Problem-based learning (PBL) has been adopted by many medical schools as an innovative method to deliver an integrated medical curriculum since its inception at McMaster University (Dornan et al., Med Educ 39(2):163–170, 2005; Finucane et al., Med Educ 35(1):56–61, 2001; Barrows, Tutorials in problem-based learning: A new direction in teaching the health professions, 1984). The student experience in PBL has been explored in detail (Merriam, New Directions for Adult and Continuing Education 89: 3–13, 2001; Azer, Kaohsiung J Med Sci 25(5): 240–249, 2009; Boelens et al., BMC Med Ed 15(1): 84, 2015; Dolmans et al., Med Teach 24(2):173–180, 2002; Lee et al., Med Teach 35(2): e935-e942, 2013) but the tutors who facilitate PBL have valuable insight into how PBL functions and this aspect has not been extensively researched.The integrated curriculum for years 1 and 2 at the Graduate Entry Medical School at the University of Limerick is delivered though problem-based learning (PBL). This programme requires collaborative teamwork between students and the tutors who facilitate small-group tutorial sessions. All PBL tutors at GEMS are medically qualified, with the majority (68%) currently working in clinical practice.MethodsA mixed-methods approach was adopted, utilising two surveys and follow-up focus groups to fully understand the tutor experience. Thirty-three tutors took part in two online surveys with a response rate of 89%. Thirteen tutors participated in two focus groups. Descriptive analysis was completed on survey data and thematic analysis on focus group discussions which highlighted five main themes.ResultsTutors reported challenges with managing group dynamics, development of confidence in tutoring with experience and a willingness to learn from peers to improve practice. Findings are in keeping with previously published work. Results also identified several less commonly discussed issues impacting student engagement in PBL including the use of mobile device technology, unauthorised access to learning objectives and PBL cases, and the importance and need for professional development amongst tutors, including the impact of tutoring on clinical practice. This study revealed that experienced tutors spend considerable time preparing for PBL tutorials in the basic sciences and that this input is rewarded by the benefits it brings to their clinical practice.ConclusionsUnderstanding PBL from the tutor’s perspective reveals valuable insights which can inform ongoing tutor development and support. Limited research exists in the area of PBL tutor’s experiences which may be of interest to medical educators, clinicians and the wider medical community. Findings highlight the value of shared tutor experiences as a resource that can be capitalised on to benefit both novice and experienced tutors.Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1214-2) contains supplementary material, which is available to authorized users.
There has been significant growth in ecological/environmental labelling of products and services internationally in recent years. Such efforts have become an integral element of the marketing strategies used by many firms. Concerns have been raised, however, that for some companies, this is little more than 'greenwashing', i.e. a cynical attempt to boost sales without any meaningful underlying sensitivity or change, in practice. Given the extremely negative track record of the global tobacco industry (Big Tobacco), it is essential that health policy makers and anti-smoking campaigners closely monitor this industry's attempts to exploit both growing environmental concerns among consumers and gaps in legislation. Although there is relatively strong legislation in some countries, to prohibit suggestions that cigarettes may be environment friendly, a further tightening of legislation is required. COMMENTARY Tobacco related deaths continue to constitute the largest cause of preventable mortality globally 1,2. Estimates of annual global deaths from tobacco related disease have grown from six million to seven million, with projections of eight million by 2030 3. Such estimates routinely underestimate the actual impact of tobacco, as they ignore both morbidity and the financial consequences associated with smoking, as well as the opportunity cost of tobacco production and purchase 4,5. However, one aspect of the global tobacco industry that is often underplayed is its adverse environmental impact 6,7. Although health researchers routinely understand this in terms of seconhand 8 and thirdhand smoke 9,10 , there is a wider environmental context to such discussions. Significant adverse environmental impacts of the tobacco industry involve: fertilizer and pesticide use; deforestation; water use; waste 11 ; transportation and pollution; and packaging 6,12. Particular attention from an environmental perspective has focussed on the impact of cigarette butts 13-16. The adverse impact of the global tobacco industry has been addressed repeatedly by the World Health Organisation (WHO) 6,17 , and is specifically addressed in Article 18 of the Framework Convention on Tobacco Control (FCTC) 18. Recent attempts to quantify the significant negative impact of the global tobacco industry include an assessment by Zafeiridou et al. on behalf of the WHO Framework Convention
Dear Editors, Li and colleagues are to be commended for their recent article 1 that uses the SimSmoke simulation model to predict that Ireland will fail to meet its target of being smoke free by 2025, which it defines as having a smoking rate of less than 5% 2. It is hoped that, despite the limitations inherent in any predictive computer modelling, their quantitative analysis of the forthcoming failure for Ireland to meet its own targets will spur the Irish Government into assertively tackling the tobacco epidemic in a more robust manner. Smoking remains a significant issue in Ireland, with The Tobacco Atlas estimating 5600 deaths per year from tobaccoinduced diseases and an economic cost of €2826 million associated with smoking for Ireland 3. The present response aims to elaborate further on some of the issues raised by Li et al. 1 , and to outline some areas of further vulnerability in Ireland's attempts to reduce smoking. Li et al. noted the higher smoking rate of Polish immigrants in Ireland 4. The Poles are Ireland's largest group of non-Irish nationals 5. However, it is perhaps also important to acknowledge the potential relevance of the high rate of smoking in Lithuania 3. Although data is lacking on smoking prevalence among Lithuanian immigrants in Ireland, smoking rates in Lithuania are significantly higher than in Ireland (38.1% among males and 22.2% among females), with Lithuanians being Ireland's third largest minority. It should be noted that a basic single ticket from Dublin to either Poland or Lithuania can be purchased routinely from a budget airline company for only €19.99. Thus, immigrant groups have potentially easy access in their country of origin to cigarettes and tobacco at a fraction of the price in Ireland and without the plain packaging requirements mandated by Irish legislation. One development that is not considered in the SimSmoke simulation is 'Brexit'; the United Kingdom's imminent exit from the European Union. It is noteworthy that repeated investigations into the illicit tobacco trade in Ireland have highlighted the significance of its magnitude 6. A government survey in 2016 estimated that the illicit cigarette trade in Ireland exceeded 20 million packets per year, representing approximately 5 packets for each man, woman and child 7. It should be noted that prosecutions related to illicit tobacco trade and smuggling in Ireland are extremely rare 6 , despite the high volume of such products consumed 6. Although it must be acknowledged that tobacco industry assessments of the scale of the illicit tobacco trade consistently overestimate the size of the problem 8-11 , it is still estimated that illicit cigarettes constitute 4.9% of all manufactured cigarettes smoked in Ireland 11. The potential impact of 'Brexit' is crucial given that previous investigations 12 on the impact of smuggling and the cross-border trade with Northern Ireland, which minimised this issue, were conducted in an era of large-scale ceasefires, political progress, a functioning Northern Ireland Assembly, and an o...
Conflicts of interest: None.
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