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Problem based learning
Problem based learning is used in many medical schools in the United Kingdom and worldwide. This article describes this method of learning and teaching in small groups and explains why it has had an important impact on medical education.
What is problem based learning?
In problem based learning (PBL) students use “triggers” from the problem case or scenario to define their own learning objectives. Subsequently they do independent, self directed study before returning to the group to discuss and refine their acquired knowledge. Thus, PBL is not about problem solving per se, but rather it uses appropriate problems to increase knowledge and understanding. The process is clearly defined, and the several variations that exist all follow a similar series of steps.
Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes, such as communication skills, teamwork, problem solving, independent responsibility for learning, sharing information, and respect for others. PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes. Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice.
However, when PBL is introduced into a curriculum, several other issues for curriculum design and implementation need to be tackled. PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences. It has implications for staffing and learning resources and demands a different approach to timetabling, workload, and assessment. PBL is often used to deliver core material in non-clinical parts of the curriculum. Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems. Recently, modified PBL techniques have been introduced into clinical education, with “real” patients being used as the stimulus for learning. Despite the essential ad hoc nature of learning clinical medicine, a “key cases” approach can enable PBL to be used to deliver the core clinical curriculum.
What happens in a PBL tutorial?
PBL tutorials are conducted in several ways. In this article, the examples are modelled on the Maastricht “seven jump” process, but its format of seven steps may be shortened.
A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor, who facilitates the session. The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions. A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges.
Students elect a chair for each PBL scenario and a “scribe” to record the discussion. The roles are rotated for each scenario. Suitable flip charts or a whiteboard should be used for recording the proceedings. At the start of the session, depending on the trigger material, either the student chair reads out the scenario or all students study the material. If the trigger is a real patient in a ward, clinic, or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room. For each module, students may be given a handbook containing the problem scenarios, and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress.
The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team. The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study. The tutor should encourage students to check their understanding of the material. He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams.
PBL in curriculum design
PBL may be used either as the mainstay of an entire curriculum or for the delivery of individual courses. In practice, PBL is usually part of an integrated curriculum using a systems based approach, with non-clinical material delivered in the context of clinical practice. A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge, skills, and attitudes. A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios. Sufficient time should be allowed each week for students to do the self directed learning required for PBL.
Writing PBL scenarios
PBL is successful only if the scenarios are of high quality. In most undergraduate PBL curriculums the faculty identifies learning objectives in advance. The scenario should lead students to a particular area of study to achieve those learning objectives.
Generic skills and attitudes
- Teamwork
- Critical evaluation of literature
- Chairing a group
- Listening
- Self directed learning
- Recording and use of resources
- Cooperation Presentation skills
- Respect for colleagues’ views
PBL tutorial process
Step 1—Identify and clarify unfamiliar terms presented in the scenario; scribe lists those that remain unexplained after discussion
Step 2—Define the problem or problems to be discussed; students may have different views on the issues, but all should be considered;
scribe records a list of agreed problems
Step 3—“Brainstorming” session to discuss the problem(s), suggesting possible explanations on basis of prior knowledge; students draw non each other’s knowledge and identify areas of incomplete knowledge; scribe records all discussion
Step 4—Review steps 2 and 3 and arrange explanations into tentative solutions; scribe organises the explanations and restructures if necessary
Step 5—Formulate learning objectives; group reaches consensus on the learning objectives; tutor ensures learning objectives are focused, achievable, comprehensive, and appropriate
Step 6—Private study (all students gather information related to each learning objective)
Step 7—Group shares results of private study (students identify their learning resources and share their results); tutor checks learning and may assess the group. | |
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