AMEE Medical Education Guide No. 15: Problem-based learning: a practical guide

This practical guide for health professions teachers provides a perspective of one of the most important educational developments in the past 30 years.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.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 generalize to other situations. PBL has many advantages. It facilitates the acquisition of generic competences, encourages a deep approach to learning and prepares students for the adult learning approach they need for a lifetime of learning in the health care professions. It is also fun. PBL helps in curriculum planning by defining core, ensuring relevance of content, integrating student learning and providing prototype cases. There are also drawbacks associated with PBL. Students may fail to develop an organized framework for their knowledge. The PBL process may inhibit good teachers sharing their enthusiasm for their topic with students and student identification with good teachers.Teachers may not have the skills to facilitate PBL.The problem scenario is of crucial significance. It should engage the students' interest and be skilfully written. While the medium selected for presentation of the scenario is usually print, other media may be used.The clinical tasks carried out by the student may replace the problem scenario as the focus for learning.Students are supported during the PBL process by tutors and/or study guides.The amount of support required is inversely related to the students' prior learning and understanding of the PBL process. A range of additional learning resources and opportunities may be made available to the students, including textbooks, videotapes, computer-based material, lectures and clinical sessions. Tutors require group facilitation skills, an understanding of the PBL process and knowledge of the course and of the curriculum in general.They need special personal qualities and it is preferable if they have expertise in the content area.While special assessment processes have been developed to assess students learning by the PBL method, the general principles of assessment apply to PBL courses and a mixed menu of assessment methods needs to be employed. 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.     

Group problems in problem-based learning

Successful small-group learning in problem-based learning (PBL) educational programmes relies on functional group processes. However, there has been limited research on PBL group problems, and no studies have been conducted on problems as perceived by both students and tutors in the same educational context. The authors investigated PBL group problems in a graduate-entry medical programme, and report the most common group problems, and those that hinder students' learning the most. The possible causes of individual quietness and dominant behaviour, and potential influences that group problems may have on the tutorial process are summarized in an exploratory model of PBL group dysfunction that could be used to guide further research. Specifically, there is a need for further evidence on which to base guidelines for tutors and students to effectively manage group problems.     

Caring for the chronically ill: a clinic for final-year medical students

In 2000 the Diabetes Centre and the Medical Oncology Department of St Vincent's Hospital, Sydney established a joint clinic for the teaching of final-year medical students. The clinic was established amid concerns that hospitals are increasingly focused on acute care and have few resources available for teaching about chronic conditions. The clinic aimed to improve both patient care and learning opportunities by engaging students in useful activities with chronically ill patients. The students met with their patients regularly to monitor progress, adjust medication (under supervision) and arrange support services. The students and staff from both units met once a week in a coordination meeting where cases were reviewed and learning issues discussed. Students had informal interactions with medical and allied health staff at other times. Overall the clinic provided a rich learning environment for students with a focus on the development of the integrated skills required in the care of chronically ill people, rather than on the specific medical disciplines involved.     

Peer consultation as a method for promoting problem-based learning during a paediatrics course

In problem-based learning (PBL) there are problems during tutorial group sessions, for example lack of participation, interaction and cohesion, and withdrawing. The authors evaluated whether these problems could be avoided with a peer consultation model. Peer consultation takes advantage of cooperation between students by encouraging them to accept more responsibility for learning from their peers. Forty-nine fifth-year students participated in three group sessions where they solved a paediatric case problem. The students were working in small groups, assuming the following roles in turn: presenters, facilitators and observers. The students reported that this consultative method forced one to actually define the problem, helped to develop communication skills and to identify problematic issues from different viewpoints and offered the possibility to evaluate personal problem-solving strategies. The method also gave an opportunity for students to learn in practice how to utilize new technology in data searching. These experiences suggest that the model of peer consultation adds new flavour, increasing enthusiasm in problem-based learning.     

The introduction of large class problem-based learning into an undergraduate medical curriculum: an evaluation

When considering implementing integrated curriculum models, such as problem-based learning (PBL), concerns may be expressed about the need for increased staff resources required to deliver tutor-led small group PBL. Less staff intensive ways of supporting PBL need to be explored. We compared the outcomes of a PBL module conducted in a large class format within a lecture theatre with a module having the same defined learning outcomes delivered in small group PBL format, both supported by e-learning resources. The pre-existing 27 small groups within the whole class (n = 246) of first year students undertaking a cardiovascular basic science module at Sheffield undergraduate medical school, UK, were randomized to 22 groups undertaking the large class Integrated Learning Activity (ILA) and 5 groups to traditional small group facilitated PBL sessions. Outcome measures were: a pre-post knowledge based test, a student educational effectiveness questionnaire, and assessment of student group work and presentations. There seemed to be no significant differences in learning outcomes between the methods although it is recognized that students would prefer the small group teaching format. Within institutions where resources to support small group PBL are limited, the large group ILA format supported with e-learning techniques may be a useful alternative approach.     

Becoming a student in PBL course: twelve tips for successful group discussion

Problem-based learning (PBL) serves as an educational method to foster self-directed learning, integration across disciplines, small-group learning and decision-making strategies. The approach is student centred. During the discussion of a PBL case there are a number of important issues to be considered by students, such as keeping ground rules, knowing their roles, keeping group dynamics, becoming a purposeful learner, planning how to use tutors' feedback to enhance group discussion and boost student's learning skills, as well as striving to become a winning team. This paper provides 12 practical tips to PBL students to enhance their skills in discussing a case in their group.     

Conceptions of problem-based learning: the perspectives of students entering a problem-based medical program

Effective learning in higher education is associated with students' perceptions of clear goals and standards of an educational program. In programs using problem-based learning (PBL), students' conceptions of what PBL is about could determine how well they perceive the clarity of goals and standards of their program. In this study the authors aim to investigate the relationship between the nature of first-year students' conceptions of PBL and their perceptions of the clarity of goals and standards of a graduate-entry, problem-based medical program. Results are that most students conceive of PBL as mainly working collaboratively to solve and understand a problem, and place less emphasis on PBL as learning independently. There is no relationship between students' conceptions and perceived clarity of course goals and standards. It is suggested that teachers not only need to help students develop their understanding of what PBL is about but also need to help students learn how to self-regulate their learning in PBL programs.     

How we capitalised on casual PBL facilitators’ expertise and experience to add value to our medical programme

While problem-based learning (PBL) has been widely implemented in medical education, it has been acknowledged to be resource-intensive, particularly in terms of academics’ time. In some institutions, such as Bond University (Australia), casual facilitators have been employed (paid hourly) to oversee the PBL tutorials. Apart from considerable experience as PBL facilitators, they also have expertise as allied health professionals or biomedical scientists. Several facilitators have educational qualifications. Recognising that their roles have expanded beyond the PBL tutorial room, we canvassed PBL facilitators in terms of their contributions to Bond University’s medical programme. We can report that our facilitators have contributed to the renewal of Bond’s medical programme, from design (e.g. curriculum structure, case-writing) to PBL case reviews. They are also involved in formative and summative assessment. Facilitators identified that, because of their prolonged involvement with the students in small groups, they consider themselves more than facilitators of student learning. They are role models and personal guides. Recognising the value these casually employed facilitators have added to our medical programme, we will continue to develop their skills in, for example, reviewing cases and assessment. We recommend that if institutions do employ casual facilitators, their expertise and experience can add value to the curriculum and to students’ experience.     

Student faculty rounds: a peer-mediated learning activity for internal medicine clerkships

Peer-mediated learning is an effective educational strategy that is rarely used during clinical training for medical students. We developed a peer-mediated learning conference, Student-Faculty Rounds (SFR), for the ambulatory component of a medicine clerkship. Designed to broaden students' exposure to common medical problems and provide practice in small-group teaching, the 30-minute conference is conducted by each student once during their clerkship. Students choose their topics and instructional formats, but they are advised to supply written learning objectives and employ interactive, problem solving opportunities. We analysed evaluations written by 280 students and 17 faculty supervisors during 1998-2001. Students presented over 150 topics. The most common were hypercholesterolemia, diabetes, headache, smoking cessation, hypertension management, and cancer screening (each presented in 3-4% of rounds). On a scale of 10 (outstanding) to 0 (lost cause), students gave SFR a score of 9.2 (95% confidence interval 9.0-9.3). In written comments, students indicated that topics were relevant and that peers provided instruction at an appropriate level of complexity, but that quality was variable. Faculty supervisors reported that 35% of students did not provide written learning objectives and 35% chose topics too broad for a 30-minute conference. SFR is a popular conference that accomplishes its educational objectives. It recognizes students' ability to educate themselves, and introduces variability and challenge into the classroom curriculum. Adequate faculty guidance is needed to assure students design conferences for maximum educational effectiveness.     

Twelve tips for setting up an ambulatory care (outpatient) teaching centre

The ambulatory care setting is becoming an increasingly important environment for clinical teaching. This reflects the changing focus of healthcare delivery with more procedures and patient treatment being delivered in this setting. Maximizing learning opportunities for students without compromising patient care has never provided a greater challenge. This paper shares 12 educational tips for developing an ambulatory care teaching centre where both students and patients benefit from a protected yet realistic clinical setting.     

Twelve tips for creating trigger images for problem-based learning cases

A trigger is the starting point of problem-based learning (PBL) cases. It is usually in the form of 5-6 text lines that provide the key information about the main character (usually the patient), including 3-4 of patient's presenting problems. In addition to the trigger text, most programs using PBL include a visual trigger. This might be in the form of a single image, a series of images, a video clip, a cartoon, or even one of the patient's investigation results (e.g. chest X-ray, pathology report, or urine sample analysis). The main educational objectives of the trigger image are as follows: (1) to introduce the patient to the students; (2) to enhance students' observation skills; (3) to provide them with new information to add to the cues obtained from the trigger text; and (4) to stimulate students to ask questions as they develop their enquiry plan. When planned and delivered effectively, trigger images should be engaging and stimulate group discussion. Understanding the educational objectives of using trigger images and choosing appropriate images are the keys for constructing successful PBL cases. These twelve tips highlight the key steps in the successful creation of trigger images.     

Small group learning in the final year of a medical degree: a quantitative and qualitative evaluation

The new undergraduate medical curriculum in Manchester uses problem-based learning (PBL) throughout the course. However, the major difference from other PBL schools is that in years 3 & 4 (phase 2) the students can use clinical experience when discussing the paper cases. The process is then developed further in year 5 (phase 3), in which there are no set PBL 'triggers' and students bring their own cases to the groups for discussion. In this study, we have explored what happens in the phase 3 (year 5) group sessions and how the students view them. A questionnaire and focus groups were used to generate data, from which a model was developed of what happens in a 'good' group session. The data suggest that most groups run on a case-presentation and discussion format, most commonly about clinical management and diagnosis. Students want tutors to act as an expert resource and to be flexible in allowing students to direct the discussions. University guidance about the group sessions was not generally used.     

A self-directed summative examination in problem-based learning in dentistry: a new approach

This paper describes and evaluates a new method of assessment in PBL, which was developed with two cohorts of dental students. The method involves students in PBL groups designing PBL problems and assessment tasks that are in line with the objectives of the course and the principles of PBL. Construction of tasks and feedback were provided. The student groups based the summative assessment on a selection of the PBL assessments provided. The evaluation indicates that senior students are capable of designing challenging PBL assessment tasks that are in line with course objectives and PBL principles. This experience raised the pass rates of the students compared those of with earlier cohorts of students. The students rated the method favourably; they considered it enabled them to demonstrate their competences and that it was more closely in line with PBL principles than other methods of assessment that they had experienced. The method is a promising innovation, which could be used in a variety of PBL courses.     

The small group in problem-based learning: more than a cognitive 'learning' experience for first-year medical students in a diverse population

In problem-based learning (PBL) curricula, first-year students need to adapt to a new learning environment and an unfamiliar new pedagogy. The small-group tutorial potentially offers a learning environment where students can become self-directed learners, collaborating with other group members to achieve individual and group learning goals. At the end of the first six-week theme in a relatively new PBL curriculum, new medical students were canvassed about coping with PBL (self-directed learning; content; time management; resources) and the value of the small-group tutorial, the latter of which is currently being reported. Almost 84% of students (n = 178) responded. The benefits of participating in small groups were categorized into three domains-cognitive, affective and social-as identified from student responses. Results were analysed in terms of gender and prior educational experience (secondary school vs. prior tertiary educational experience). For almost 94% of students, the small-group tutorial provided a conducive learning environment that influenced their personal development (i.e. tolerance, patience) and socialization into the faculty. Significantly more males indicated that they had developed social skills, while more school-leavers (matriculants) than mature students felt more receptive to the views of others. More mature students claimed to have made friends. Irrespective of some conflicting opinions in the literature, the present results suggest that the PBL tutorial may be important in facilitating student socialization into a new and unfamiliar academic environment, particularly when the pedagogy differs markedly from their past educational experiences. Through interacting with fellow students from diverse origins who hold different views in the intimate setting of the small group, students felt that they had not only increased their knowledge but had also developed personally and socially. It is proposed that the small group may be useful for integrating a diverse population of students into a new academic environment.     

Assisting the integration of social media in problem-based learning sessions in the Faculty of Medicine at King Abdulaziz University

Abstract

Purpose: Issues related to traditional Problem-Based Learning (PBL) at King Abdulaziz University Faculty of Medicine (KAU-FOM), including lack of student interaction between sessions and outdated instructional materials have led to the examining the use of social media. This study examines factors affecting the implementation of social media into PBL sessions

Methods: Mentored social media activities were incorporated between PBL sessions to third year medical students. Ground rules were set, and students were kept on track with learning objectives and authentic references. An online survey consisting of 18 questions were administered to measure the impact of the social media model embedded between PBL sessions.

Results: Feedback showed major improvements in students’ learning process as well as identifying areas for improvement. The highest ratings were in participation and communication, knowledge and information gathering, and cooperation and team-building.

Conclusions: This paper indicates that incorporating social media could facilitate learning between PBL sessions. Furthermore, guidelines are proposed to help educators implement a social media model into their PBL sessions.     

Problem-based learning: Where are we now? Guide supplement 36.2 - viewpoint

The educational principles of self-directed, collaborative, and life-long learning can be effectively inculcated into the curriculum where PBL is adopted as a major learning strategy instead of PBL as a whole-curriculum-concept. In developing countries, where the entry level of the majority of students is at the high-school leaving level, a guided discovery model may well be the answer. A curriculum that introduces students to carefully constructed problems sequenced according to a matrix design ranging from simple to complex conditions and according to a logical progression of anatomical and/or physiological and/or pathological and/or pharmacological concepts makes learning easier. Centralized curricular governance, conceptualization and management have a very strong impact on the kind of curriculum, or more specifically which variant of PBL, an institution is able to implement. However, decentralized empowerment of a large number of faculty members is crucial for faculty ownership. A curricular change, especially to PBL from a traditional curriculum, demands adequate preparation time of at least 2-3 years. The time between proposing the change to introducing the change should focus not only on faculty development and training, development of the curriculum and its policies, but also on resource development and preparation of the student body.     

Task-based learning (TBL) in undergraduate medical education

Problem-based learning (PBL) is a proven method to learn medicine during the first years of studies. In the clinical phase the active, self-directive student may experience difficulties in adapting to the life of professionals in health care units, where students usually have to attend and work according to preplanned timetables. Task-based learning (TBL) can serve as an intermediary in the meeting of these two cultures. Here we describe a TBL study module for fourth-year medical students and experiences of implementing it at the University of Tampere in Finland. Eighty-five students participated in this study in 1998 and 1999. Our results show that this method works and that it leads to learning. Students evaluate their skills connected with the general practitioner's work in a health centre hospital as better after the study module than at the onset.