Title
Problem-Based Learning
(PBL): A Review of the Current Literature
Category
Higher Education – Medical Education
Summary
Problem-Based Learning (PBL) is a relatively new pedagogical system that has revolutionized the
teaching-learning Process in multiple different parts of the world, as well as
in various fields of knowledge.
This methodology was firstly coined and implemented at McMaster
University School of Medicine in Hamilton, Ontario, Canada around 1969 both as
a teaching strategy and as part of a new curricular design. It has impacted in
such a way that it has grown in an exponential fashion, expanding to almost all
continents until in 2013 it was welcomed in the Dominican Republic. It is
important to acknowledge that the School of Medicine of Universidad Dominicana
O&M (O&Med) was the pioneering Dominican academic institution in
fostering PBL and in formally including it as one of the pillars of its
integrated curricular platform. Problem-Based Learning (PBL) innovative
implementation and its outcomes provide to both students and the university sufficient
foundation to achieve the ultimate goal, which is inserting our graduates
within the community as outstanding professionals and leaders. Many articles have
been published on research made in the context of Problem-Based Learning, however,
several authors agree that there is still a lot of research and innovation
pending.
Those who understand that education is one of the pillars of people’s development
face a great challenge as far as curricular and academic innovation concerns,
yet creating an easier and more fruitful path through this teaching-learning
process.
Body
Problem-Based
Learning (PBL) is a relatively new teaching strategy that has revolutionized the teaching and learning processes in
multiple parts of the world, and in different fields of knowledge.
This teaching method was conceived and implemented at
McMaster University School of Medicine in Hamilton, Ontario, Canada around 1969
both as a teaching strategy and as part of a new curricular design. American
neurologist and medical educator, Dr. Howard S. Barrows (Oak Park, Illinois,
1928 - 2011) was the pioneer of this endeavor. Today, after forty six years of
its creation and put into practice, PBL has experienced modifications within
its fundamentals of conceptualization, practice guidelines, implementation, adaptation
improvements, subject to research studies, and extensive debate carried out by
numerous academic institutions, as well as the creation of indexed journals
that compile all this information serving as the main mechanism of knowledge
release. Furthermore, its impact has been such that it has grown at an
exponential level, expanding across all continents until, in 2013, it landed in
the Dominican Republic. It was the School of Medicine of Universidad Dominicana
O&M (O&Med) the first academic institution to incorporate Problem-Based
Learning (PBL) in its curriculum and throughout the entire 6-year career
program.
The traditional
teaching methology, is the one in which the center of attention, for
knowledge delivery, is the teacher (Teacher-Centered
learning). The teacher comprises the active
part of the student-teacher binomial
following the traditional format, known and implemented for centuries, of
conveying knowledge to a student group or audience so they are able to learn. So, how do we accomplish this
task using the traditional teaching strategy? Taking notes, asking questions, reading
from different sources like textbooks or journals. In this fashion, one learns
about the taught subject to, ultimately, be assessed with exams, papers or
practical work that may, in turn, be passed or failed. This is why this traditional
methodology is called Teacher-Centered learning2. In contrast, students
are the passive component in the context
of the binomial relationship and, in spite that the vast majority of people have
been educated in this fashion, it is not necessarily the one that promotes the
development of some specific and key skills, aptitudes and competences in the
students that will eventually complement the acquired knowledge.
In Problem-Based Learning, the building of knowledge
relies in the fact that, to solve a
problem or case that is presented by the teacher, students must be guided
through the process of discussion, research and practical application of
knowledge to actually obtain the expected outcome; solve the problem. All this
occurs integrating the load of information of almost all courses taken alongside
during an academic term and applying newly-acquired knowledge to the “case”. In
general, Problem-Based Learning claims that solutions are obtained on the basis
of collaborative work among students, working in groups with the support and
guidance of the facilitator.
PBL argues that problem-solving through real cases’
discussions requires being knowledgeable in a field; however, blending this
information does not take place nor remains as a merely act of rote, but rather
as part of a critical-thinking process and practical application of learned
material. Teachers exposed to this methodology shares knowledge, provide
guidance, follows the case’s learning objectives and afterwards assesses
students with a classical exam, but also establishes the unsolved problem so learners are prompted to apply information to
different contexts – and approach it from different perspectives – through
deliberation, reflection and deep analysis, developing and strengthening clear
and organized reasoning and creativity, among other skills.
PBL focuses in learning, research and reflection by
students related to a topic, where the teachers perform as facilitators and
guides toward problem-solving but not as an absolute authority that only
conveys information on the subject matter. The facilitators’ role is not
limited to the sole transmission of information but to the orientation and
monitoring of students to guarantee the compliance of the case’s Learning
objectives, promoting the gain and development of transferable skills – defined
previously – that will couple with the conceptual baggage to achieve the final
product: a graduate or postgraduate with developed unparalleled cognitive and
learning skills and competences. This array of teaching-learning features
enables students and graduates to be positioned in selected strata of both academic
and professional excellence, and it stimulates them to be highly competitive
within the global markets context. Hence, graduates will be enabled and trained
with useful tools which, in turn, will enhance self-confidence and
competitiveness to pursue further academic training, employment or
entrepreneurship.
In problem-based learning students’ performance and
progress are evaluated based on two major measurable assessment aspects:
§
Quantitative,
and
§
Qualitative
Quantitative assessment
encompasses three measurable subsets: 1) active group participation during every session, 2) self-directed study or
independent work, and 3) preparation
and presentation of the solved case in a plenary
session. All these subcategories are graded as a percentage of a more
complex assessment process. Besides, students also sit for both a mid-term and a
final exam in every academic term. This evaluation process helps teachers
(facilitators) better assess the objective
aspects of the methodology. The complete evaluation process takes place once
the groups have already presented more than 2 cases, sometimes just one
depending on the length and complexity of the problems. Both exams are also
assigned a percentage of the total grade.
In contrast, the qualitative
evaluation focuses more on the level of acquisition and improvement of transferable skills and competences, which
I have already mentioned previously. They will be discussed in more detail
ahead. Before I proceed to break down these concepts I would like to define
upfront what transferable skills stand for. They are nothing but the capacities
and abilities, inherent to all human beings, that are firstly identified,
developed and later on shaped in such a way that the bearer may, eventually, practically
apply, transfer or extrapolate to any environment or field of knowledge which
they may find themselves. These skills are not just called “transferable” for
the sole fact that students copy them from others, but rather because of their
extrapolarity to similar or different areas beyond healthcare. These skills are
also applicable to non-professional environments, i.e. household activities,
family-related encounters, sports, politics, etc. and they can very effectively
contribute to one’s achievement of any goal.
To cite examples of these so-called transferable
skills that I mention, and that students develop through problem-based learning
(PBL), we find:
o
Critical
thinking
o
Time
management
o
Organizational
o
Decision
making
o
Problem
solving
o
Team work, both as team leaders and as team players
o
Leadership
o
Inter-
and intraprofessional comunication
o
Creativity
o
Self-confidence
o
Public
speaking
o
Analysis
and synthesis
o
Capacity of interdisciplinary integration of knowledge
Both types of evaluations are made throughout the
academic term and results are monitored accordingly. Afterwards, there is a
feedback time allocated for active discussion, between facilitators and
students, to share the reports on their outcomes in each subset of assessment. The
combination of all these evaluations and results are parameters which provide
us with a more objective, concurrent and quasi
predictable idea of our desired graduates’ profile’s and trajectory
forecasting.
In 1994, and again later in 1996, Howard S. Barrows
acknowledged that, in the medical field, the act of diagnosing a patient –
which is part of a physician’s duty – rested in a combination of processes of
hypothetical-deductive thinking and expert knowledge in different domains. To
teach specific contents of a discipline (i.e. anatomy, neurology, pharmacology,
psychology, etc.) as clearly separate subjects and applying the traditional teaching
technique contributed very little in providing the students with a “context”.
Problem-Based Learning (PBL) along with its positive
outcomes, as innovative and multifaceted as it is, provides to both students
and academic institutions the necessary capabilities that enable graduates to
blend within the community as professionals with high levels of integrity, in
order to play their roles as leaders, decision makers and opinion formers in
any given field. This also exerts its effects on other high-level institutions
or people contributing to enhance health promotion and disease prevention, or
timely interventions as appropriate. These characteristics grant professionals
the opportunity to impact at the individual, community, national and global
levels.
Many articles from all corners of the planet have been
published on research in the context of PBL, and many authors agree that there
is still a lot to investigate and to innovate. Among the existent relevant
research studies on PBL I shall mention those of Juri Valtanen (Finland, 2014) about
Question-asking patterns in PBL tutorials; the array of publications made by Hmelo-Silver
& Barrows et. al.; Catherine Coelho in Facilitating facilitators to
facilitate; Constance Bowe & Thomas Aretz on PBL during pre-clinical years
of medical school, and many more.
Most researchers coincide with the still-existing lack
of more investigations, particularly outlining the following specific areas of
PBL: 1) establishing a clear and objective guideline on the principles and
fundamentals of PBL, 2) set out conceptual improvements in the role of
facilitators, 3) long-term monitoring of question-asking patterns that arise
during tutorial sessions, 4) targeting quantitative and qualitative assessments
of questions and answers arising during PBL tutorials focusing on both
facilitators and students to establish a long-lasting point of balance, 5) promoting
the strategy that most of the questions come from students, encouraging debate
and discussion, and not from the facilitators. These are the more prevalent
concerns in the literature but the recommendations for further research are not
limited to them.
My personal position is that, in a matter of five to
ten years – hopefully less – when problem-based learning becomes a more
widespread, tested and defined both the educator’s and researchers’ communities
will report much better, more accurate and well-defined outcomes in general
terms, so there will be a greater understanding and acceptance of PBL in most
curricula. So much so that I insist in
believing there will not be one field of knowledge (medicine, law, engineering,
nursing, accounting, economy, IT technology, architecture, etc) that will not
have an experience applying problem-based learning as a useful methodology.
Those of you – like me – to whom education is a basic
pillar to people’s and society’s growth and development, face a great challenge
as to what curricular innovation and better learning outcomes concerns. I am
certain it is timely to ponder on where are we right now, where are we heading
to and whether we want to go there, to really focus on our
teaching and learning objectives in the twenty-first century. World expert’s work
shows that active learning – through
PBL – is key to achieve academic success, especially in times when open access to information is easily
reachable by all kinds of students from everywhere; making these whole
processes – of self-directed and active learning – an easier and more fruitful
one.
Kew Words
Problem-Based Learning – Medical Education – Active Learning –
Curricular Integration – Transferable Skills
Recursos
As the PBL Coordinator, and facilitator, in my medical school I acknowledge
the amount of information available, success stories, however, there is still
controversy as to what the outcomes will be upon PBL implementation in academic
settings. My proposal is that we, in Dominican Republic, continue research,
innovation and reporting our own statistics and outcomes within the context of
Problem-Based Learning, for the benefit of students, faculty and academic
institutions. Every academic field, profession or technical career should
benefit from utilizing Problem-Based Learning.
Author
Pedro Carpio
