MEDEV

School of Medical Sciences Education Development

Task-based learning: an educational strategy for undergraduate, postgraduate and continuing medical education

An extended summary of AMEE Medical Education Guide No 7 by R M Harden, Jennifer M Laidlaw, Jean S Ker and Helen E Mitchell

Published in Medical Teacher (1996) 18,1 pp 7-13 and 18,2 pp 91-98

Guide overview:

Task-based learning (TBL) is an educationally sound, effective and efficient strategy for delivering relevant education. TBL ensures that the learning outcomes are achieved, while advantage is taken of the rich opportunities and experiences to which a student or doctor can be exposed in a real or simulated clinical setting. The tasks of the healthcare professional provide the context and the focus for learning just as a ‘problem’ provides a focus for learning in problem-based learning. The learning is built around the task, the task stimulating further reading by the student. Students gain a basic understanding of the principles of health and disease, and acquire generic competences, such as communication and management skills through a study of the tasks undertaken by a healthcare professional.

In undergraduate education, TBL facilitates vertical integration of the curriculum. It introduces relevance and the application of theory to practice in the early years of the curriculum and provides a strategy for continuing a study of the basic sciences in the later stages. In postgraduate education, TBL enhances the value of on-the-job learning and helps to resolve the conflict between training the doctor and providing a service. In continuing education, TBL assists the doctor to build repertoires of skills, knowledge and understanding based on continuing practice.

Rationale of task-based learning

Task-based learning is an educationally sound and practical strategy for medical education. It has three advantages:

1. learning built round tasks is more effective than traditional didactic memory-based or purely apprenticeship-type learning;
2. learning structured round the tasks is an efficient approach to learning;
3. task-based learning is likely to lead to more relevant and appropriate education.

Effective learning

TBL’s effectiveness as an educational strategy is supported by nine areas of thinking in education:

• On-the-job or experiential learning: Increasingly, educators are becoming aware of the need to develop forms of learning that are rooted in the learner’s practical experience and in the job they are to undertake as a professional on completion of training.
• Situated learning: The argument is that knowledge is contextually situated: it is fundamentally influenced by the activity, context and culture in which it is used. If this view is correct, learning should take place in the context of actual work or realistic simulations of that work. Task-based learning is both situated (in the task identified) and unsituated (in that the learner has to generalise beyond that task).
• Action and reflection: Task-based learning offers action and reflection. In contrast, rote learning is low in action and in reflection. Incidental learning, such as occurs in on-the-job learning, is rich in action but may be low in reflection. Classroom, or formal, learning is frequently high in reflection but low in action.
• Integration of theory and practice: Task-based learning links theory with practice. The practical task becomes the starting point for the theory: in turn, theory informs and leads to a better understanding of the task.
• Education and training: With an increasing emphasis on vocational training in medicine there is a risk that we lose out on education. Student or trainee learners should not only know how to do a task; they should understand the rationale for that task and the basic theory underpinning it.
• Theories-in-use: The actions of individuals are informed by their beliefs and assumptions, most of which are internalised and not consciously referred to when taking action. This has been described as ‘theories-in-use’. For appropriate learning, the tacit values and assumptions embedded in actions must be made explicit and their implications learned. TBL allows such insight to be acquired. Students look at and analyse reasons and principles underpinning the decisions and actions as they relate to the task. They explore the general nature of these principles and know how they are applied in a different context.
• ‘Mental models’ and a structure for learning: Students must develop a structure or framework on which to build their knowledge. ‘Mental models’ have a role to play in the promotion of thoughtful learning and higher learning objectives, including understanding and insight. TBL, by placing the learning in the context of the task of a healthcare professional, encourages the development of appropriate mental models.
• Motivation: If the student or trainee lacks motivation, education may be ineffective. A powerful argument for TBL is that learning round the actual tasks of a healthcare professional is inherently motivating.
• Achievable staged learning: A good educational strategy is to break the learning into achievable steps or stages. TBL achieves this through building the learning round a series of tasks.

Efficient learning

Many of the effectiveness arguments above apply also to the efficiency of the learning. The following contribute to the efficiency of TBL as an approach to learning:

• Planned education: TBL provides an appropriate framework for planned education. It makes explicit what is to be achieved and how the learner should do this.
• Combined education and service: A conflict is frequently seen to exist, particularly in postgraduate and continuing education, between service and education. The answer must lie in adding educational value to existing service commitments. TBL can bring this added value and efficiency to postgraduate and continuing education.
• Extended role of the teacher or trainer: TBL allows the teacher or trainer to make more efficient use of time. Teachers may have different roles in TBL, eg, planning the educational programme, developing resource materials. The roles can be shared.
• Efficient use of student’s or trainee’s time: Clinical experiences although they offer rich learning opportunties, require a significant investment in time from the student. TBL helps maximise the benefit from the student’s investment of time.

Appropriate learning

TBL helps to ensure that curriculum content is relevant to the needs of the practising doctor. It supports a core curriculum and facilitates education for capability.

• A TBL approach is likely to result in greater relevance of curriculum content. The decision to include some aspect of medicine for the student to study will depend on whether it can be related to the practice of medicine.
• TBL provides the basis for the specification of a ‘core’ curriculum including the essential knowledge, skills and attitudes related to the tasks performed by a healthcare professional.
• The generic competences emphasised in ‘education for capability’ can be more meaningfully addressed in TBL than in the traditional approaches.

Implementation of task-based learning

There are eight steps in the implementation of task-based learning.

1. Define the learning outcomes

Consider both mastery of a subject or topic and generic or transferable skills.

2. Specify the tasks
   • Does the student or trainee have access to the task?
   • What learning outcomes can be achieved through a study of the task?
   • What is the clinical context?

When specifying or selecting the tasks that will be used as the focus for the learning, consider:

3. Use grids to match learning outcomes with tasks

In planning a course prepare a grid on which the learning outcomes are related to the specified tasks. Some outcomes will be addressed through more than one task.

4. Determine the role of TBL in the curriculum

TBL can be adopted wholesale as the strategy for a new innovative curriculum or more gradually as part of the evolution of a more traditional curriculum. At one end of the spectrum, the curriculum is built round a TBL approach. At the other end of the spectrum, TBL is added to, and complements, an established programme. TBL can be adopted in both integrated and discipline-based curricula. The way in which TBL is introduced will also be influenced by the degree of integration in the curriculum. TBL is itself a powerful tool to facilitate integration.

5. Review the learning opportunities

It is important to consider the learning opportunities that will be available to support the student or trainee in TBL, eg, small-group work, independent study, lectures, practical classes and clinical sessions.

6. Clarify the staff role and organise appropriate staff development

Are staff to be involved with planning the TBL programme, developing resource material, providing student support and facilitation, providing specialist input or in assessment? The introduction of TBL must be accompanied by a staff development programme.

7. Ensure appropriate communication by the provision of study guides

An essential aspect of TBL is communication with staff and students. All concerned should become familiar with programme learning outcomes, and how these will be achieved. A study guide will be of assistance to staff and students alike.

8. Design a reliable and valid student assessment procedure

In the introduction of any new approach to teaching and learning, assessment is critical. The assessment process should reflect the learning outcomes for the curriculum and the task-based approach.

Task-based learning in the three phases of education

TBL is of value to the three phases - undergraduate or basic, postgraduate or vocational, and continuing education.

1. Undergraduate or basic education

In undergraduate medical education, the emphasis has progressed over the last four decades: from a student-centred approach, through integration among disciplines and on through problem solving to relevance and the problem of information overload. TBL is a response to this challenge, focusing on the tasks undertaken by healthcare professionals and on the learning related to these tasks.

2. Postgraduate education

After qualification, the pattern of training changes dramatically, and education now has to compete with the doctor’s service commitments. The model of education is one where the junior doctor or trainee is an apprentice. He or she learns by watching seniors practising medicine and by practising under supervision. Through the use of a study guide, TBL can help ensure that the doctor further develops an understanding of basic processes and mechanisms of disease and that the knowledge and skills gained in the apprenticeship model are not situated only in one particular context but are generalised to other situations.

3. Continuing education

TBL can enhance the educational potential of the doctor’s service commitments. This is even more important in CME, where the amount of time available for formal education is limited. TBL, used appropriately, helps ensure that continuing professional education is more than technical updating.

4. The continuum of education

By planning TBL throughout the continuum of education, tasks first encountered in undergraduate education can be revisited in postgraduate studies.

Discussion and conclusion

TBL offers a focused and structured approach to learning, and supports the notion that learning in medicine can occur most effectively when related to the tasks undertaken by a healthcare professional. TBL encourages the development of the reflective practitioner, and accommodates a wide range of learning styles. Like problem-based learning, TBL offers an attractive combination of pragmatism and idealism: pragmatism in the sense that learning with an explicit sense of purpose is seen as an important source of student motivation and satisfaction; idealism in that it is consonant with current theories of education.

© 2002 AMEE

The full text of this guide comprises 19 pages and 43 references and is available from:

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