PROBLEM-BASED LEARNING
What is problem-based learning (PBL)?
PBL is the learning that results from the process of working toward the understanding or resolution of a problem.
The problem is encountered first in the learning process and serves as a focus or stimulus for the application of problem-solving or reasoning skills, as well as for the search for or study of information or knowledge needed to understand the mechanisms responsible for the problem and how it might be resolved.
In this approach, the student takes on a patient problem (or a health delivery problem or a research problem) as a stimulus for learning in the areas, subjects, or disciplines that are appropriate for the students at the time.
Several educational objectives may be attained:
1. Structuring of knowledge for use in clinical context.
2. Acquisition of an integrated body of knowledge related to the problem.
3. Developing of an effective clinical reasoning process.
4. Development or application of problem-solving skills.
5. Developing of effective self-directed learning skills.
6. Increased motivation for learning.
Acquisition of knowledge -
Information, concepts, and skills learned by the student are put into memory in association with a problem. This allows easy recall.
Problem-solving skill -
He must get information, look for cues, analyze and synthesize data available, develop hypothesis, and apply strong deductive reasoning to the problem at hand.
What is the rationale behind PBL?
PBL stimulates the learning process that people utilize when they attempt to solve the problems they encounter in life.
The learning acquired in PBL is better remembered (because of relevance and direct contact), is recalled faster, and easily transferred to a future problem.
PROBLEM-BASED LEARNING
RATIONALE
A number of influences led to this educational concept:
The "founding fathers" recalled their own medical education experiences. In particular, they recalled usually being unable to remember the facts (by which they had passed exams) from the
first 2 years of medical school, for application to patients in the clinical years. They also remembered the difficulty of "integrating" knowledge from a range of disciplines in the management of a single clinical problem.
There was evidence from the general medical literature that retention is enhanced when facts are learned in a context which closely approximates real life - e.g. a clinical problem.
More recent research into how physicians think has clarified the nature of the clinical reasoning process. These insights include the central role of hypotheses which occur early in the clinical encounter and which strongly influence the sequence and range of clinical data obtained. This thinking process can be replicated in an educational setting which begins with the analysis of a clinical case.
SELF-DIRECTED LEARNING
RATIONALE
Several influences led to the adoption of this idea:
In general, it seems that health professionals have limited motivation and skills to continue their learning. This becomes more apparent as they get older.
Medical information becomes obsolete as new knowledge supercedes or contradicts the old. Within a decade of graduation, only a small proportion of the knowledge used by physicians was learned in medical schools.
Research in education suggests that there is enormous variation in which individuals learn, both in terms of content and "style". It is therefore important to allow for flexibility and individualization" of the learning arrangement.
A SUMMARY OF THE PROCESS OF PROBLEM-BASED LEARNING
1. The problem is encountered first in the learning sequence, before any preparation or study has occurred.
2. The problem situation is presented to the student in the same way it would present in reality.
3. The student works with the problem in a manner that permits his ability to reason and apply knowledge to be challenged and evaluated, appropriate to his level of learning.
4. Needed areas of learning are identified in the process of work with the problem and used as a guide to individualized study.
5. The skills and knowledge acquired by this study are applied back to the problem, to evaluate the effectiveness of learning and to reinforce learning.
6. The learning that has occurred in work with the problem and in individualized study is summarized and integrated into the student's existing knowledge and skills.
A SUMMARY OF THE PROCESS OF SELF-DIRECTED STUDY
1. During the problem encounter, all questions, insecurities, or holes in knowledge should be noted down as learning issues.
2. Whenever work with the problem has to stop due to lack of knowledge or understanding, the learning issues should be reviewed and a study plan devised, relative to the goals of the curriculum.
3. The study plan should be sensitive to the specific learning needs and background of the learner.
4. Learning resources can be books, monographs, journals, cadavers, specimens, models, faculty experts, field trips, and audiovisual units, as appropriate (those emphasized are available to physicians generally).
5. At an agreed time, the learning acquired should be brought back to the problem.
TRADITIONAL VERSUS PROBLEM-BASED LEARNING
PROBLEM-BASED LEARNING
(For the student)
In problem-based learning, given a health care problem, the following steps will be followed:
1. Clarification and definition of the problem.
2. Analysis of the problem.
3. Development of hypothesis (ses) / plausible explanations.
4. Identification and characterization of the knowledge needed.
5. Identification of what is already known.
6. Identification of appropriate learning resources.
7. Collection of new information / knowledge.
8. Synthesis of old and new information and understanding of it by application to the problem, i.e., how much of the problem can now be explained.
9. Repetition of all or some of the previous steps, as necessary.
10. Identification of what was not learnt.
11. Summary of what was learnt, and if possible,
12. Testing the understanding of the knowledge by its application to another problem.
BASIC SEQUENCE OF PROBLEM-BASED LEARNING
(For the Faculty)
1. Identification of the objectives of the session.
2. Interaction with the patient problem.
3. Identification of self-study questions raised by work with the problem.
4. Self-directed study.
5. Application of acquired information back to the problem.
6. Review and synthesis of what has been learned.
7. Evaluation.
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