Problem-based learning: a practical guide

 

An extended summary of AMEE Medical Education Guide No 15 M H Davis and R M Harden

Published in Medical Teacher (1998) 20, 2 pp 317-322

The full text of this guide comprises 24 pages and 66 references and is available from:

Association for Medical Education in Europe (AMEE), Tay Park House, 484 Perth Road, Dundee, DD2 1LR

Tel: +44 (0) 1382 631953; Fax +44 (0) 1382 645748; Email: amee@dundee.ac.uk

http://www.amee.org/

Guide Overview:

Problem-based learning (PBL) has been widely adopted as an educational strategy. This guide provides an understanding of the principles behind PBL and answers the question: what is PBL?.

It discusses the advantages and problems associated with PBL. Different approaches are discussed.

What is PBL?

Confusion and misunderstanding often exist about what is PBL. The term PBL is employed to convey different concepts and with different meanings. PBL can be thought of as active learning stimulated by, and focused round a clinical, community or scientific problem. It is not simply the opportunity to solve problems, but rather learning opportunities where solving problems is the focus or starting point for students' learning. PBL reverses the traditional approach to teaching and learning. It starts with individual examples or problem scenarios which stimulate student learning. In so doing, students arrive at general principles and concepts which they then generalise to other situations. The guide argues that Problem-based learning (PBL) is a continuum of approaches rather than one immutable process. It is a teaching method that can be included in the teacher's tool-kit along with other teaching methods rather than used as the sole educational strategy.

Advantages of PBL

PBL offers a number of real benefits to education in the healthcare professions:

  • Relevance of curriculum content is facilitated by structuring student learning round common clinical problems.
  • The PBL approach, through its identification of core, has the potential to make an important contribution towards the reduction of information overload that overburdens many of our students.
  • The approach contributes to the acquisition of generic competencies or personal transferable skills such as problem solving, communication and team working.
  • The PBL process involves the student taking more responsibility for his or her learning.
  • PBL is an important educational strategy for integrating the curriculum.
  • PBL can be fun and rated enjoyable by both students and staff.
  • PBL encourages a deep approach to learning.
  • PBL facilitates a constructivist approach to learning. When generating learning issues, students make use of existing or prior knowledge to identify what they still need to learn.
  • The scenarios in PBL may in many instances be considered by students as prototype cases which can be used as a framework for their learning.

Disadvantages of PBL

  • In PBL the teacher serves as a facilitator rather than acting as a role model. This may deprive students of the benefits of learning from an inspirational teacher.
  • Staff are denied the fun of sharing their processes of understanding with their students and of getting a buzz out of teaching.
  • The knowledge acquired through PBL tends to remain unorganised. Organisation of knowledge in traditional courses comes from students being introduced to a topic by experienced teachers able to distinguish between what is important and what is unimportant.
  • PBL requires teaching competencies many teachers do not possess.
  • Concern has also been expressed about the cost of implementing a PBL programme.
  • PBL may be time consuming for students, particularly if they need to identify educational resources for themselves.

To a greater or lesser extent, these disadvantages can be overcome if appropriate strategies are adopted when PBL is introduced into the curriculum.

Which approach to PBL should you adopt?

The approach to PBL best adopted will depend on a number of issues:

  • The expected learning outcomes
  • The availability of motivated staff with appropriate skills
  • The availability of supporting learning resources
  • The learning context, eg, the early or later years of the curriculum
  • Students' choice.

The PBL process

The details of how the PBL process is implemented differ from institution to institution. However the general principles remain the same. Students are not regarded as passive vessels to be filled with facts by lecturers or teachers. They actively learn for themselves using the problem as a focus for their learning

A number of identifiable stages or steps in the PBL process have been described. This begins with the problem scenario. Students, either working individually or more usually in groups, read through the scenario and identify unfamiliar terms or concepts. From their prior learning, the group determines underlying mechanisms and develops possible explanations for the problem scenario. Further information about the scenario may be made available to the students if they request it. The group will encounter gaps in their understanding and identify these as the learning issues.

Following this first stage there is a period for individual study. Students tackle the learning issues through accessing a range of educational resources. When the group meets again, students share what they have learned and apply the learning to the problem scenario. Students organise prior and new learning around the problem scenario.

The final vital step in the PBL process is to generalise the learning to other situations in which such knowledge, skills and attitudes would be applicable.

Individual medical schools have organised problem-based learning in different ways: the Harvard six steps approach and the Maastricht seven jump approach are described.

The problem and its presentation

The guide looks at what makes a good problem scenario and the medium used to present it. Problems have been presented to students, traditionally in print. However, other media may be used. Newspaper clippings, audio tape, videotape and computer simulations may all be used. In Task Based Learning, the real life clinical tasks carried out by the student provides the learning stimulus.

Facilitating PBL

In PBL, students require a measure of support. This may be supplied through a facilitator in a PBL group or through supportive resource material provided, for example, in a study guide. The amount of external support required is dependent on the prior learning of the students and on their understanding of the PBL process. Internal support may also come from other members of the group through a collaborative learning process in which students learn from each other. Where there is a high level of internal support the need for external support is reduced.

The role of the tutor in PBL is as a guide or facilitator. The PBL facilitator should have:

  • Skills in facilitation of the small group learning;
  • An understanding of the curriculum;
  • and the overall educational programme

It is also helpful if the facilitator has some knowledge of the content matter.

Student assessment and PBL

The approach to student assessment should be reviewed at the same time as PBL is introduced as a learning strategy. If the assessment process emphasises factual recall and rote memorisation, PBL may appear less attractive to students and students may be less enthusiastic to participate in the PBL process. If, on the other hand, the assessment process tests a deeper learning, understanding and/or problem solving, then the relevance of the PBL will be apparent. An innovative approach which offers potential is the use of portfolios for assessment. One issue for consideration is whether the student's performance in the PBL group should be assessed by their tutor and/or other members of the group. Curriculum design involves a skilful blend of educational strategies designed to help students achieve the curriculum outcomes. PBL may make a valuable contribution to this blend but attention needs to be paid to how it is implemented.

© 2002 AMEE

The AMEE Guides series comprises 29 guides on key topics in medical education and is available from:

Association for Medical Education in Europe (AMEE), Centre for Medical Education, Tay Park House, 484 Perth Road, Dundee DD2 1LR, UK

Tel: +44 (0) 1382 631953; Fax +44 (0) 1382 645748; Email: amee@dundee.ac.uk

http://www.amee.org/

enquiries@medev.ac.uk

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The Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine

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