BMJ 2003;326:328-330 ( 8 February ) Clinical review ABC of learning and teaching in medicine Problem based learning Diana F Wood

Advantages and disadvantages of PBL Advantages of PBL Student centred PBL !" #os"ers ac"ive learning% im&roved unders"anding% and re"en"ion and develo&men" o# li#elong learning s'ills Generic competencies P*+ allows s"uden"s "o develo& generic s'ills and a""i"udes desirable in ")eir #u"ure &rac"ice !ntegration P*+ #acili"a"es an in"egra"ed core curriculum Moti#ation P*+ is #un #or s"uden"s

Disadvantages of PBL Tutors who can't "teach" $u"ors en(oy &assing on ")eir own 'nowledge and unders"anding so may #ind P*+ #acili"a"ion di##icul" and #rus"ra"ing uman resources ,ore s"a## )ave "o "a'e &ar" in ")e "u"oring &rocess "ther resources +arge numbers o# s"uden"s need access "o ")e same library and com&u"er resources simul"aneously $ole models -"uden"s may be de&rived access "o a &ar"icular ins&ira"ional "eac)er w)o in a "radi"ional curriculum would deliver lec"ures "o a large grou& !nformation o#erload -"uden"s may be unsure )ow muc) sel# direc"ed s"udy "o do and w)a" in#orma"ion is relevan" and use#ul

and "u"ors% and ")e &rocess re.uires all s"uden"s "o be engaged in ")e learning &rocess "%eep" learning P*+ #os"ers dee& learning (s"uden"s in"erac" wi") learning ma"erials% rela"e conce&"s "o everyday ac"ivi"ies% and im&rove ")eir unders"anding) Constructi#ist approach -"uden"s ac"iva"e &rior 'nowledge and build on e/is"ing conce&"ual 'nowledge #ramewor's )""&:00www bm( com0cgi0con"en"0#ull0326013820328

PBL tutorial process Step & !den"i#y and clari#y un#amiliar "erms &resen"ed in ")e scenario; scribe lis"s ")ose ")a" remain une/&lained a#"er discussion Step ' 3e#ine ")e &roblem or &roblems "o be discussed; s"uden"s may )ave di##eren" views on ")e issues% bu" all s)ould be considered; scribe records a lis" o# agreed &roblems Step ( 4*rains"orming4 session "o discuss ")e &roblem(s)% sugges"ing &ossible e/&lana"ions on basis o# &rior 'nowledge; s"uden"s draw on eac) o")er5s 'nowledge and iden"i#y areas o# incom&le"e 'nowledge; scribe records all discussion Step ) 6eview s"e&s 2 and 3 and arrange e/&lana"ions in"o "en"a"ive solu"ions; scribe organises ")e e/&lana"ions and res"ruc"ures i# necessary Step * Formula"e learning ob(ec"ives; grou& reac)es consensus on ")e learning ob(ec"ives; "u"or ensures learning ob(ec"ives are #ocused% ac)ievable% com&re)ensive% and a&&ro&ria"e Step + Priva"e s"udy (all s"uden"s ga")er in#orma"ion rela"ed "o eac) learning ob(ec"ive) Step , 7rou& s)ares resul"s o# &riva"e s"udy (s"uden"s iden"i#y ")eir learning resources and s)are ")eir resul"s); "u"or c)ec's learning and may assess ")e grou&

PBL in curriculum design

P*+ may be used ei")er as ")e mains"ay o# an en"ire curriculum or #or ")e delivery o# individual courses !n &rac"ice% P*+ is usually &ar" o# an in"egra"ed curriculum using a sys"ems based a&&roac)% wi") non-clinical ma"erial delivered in ")e con"e/" o# clinical &rac"ice 8 module or s)or" course can be designed "o include mi/ed "eac)ing me")ods (including P*+) "o ac)ieve ")e learning ou"comes in 'nowledge% s'ills% and a""i"udes 8 small number o# lec"ures may be desirable "o in"roduce "o&ics or &rovide an overview o# di##icul" sub(ec" ma"erial in con(unc"ion wi") ")e P*+ scenarios -u##icien" "ime s)ould be allowed eac) wee' #or s"uden"s "o do ")e sel# direc"ed learning re.uired #or P*+

Top What is problem based... What happens in a... PBL in curriculum design Writing PBL scenarios Staff development Assessment of PBL Conclusion

9uali"ies o# ")e "u"or0#acili"a"or in &roblem-based learning :$)e role o# ")e "u"or in &roblem-based learning is "o sca##old s"uden" learning ; (de 7rave% 3olmans% < van der =leu"en >???% & ?0>) $)e e/&er" "u"or (a#"er de 7rave% 3olmans < van der =leu"en >??? & ?02) > @/&er" "u"ors need "o )ave sub(ec" ma""er 'nowledge bu" also sub(ec"-s&eci#ic &edagogical 'nowledge "o deal wi") di##icul"ies s"uden"s e/&erience wi") learning sub(ec" ma""er% and e/&er" "u"ors need more general &edagogical 'nowledge 2 @/&er" "u"ors dis&lay a )ig) level o# a##ec"ive su&&or" and nur"ure ")eir s"uden"s 3 @/&er" "u"ors use a -ocra"ic s"yle o# "u"oring% ")a" is ")ey see' "o draw as muc) as is &ossible ou" o# ")eir s"uden"s and "o ma'e learning an ac"ive and cons"ruc"ive &rocess 2 @/&er" "u"ors are commi""ed "o ma'ing increasing demands on ")e s"uden" in eac) "u"oring session A @/&er" "u"ors convey ")ese )ig) e/&ec"a"ions in a very indirec" and unders"a"ed manner 6 @/&er" "u"ors are more li'ely "o ar"icula"e and es&ecially "o encourage and )el& ")e s"uden" "o ar"icula"e ")e reasoning and meaning underlying ")eir ")in'ing% #or e/am&le by s"imula"ing sel#-genera"ed e/&lana"ions 1 @/&er" "u"ors devo"e subs"an"ial e##or" "o encouraging and mo"iva"ing s"uden"s Four 'ey dimensions o# ")e e/&er" &roblem-based learning "u"or (a#"er de 7rave% 3olmans < van der =leu"en >???) > -"imula"es elabora"ion o# in#orma"ion and ideas 2 3irec"s ")e learning &rocess 3 -"imula"es in"egra"ion o# 'nowledge 2 -"imula"es s"uden" in"erac"ion and individual accoun"abili"y 8 signi#ican" concern in P*+ in medicine is ")e im&ac" o# con"en" e/&er" versus non-con"en" e/&er"s as "u"ors0#acili"a"ors 8 ma(or review o# ")is li"era"ure is ")a" by 3olmans% 7i(selaers% ,ous"% de 7rave% Bol#)agen and van der =leu"en (2002) $)ey #ind mi/ed resul"s For "o&ics w)ere s"uden"s are "u"ored by con"en" e/&er"s% some s"udies s)ow grea"er de&") o# s"uden" learning bu" o")ers s)ow no signi#ican"ly di##eren" ou"comes 3olmans e" al sugges" ")a" w)ere s"uden"s s"udy a "o&ic #or ")e very #irs" "ime ")en con"en" e/&er" "u"ors may well )el& ")em "o a grea"er ini"ial unders"anding ")an non-con"en" e/&er"s -imilar ambigui"ies are #ound abou" w)e")er ")e "u"orial &rocess i"sel# is be""er #acili"a"ed by a con"en" e/&er" Con"en" e/&er"s "end "o "a'e a more direc"ive a&&roac) w)ereas non-con"en" e/&er" "u"ors "end "o #ocus more on grou& dynamics B)ere ")e &roblem "rigger genera"es a lo" o# con"en" rela"ed issues% ")ere seems "o be agreemen" ")a" con"en" e/&er"s )el& "u"orial grou&s &roceed #as"er and 'ee& ")e discussion more on "rac' 3olmans e" al conclude ")a" :C a "u"orDs &er#ormance is no" a s"able "eac)er c)arac"eris"ic% bu" is ra")er si"ua"ion s&eci#ic ; (&>11) 6easons w)y a "u"or may no" ma'e a good &roblem-based learning #acili"a"or (a#"er Eli##e% 2000)

F Personal educa"ional &)iloso&)y% es&ecially no" believing in or being &re&ared "o "rus" P*+ as a s"uden"-cen"red% ac"ive and cons"ruc"ivis" a&&roac) "o learning and ins"ead de#aul"ing "o a didac"ic% "eac)er #ocused and in#orma"ion "rans#er mode o# "eac)ing F +ac' o# &ersonal e/&osure "o P*+ ($)e c)ances are ")a" rela"ively #ew P*+ "u"ors will ")emselves )ave e/&erienced P*+ as s"uden"s) F +ac' o# s'ills and e/&erience wi") "u"oring in P*+% es&ecially lac' o# ")e range o# a&&ro&ria"e s'ills and ")e con#idence "o 'now w)en "o swi"c) #rom one "o ano")er F Personal ego $)e P*+ "u"or #acili"a"es ")e learning o# o")ers unob"rusively $)e lec"urer #re.uen"ly &er#orms "o (in #ron" o#G) s"uden"s F 6esis"ance "o c)ange F Ebsession wi") con"en" -ome sugges"ions on im&roving P*+ "u"or con#idence and &er#ormance (a#"er Eli##e% 2000) F 6e#lec"ion on oneDs role and &er#ormance% es&ecially ")roug) (ournal 'ee&ing and re#lec"ive wri"ing F 6egular mee"ings o# P*+ "u"ors "o review ")e &roblems "riggers being used and issues in #acili"a"ing "u"orial grou&s F +i"era"ure review and (ournal clubs ("o cover bo") ")e &roblem "rigger "o&ics and ")e &edagogic researc) on s"uden" learning) F Peer observa"ion o# "u"orial sessions F 6egular moni"oring o# s"uden" #eedbac' on P*+ "u"orials -ome a&&ro&ria"e #acili"a"or "ac"ics (a#"er Eli##e% 2000) F @ncourage s"uden"s "o "al' abou" relevan" e/&erience F $olera"e silences F 3ivide ")e grou& "o discuss im&or"an" issues F @ncourage s"uden"s "o em&a")ise wi") all ")e &eo&le in ")e &roblem scenario F 8s' s"uden"s "o elabora"e% es&ecially on ")eir reasoning and deduc"ive &rocesses F 8s' &robing% bu" non-direc"ive .ues"ions F @ncourage lis"ening F 8void sugges"ing ")e :rig)"; answer F 7en"ly crea"e s"uden" dissa"is#ac"ion wi") ")eir curren" ideas F @ncourage s"uden"s "o iden"i#y and e/&lore issues F @ncourage s"uden"s "o direc" ")eir own learning F ,odel use#ul and cons"ruc"ive be)aviour% es&ecially by ")in'ing and re#lec"ing aloud and summarising &rogress on con"en" and &rocesses o# wor'ing in ")e "u"orial 6e#erences: 3e 7rave% B -% 3olmans% 3 H I , < van der =leu"en% C P , (>???) Pro#iles o# e##ec"ive "u"ors in &roblem-based learning: sca##olding s"uden" learning ,edical @duca"ion 33 ?0>-?06

3olmans% 3 H I ,% 7i(selaers% B I H% ,ous"% I H C% de 7rave% B % < van der =leu"en% C P , (2002) $rends in researc) on ")e "u"or in &roblem-based learning: conclusions and im&lica"ions #or educa"ional researc) ,edical $eac)er 22 >13->80 Eli##e% I (2000) Facili"a"ion in P*+ J es&oused ")eory versus ")eory in use: re#lec"ions o# a #irs" "ime user 8us"ralian @lec"ronic Iournal o# Kursing @duca"ion A(2)

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-uccess#ul online discussions de&end on "wo ")ings: a good .ues"ion and a good #acili"a"or $)e #orma"ion o# .ues"ions is es&ecially im&or"an" Lnowledge and com&re)ension .ues"ions belong on a "es"% no" a discussion board !# ")ere is only one answer% ")en ")ere is no")ing "o discuss 9ues"ions ")a" re.uire analysis% syn")esis% or evalua"ion o# ma"erial lead "o good discussions :B)a" i#; .ues"ions% s"ruc"ured deba"es% role-&laying% case s"udy analyses% and s"uden" res&onses "o con"roversial views are (us" a #ew o# ")e ways "o crea"e meaning#ul online discussions 8 good #acili"a"or guides ")e discussion and 'ee&s i" moving $)e #acili"a"or s)ould s"ay neu"ral% use summaries and .ues"ions "o 'ee& ")e discussion on course w)en i" s"ar"s "o s"ray% &reven"or in"imida"ing o")ers% and encourage s"uden"s "o )el& eac) o")er $)e #acili"a"orDs (ob is a balancing ac"; in"ervening enoug) "o 'ee& discussion going% bu" no" so muc) ")a" s"uden"s become a#raid "o con"ribu"e -"uden"Ds com#or" level and willingness "o con"ribu"e "o discussion de&ends muc) on ")e s'ill o# ")e #acili"a"or Enline discussions are no" &er#ec" $)ey are o#"en riddled wi") s&elling and gramma"ical errors $)e #orma" can be c)allenging #or ")ose new "o "ec)nology 8n ac"ive discussion re.uires a lo" o# reading on ")e &ar" o# s"uden"s and #acili"a"ors *u" w)en )andled well% discussions can be a &ower#ul% "rans#orma"ive "eac)ing "ool