Problem-based learning: description, advantages, disadvantages, scenarios and facilitation.SUMMARY
Problem-based learning arose out of educational initiatives in the 1960s and is often one of the most contentious issues within medical education. McMaster University McMaster University, at Hamilton, Ont., Canada; nondenominational; founded 1887. It has faculties of humanities, science, social sciences, business, engineering, and health sciences, as well as a school of graduate studies and a divinity college. in Canada was the first to implement problem-based learning on a large scale within medicine and this was soon followed by universities in Europe and Australia. In modern times, few western medical schools do not include at least some aspect of problem-based learning within their instructional itinerary, and many build their entire curriculum and instructional procedures around problem-based learning. This article provides an overview of problem-based learning within medical education, pertinent background, describes the characteristics of problem-based learning, its advantages and disadvantages, problem-based learning scenarios and facilitation Facilitation
The process of providing a market for a security. Normally, this refers to bids and offers made for large blocks of securities, such as those traded by institutions. .
Key Words: problem-based learning, facilitation, scenarios, medical education
Problem-based learning (PBL PBL Problem-Based Learning
PBL Phi Beta Lambda
PBL Performance Based Logistics
PBL Planetary Boundary Layer
PBL Publishing and Broadcasting Limited (Australia)
PBL Philippine Basketball League
PBL Peripheral Blood Leukocyte ) arose out of educational initiatives in the 1960s that were primarily based on theoretical advances in behavioural psychology. Several researchers (1-3) successfully argued that learners who commenced learning by focusing on problems before attempting to understand underlying principles had equal or greater success than learners using a traditional approach whereby underlying principles are presented first and then applied to a specific problem.
PBL was initially developed and applied in a medical education context at McMaster University in Canada by Howard Barrows (4-6). Shortly thereafter, problem-based learning curricula were established in both Europe and Australia at Maastricht University and the University of newcastle University of Newcastle can refer to:
anesthesia. and intensive care may have their own questions about PBL, what it is, its advantages and disadvantages, choosing PBL scenarios and the facilitation of PBL. This article seeks to provide an overall summary of these questions for those involved in the education of anaesthetists and intensive care specialists.
Much misunderstanding and confusion exists about PBL, largely because it is a broad term used to convey numerous concepts with different meanings. PBL has been defined as "active learning stimulated by, and focused round a clinical, community or scientific problem" (8). The key notion is that learning commences as a problem, query or question that the learner seeks to solve (9). PBL goes beyond merely providing an opportunity to problem solve to make problem solving problem solving
Process involved in finding a solution to a problem. Many animals routinely solve problems of locomotion, food finding, and shelter through trial and error. the main reason for learning. In this regard, learners specifically identify and seek out the knowledge they themselves require to solve the problem (8). Herein lies the power of PBL because the learner is required to solve a specific problem whilst acquiring knowledge on how to solve similar problems. It is argued that it is this latter knowledge which becomes of greatest benefit in professional life as a practising anaesthetist or intensive care specialist. of the numerous definitions of PBL, most have four common elements:
1. learning objectives are translated into a problem,
2. successful solutions require an explanation, with a possible diagnosis and treatment options,
3. learners use small group discussions to analyse and understand the problem and potential solutions,
4. questions or issues that are not answered within small group discussion form the basis for further learning outside the group.
In 1987 international experts in the area of PBL from within and outside medical education gathered at a symposium at the Centre for Medical Education, the University of Dundee As the above opinion represents, there was a significant movement with the intention of decanting the entire university to Dundee, which the Royal Commission observed was now a "large and increasing town" - or indeed the establishment of a college along very similar lines to the present . one of the results of the symposium was an acronym acronym: see abbreviation.
A word typically made up of the first letters of two or more words; for example, BASIC stands for "Beginners All purpose Symbolic Instruction Code. identifying eight key features of PBL (10). The acronym was appropriately spelt spelt
Subspecies (Triticum aestivum spelta) of wheat that has lax spikes and spikelets containing two light-red kernels. Triticum dicoccon was cultivated by the ancient Babylonians and the ancient Swiss lake dwellers; it is now grown for livestock forage and used in baked "PROBLEMS".
The key units for studying relevant learning are problems.
Provision of adequate resources (e.g, instruction, peers, library, internet and other members of the health care team) allows self-learning to take place.
Learning objectives are planned by teachers but may have trainee input.
As a trainee's knowledge increases so their behaviour progressively evolves to become more like an expert.
Learning is active, trainee-directed and sometimes monitored by peers and facilitators.
Peers and facilitators facilitate use of higher order cognitive skills through the use of examples.
The PBL approach should be designed to stimulate interest in a topic and motivate learning.
Self-directed learning and self assessment:
Trainees are equipped with the tools to undertake self-directed learning and self-assessment once they graduate formal education to become lifelong learners. This is thought to be a potentially useful skill for anaesthesia and intensive care specialists whose clinical practice often occurs in isolation from their peers.
ADVANTAGES OF PBL
The popularity of PBL and its rapid widespread adoption by the medical community has arisen from several powerful advantages. These include (8):
1. Making curriculum content relevant by building learning around clinical, community or scientific problems.
2. Focusing learning on core information relevant to real scenarios and reducing information overload A symptom of the high-tech age, which is too much information for one human being to absorb in an expanding world of people and technology. It comes from all sources including TV, newspapers, magazines as well as wanted and unwanted regular mail, e-mail and faxes. .
3. Fostering the development of valuable transferable skills useful throughout lifelong learning Lifelong learning is the concept that "It's never too soon or too late for learning", a philosophy that has taken root in a whole host of different organisations. Lifelong learning is attitudinal; that one can and should be open to new ideas, decisions, skills or behaviors. . These include leadership, teamwork and communication as well as problem solving.
4. Facilitating trainees becoming responsible for their own learning. This is an essential skill for medical specialists actively engaged in their own continuing professional development CPD is the means by which members of professional associations maintain, improve and broaden their knowledge and skills and develop the personal qualities required in their professional lives. throughout their professional lives.
5. Increased motivation of trainees to learn by focusing the learning on 'real-life' scenarios.
6. Encouraging a deep rather than surface approach to learning by forcing trainees to interact with information on multiple levels and to a greater depth than traditional teaching approaches.
7. Using a constructional approach to learning whereby trainees construct new learning around their existing understanding. numerous researchers argue for the benefits of PBL (11-13).
DISADVANTAGES OF PBL
Unfortunately no single education strategy is perfect for all educational situations and PBL has several significant disadvantages. These include (8):
1. The replacement of the traditional teacher role by the facilitator
which may make it difficult for trainees to emulate good teachers as role models.
2. Teaching faculty being required to facilitate learning rather than to directly impart their knowledge. This may be considered inefficient and, possibly, demotivating to faculty.
3. Knowledge acquired through PBL being less organized than knowledge acquired through traditional learning.
4. The difficulty of training facilitators and the scarcity of teaching faculty with the skills of facilitating rather than the skills of traditional teaching.
5. The time required of trainees to fully engage in PBL. This can be particularly problematic for time-poor faculty and trainees who are being asked to teach and learn within an increasingly crowded curriculum.
Additional disadvantages include the significant costs, resources and time required to train effective facilitators. PBL experts also point to concerns about the costs of implementing PBL programs, though note that other researchers argue that PBL is not necessarily more expensive than traditional educational approaches (14,15) and raise the issue of PBL not necessarily covering all areas within a medical topic (8).
The notable advantages and disadvantages described above make PBL a potentially useful strategy for the training of anaesthesia and intensive care specialists, but one which is unsuited unsuited
1. not appropriate for a particular task or situation: a likeable man unsuited to a military career
2. to all situations or for the teaching of all relevant knowledge, skills and abilities. Additional comprehensive reviews of the research evidence for and against PBL have been published (16-18).
CHOOSING PBL SCENARIOS
Within medical education a scenario is typically used to provide an example from which a trainee may learn. Such a scenario may be related to a clinical, scientific or community problem (19). Part of the rationale for this approach arose from a contrast of the medical reasoning skills of novices and experts. Research has shown that experts compare a novel scenario to real scenarios with which they are familiar (20). Much of an expert's diagnostic and reasoning efforts are focused on the similarities and differences of a novel case with known cases. Thus PBL offers the opportunity to provide trainees with scenarios that will be of use throughout their professional life. In this regard the choice of PBL scenario is pivotal for the ultimate effectiveness of the PBL experience.
Carefully structured problems ensure trainees cover appropriate knowledge, skills and abilities. In this regard the scenario has been described as either a 'peg' or 'growing web' (21). The peg is viewed as a convenient hook upon which to arrange acquired knowledge whereas the growing web uses the problem as a focus for acquired practical understanding. The most effective problem scenarios exhibit several characteristics (22). The problem should:
1. Address one or more learning outcomes relevant to the trainee.
2. Facilitate trainees activating their prior learning and building upon existing knowledge.
3. Be consistent with the stage of learning at which a trainee is located at any given time.
4. Motivate trainees and, ideally, be relevant to the current or future practice of trainees as anaesthetists or intensive care specialists.
5. Provide an overall clinical context in which new knowledge is placed.
6. Stimulate trainee thought and discussion, provide guidance and encourage trainees to actively seek solutions.
7. Phrase an open-ended problem to facilitate discussion and explanation (i.e., closed problems with limited scope should be avoided).
8. Promote trainees to become actively involved in the pursuit of solutions using available resources including peers, instructors, members of the medical team, literature and the Internet.
Wherever possible, PBL scenarios should be based on real patients, or composites of real patients, in order to ensure trainees appreciate that they may encounter the same or similar problems in practice. Furthermore, the use of actual patients allows the designers of PBL scenarios to incorporate deidentified laboratory results, X-rays, scans and pathological materials (7). When choosing a scenario, designers should consider what topic area experts believe should be taught and the prevalence, severity, magnitude, treatability and intervention effectiveness (7,23).
Beyond the PBL scenario the single greatest factor that influences the success of a PBL program is the facilitatory skill, knowledge and ability of the teacher. Such is the importance of facilitation that, within PBL, the teacher is usually referred to as the 'facilitator'. The facilitator monitors and stimulates the PBL process by posing leading questions, challenging trainee thinking, and raising facts or issues relevant to the problem. In this regard, the facilitator is a guide who assists trainees develop the necessary skills in reasoning, hypothesis design and testing, study and self-evaluation (4). Facilitator competence must include (8) the facilitation of small group learning; a comprehensive understanding of the PBL program such that the facilitator can relate immediate and future learning opportunities to the PBL scenario and guide trainees to these opportunities; and a global understanding of the overall educational curriculum so that the facilitator can place discrete problems within the global educational experiences of the trainee. The abilities of facilitators to establish effective two-way communication Two-way communication is a form of transmission in which both parties involved transmit information. Common forms of two-way communication are:
There is considerable debate about the importance of the facilitator being a content area expert. Some argue that a content area expert is more likely to give trainees answers or revert to a traditional teaching approach. Conversely a facilitator who is not a content area expert must rely solely on his or her facilitatory ability and is forced to behave in a way that sees trainees develop their own solutions. However, whereas the extent to which a facilitator is required to be a content expert is a matter of some debate within the literature, all PBL specialists agree that adequate training in the role of facilitator is essential for the success of a problem-based learning program. on balance, the best facilitator is probably a content area expert, who is fully familiar with the medical curriculum being taught, and has been appropriately trained in facilitation. Such a facilitator would be ideally placed to be able to limit the extent to which they provide solutions for trainees, in keeping with the underlying principle of PBL, yet able to provide the minimal level of clinical structure necessary for trainees to obtain optimal benefit from PBL (25,26). Certainly (and as mentioned above) few faculty are trained in the role of PBL facilitation and many are most comfortable with the more traditional role of information provider typified in traditional clinical teaching and lectures (8). However, adequate training in facilitation is essential for the success of PBL (7) and several successful approaches to faculty development have been documented specifically for PBL (27,28).
Accepted for publication on May 15, 2006.
(1.) Foord M. inductive inductive
1. eliciting a reaction within an organism.
a form of radiofrequency hyperthermia that selectively heats muscle, blood and proteinaceous tissue, sparing fat and air-containing tissues. versus deductive de·duc·tive
1. Of or based on deduction.
2. Involving or using deduction in reasoning.
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v. hard·ened, hard·en·ing, hard·ens
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R. W. JONES *
Australian and New Zealand New Zealand (zē`lənd), island country (2005 est. pop. 4,035,000), 104,454 sq mi (270,534 sq km), in the S Pacific Ocean, over 1,000 mi (1,600 km) SE of Australia. The capital is Wellington; the largest city and leading port is Auckland. College of Anaesthetists, Melbourne, Victoria, Australia
* B.Sc., Dip.Ed., B.Ed (Hons)., Ph.D., Director of Education.
Address for reprints: Dr R. W. Jones, Australian and new Zealand College of Anaesthetists, ANZCA ANZCA Australian and New Zealand College of Anaesthetists House, 630 St Kilda Road, Melbourne St Kilda Road is a street in Melbourne, Victoria, Australia. , Vic. 3004.