinded review of, cases remains one of the few opportunities for junior faculty to participate in the meeting and for private practice physicians to share their invaluable clinical experiences in an academic forum. Every year the members of the Committee on PBLDs read hundreds of submissions in order to create a program that represents the breadth of our specialty and includes both current “hot” topics and standard favorite scenarios.

PBLDs are unique because they encourage active learning in a small-group forum. These problem-oriented, case-based sessions are intended to allow attendees to confront and work through challenging issues. The discussions should provide a model that the participants will be able to adapt to future cases that they might encounter in their medical practices.¹ The moderator’s role is not to be a lecturer but rather to be a mediator who encourages participation and re-focuses the group when the discussion leads too far from the stated objectives of the session. For this reason, the use of slides (which would make the session “teacher centered”) is prohibited.

Any attending physician member of ASA is welcome to propose a PBLD for consideration by using the PBLD submission section of the ASA Web site, which is open for submissions between mid-December and mid-February. Particularly welcomed cases for submission include those that provide an opportunity to discuss systems issues in the delivery of patient care, ethical quandaries and quality improvement. Also lending themselves to good discussions are cases that include complex but realistic scenarios in which there are several reasonable alternatives for anesthetic management. Other good cases include situations that are unexpected or that offer consideration of potential differential diagnoses. The submissions are reviewed by members of the Committee on PBLDs according to their subspecialty areas of interest. Each case is evaluated by at least three committee members. Cases are graded on their relevance, content, enigma and scholarship.

A PBLD presentation should include:

Title: Short description of the case.

Objectives: Three to five statements of purpose. Learning objectives should employ measurable verbs rather than passive ones like “know” or “understand.” For example, “At the conclusion of the PBLD session the learner should be able to ‘apply, define, describe, explain, list, utilize’ a new concept or therapy.”

Case for Discussion: The stem should be clearly presented, with pertinent information. Questions should be interspersed throughout as the case continues to guide the attendees through the important considerations. These questions should ask the participant to articulate opinions or to devise multiple options in response to an issue, and they should stimulate dialog among the attendees rather than a lecture by the discussant.

Discussion: A scholarly explanation of the important points in the case should be included and should be more than a skeletal outline of the salient points. The purpose of this written discussion (which should not be read by the participants prior to the session) is three-fold. It should reference the current state of our understanding of the topic and identify unsolved issues by providing facts and established principles of care to reaffirm what occurred in the PBLD session. It should serve as a guide for someone who was unable to attend the specific PBLD session but who has an interest in the topic. Finally, it should make the case applicable for use in another forum such as resident teaching or studying for certification or recertification.

Selected References: Three to five papers that would help the attendee in the preparation for the PBLD session.

References: Bibliography for the discussion section, if necessary.

Once the selection process is completed and invitations offered, we field many questions about why cases have or have not been selected for presentation. The major reasons for cases not being selected include:

1. Telling the story of what “you did” as if it were the only option. The learning value of the PBLD comes from the discussions that the case engenders. Questions should be open-ended and allow for multiple and alternative interventions. Walking the participants through a case exactly the way it was performed limits and discourages the meaningful interaction between attendees. If a clinical scenario in which you participated was the stimulus for your case submission, you should consider altering some of the key factors to make the clinical presentation theoretical. Also remember that a patient’s protected health information must not be presented in a public forum without that patient’s consent. Therefore take care to avoid having the case identifiable. Good ways to do so are to change the specifics (age, exact surgical procedure and gender, where feasible), add features (comorbidities, for example) or delete others.

2. Poor grammar or multiple typographic errors. The reviewers are not editors, and once the cases are accepted, we can only suggest changes rather than mandate them. Cases that are unreadable or contain numerous errors will not be reviewed favorably.

3. Submission of cases representing extremely rare patient conditions, co-existing diseases or “made-up” procedures are not typically as good for PBLDs, because the moderator tends to become a content expert rather than a discussion facilitator.

Unfortunately not all of the good cases that are submitted can be accepted because we receive multiple submissions on the same topic. Every year there seem to be one or two topics about which we receive four to five cases. Rarely, too, one of the learning tracks is over-represented in its submissions. It is difficult to reject some of these cases, but the truly outstanding cases always manage to end up on the final program.

When queried, 95.4 percent of the PBLD attendees at the 2002 ASA Annual Meeting considered the PBLDs a worthwhile learning experience that offered an increased ability to anticipate problems and/or complications and an increased knowledge and awareness about issues. Ninety-eight percent expressed a willingness to participate in future PBLD sessions.² We continually strive to put together a comprehensive and vibrant program that is enjoyed and valued by our membership.

We hope this essay has presented a faithful account of what the Committee on PBLDs members are looking for in submissions and hope that it encourages your participation as a moderator or participant in the 2007 PBLD program.

References:
1. Liu PL, Liu LMP. A practical guide to implementing problem-based learning in anesthesia. Curr Anes Crit Care. 1997; 8:146-151.
2. Rosenblatt MA. The educational effectiveness of problem-based learning discussions as evaluated by learner-assessed satisfaction and practice change. J Clin Anesth. 2004; 16:596-601.

Meg A. Rosenblatt, M.D., is Associate Professor of Anesthesiology, Mount Sinai School of Medicine, New York, New York.