Problem-based learning

Students sit round a table in a small room concentrating on a problem.

What is it?

Tutorial groups of eight to twelve students address realistic, ill-structured scenarios in complex, interdisciplinary domains, through a defined sequence of steps facilitated by a tutor. PBL is a curriculum approach – a repeating cycle embedded into a curriculum either at the level of a single module or integrated across an entire programme. It was founded in the 1960s by five Canadian medical doctors disgruntled with their own educational experiences. They hoped to improve students’ motivation by introducing patients and their problems from the beginning (Sevant-Miklos, 2019). PBL is now used in a wide range of subject areas in higher education, and is mainstreamed across the disciplines in some institutions – the University of Maastricht, for example. Approaches to PBL have evolved differently over time but share five core characteristics (Wijnia et al, 2019):

  • A realistic scenario or case to trigger the learning process.
  • Small-group collaborative learning.
  • Tutor facilitation.
  • Student-centred approaches (facilitators attend to group dynamics and promote self-direction).
  • Ample self-directed study time.

Why do it?

The originators of PBL were responding to curricula they regarded as over-theoretical, segregated from the realities of practice, and consequently demotivating and inefficient. They hoped that approaching basic concepts through authentic scenarios would stimulate students to apply and integrate what they were learning. The self-directed learning inherent to PBL promotes autonomy and motivation, while learning in a group expands the knowledge and perspectives available to each member and brings opportunities to articulate and challenge ideas.

Moreover, self-directed learning in groups supports generic qualities which are valued in wider society and the world of work, such as criticality, problem-solving, communication and interpersonal relations. Together these anticipated benefits are summarised by Wood (2003) as:

  • Generic skills and attitudes,
  • Teamwork,
  • Chairing a group,
  • Listening,
  • Recording,
  • Cooperation,
  • Respect for colleagues’ views,
  • Critical evaluation of literature,
  • Self-directed learning and use of resources,
  • Presentation skills.

Does the actuality measure up to these hopes? In their review of meta-analyses, meta-syntheses and large-scale reviews on the effectiveness of PBL compared to established curricula, Hoidn & Kärkkäinen (2014) considered three categories of student outcomes:

  • Knowledge acquisition and academic achievement: PBL breaks even in terms of short-term conceptual (declarative) knowledge acquisition measured in standardised tests, but PBL students appear to retain knowledge for longer and are better able to integrate and explain concepts.
  • Reasoning and knowledge application: PBL helps students apply knowledge in practice; PBL students outperform their counterparts on skills- or performance-based assessment.
  • Social and behavioural skills: PBL students show signs of more productive approaches to study, better interpersonal skills, frequently appear to be more motivated and confident, and are more satisfied.

Although the studies Hoidn & Kärkkäinen reviewed were primarily in a medical and allied health education setting, they note benefits in other subjects.

How to set it up

Whatever model they are using, PBL cycles always follow a formalised sequence of steps which together represent a strategy for explaining underlying mechanisms, processes or principles of phenomena described in a problem (Moust et al, 2005). The video below describes how the widely-used Maastricht Seven Jump model is enacted at Stenden University in the Netherlands, followed by a summary of its steps (Davis & Harden, 1999).

Example – the Maastricht Seven Jump model

First meeting of cycle:

1. Working in a group, students clarify the concepts in the problem scenario.
2. The group develops a shared definition of the problem.
3. The group brainstorms explanations.
4. The group analyses the problem to reach an tentative explanation.
5. The group formulates learning objectives to further investigate their explanation.

Self-directed study:

6. Students pursue the learning objectives independently.

Second meeting of cycle:

7. The group reconvenes to synthesise the knowledge they have acquired.

Other approaches include the Optima 7-Jump model for fully-online learning at Maastricht, the Malmö model for undergraduate dentists at Lund University, and the Eight Step Approach at the University of Manchester which emphasises clinical experience (Wijnia et al, 2019).

Forming groups and allocating roles

Groups tend to have between eight and twelve members. The time a group stays together varies (Wood, 2003); ideally the duration is sufficient to allow fruitful group dynamics to develop over time, and there is a process in place to respond to interpersonal difficulties or other issues with group dynamics.

Students have group roles and responsibilities which typically rotate to give every member experience of each role. Summarised graphically by Wood (2003), these are:

    • Scribe, who records the points made and helps the group organise their thoughts, as well as participating in the discussion.
    • Chair, who leads the group through the process, maintains focus and promotes good group relations and dynamics, and ensures everyone can participate.
    • Group Member, who participates in the discussion, asks open questions, researches all the objectives and shares their findings with the group.
    • In addition each group has a Tutor, a staff member who assists the Chair and Scribe in their roles, ensures the learning objectives are focused, achievable, comprehensive, and appropriate, checks understanding and assesses learning. Tutors are carefully inducted to their role (see below) which, unlike the others above, does not rotate.

Curriculum design and assessing PBL

Most contemporary PBL curricula are ‘hybrid’ i.e. not purely constructivist but incorporating more structured teaching such as lectures and practicals. Typically these taught, practical and PBL sessions occur within a curriculum organised around themes. They are timetabled to give students ample self-directed study time along with other learning opportunities related to the  current PBL scenario before the final meeting (Step 7).

To promote alignment of objectives, assessment and learning activities, assessment is designed at the same time as the PBL curriculum. Since PBL orients students to acquiring integrated knowledge in the context in which they are expected to use it, formal assessment focuses on students’ performance and practice (process) as well as factual recall (content); “the fact that students know something is no assurance that they know when or how to use that information” (Nendaz and Tekian, 1999). Outcome-oriented assessment approaches in medical education include simulations and modified essay questions to test the reasoning process, while process-oriented assessment approaches include mid-term peer assessment of group members’ contribution to the PBL process, combined with reflection. Albanese and Hinman (2019) review the different kinds of assessment used in PBL:

    • Purely formative assessment:
      • Peer feedback on contribution to the process.
      • Facilitator assessment of contribution to the process.
      • Portfolios.
      • Self-assessment.
      • Progress tests of knowledge – they note that while not in the spirit of PBLs, MCQs help students identify and remedy gaps in there knowledge if the marks and feedback are available immediately (as afforded in Moodle Quiz).
    • Summative assessment:
      • Grading – they note problems with grading and consequently identify pass/fail as most compatible with the PBL ethos and least likely to undermine group work, but note that this may not motivate students’ best efforts.
      • MCQ exams – often in case clusters with a few questions on each case.
      • Essays and modified essays (responses to a series of unseen prompts on a case).
      • Simulations (and for health professionals, OSCEs) – often based around standardised patients or clients, which can also serve to compensate for the vagaries of experience on practical placements.
      • Peer assessment of contribution to the process – they caution against conflicts of interest and undermining group work.
      • PBL tutor assessment of contribution to the process – they note that this is a formidable burden on tutors.

Formative assessment is inherent to PBL – for example, in the self-assessment students undertake during Steps 4 and 5 where they identify gaps in their knowledge, and in the peer feedback students give on each other’s ideas at each stage.

Each PBL cycle yields formative feedback for students from the PBL tutor – especially at the point when students formulate their learning objectives (Step 5), and the second meeting when they share their findings and reach a consensus on an explanation of the scenario (Step 6).

Authoring scenarios

The scenarios (sometimes known as problems, cases or triggers) are informed by the unit’s learning outcomes. Wijnia and colleagues (2019) identify two broad types of case:

    • Strategy problems – simulations of professional practice which require students to identify a course of action, and in doing so learn the kinds of procedural knowledge and reasoning processes experts use.
    • Explanation problems through which students learn declarative knowledge and construct mental models of a topic.

Dolmans and colleagues (1997) have identified seven principles for effective case design (adapted by Wood, 2003), which are relevant beyond their original medical education context:

    1. The contents of a case should adapt well to students’ prior knowledge.
    2. A case should contain several cues that stimulate students to seek explanations for the issues presented.
    3. A case should have intrinsic interest for students, or relevance to future practice.
    4. To encourage integration of knowledge, present relevant basic science (or foundational concepts) in the context of the case.
    5. A case should stimulate self-directed learning by encouraging students to generate learning issues and conduct literature searches.
    6. A case should enhance students’ interest and sustaining discussion about possible alternative explanations.
    7. The learning objectives students are expected to generate should be consistent with the learning objectives for the unit (or module or programme).

Scenario material can take different forms including data, newspaper articles, video and images.

The author of each scenario also prepares supporting material. Accompanying notes for PBL tutors contextualise the scenario within the curriculum and help those who are not subject experts anticipate and respond to students’ misunderstandings. The author may also prepare a select list of readings and other resources to guide the reading of inexperienced students.

Preparing tutors to facilitate the PBL sessions

PBL tutors may be subject specialists or they may be enthusiastic non-specialists who know the curriculum and have access to tutor notes. In turn they induct students to the process and facilitate each group. Tutors need the judgement to progressively foster students’ self-direction and self-regulation, and to promote fruitful group dynamics.

During their induction new tutors may be given a PBL scenario to work through in groups, affording them direct experience of Steps 1-5. In this way they familiarise themselves with the PBL process and sensitise themselves to what their students may experience. Another important element of induction is facilitating groups. In addressing some challenges PBL tutors can face, Samy Azer (2005) proposes twelve principles for PBL tutoring, some of which (in the spirit of PBL) have a corresponding scenario and accompanying commentary. Along the same lines, Diana Dolmans and colleagues (2005) set out some frequent problems and how to address them.

Considerations

PBL can be thought of as an ecosystem. It is highly dependent on the quality of the scenarios, adherence to the steps, tutor facilitation, and the preparedness of the students to learn together in this way. As research evidence has shed more light on the interactions between these and other factors, recommended approaches to PBL have become more formalised and less fluid compared with the experiments of the 1960s. Moust and colleagues (2005) caution against adapting a well-researched existing approach unless there is a clear educational rationale and the changes are carefully evaluated.

Facilitators may need to remind students to complete each step thoroughly before proceeding to the next. For example, during the brainstorming step it is important that students hold back from providing explanations which narrow down the problem.

Some common pitfalls in PBL and how to avoid them have been summarised (Dolmans et al, 2005) as:

  • Over-structured – closed or simple – scenarios which do not stimulate students’ learning. This can be addressed through designing complex, realistic, open-ended and ill-structured problems, and introducing students to contrasting but related problems which prompt them to transfer their knowledge to new contexts.
  • Dominant or passive tutoring which does not foster self-directed learning. This can be addressed through inducting tutors carefully to the process of supporting students’ transition from tutor regulation to self-regulation.
  • Poor group dynamics. This can be addressed through well-designed scenarios, effective PBL tutoring, and aligning the different elements of the curriculum and assessment to focus students’ efforts.

Examples and resources

References

  • Albanese, M. A., & Hinman, G. L. (2019). Types and Design of Assessment in PBL. In M. Moallem, W. Hung, & N. Dabbagh (Eds.), The Wiley Handbook of Problem‐Based Learning (1st ed., pp. 389–409). https://doi.org/10.1002/9781119173243.ch17
  • Azer, S. A. (2005). Challenges facing PBL tutors: 12 tips for successful group facilitation. Medical Teacher, 27(8), 676–681. https://doi.org/10.1080/01421590500313001
  • Davis, M. H., & Harden, R. M. (1999). AMEE Medical Education Guide No. 15: Problem-based learning: a practical guide. Medical Teacher, 21(2), 130–140. https://doi.org/10.1080/01421599979743 
  • Dolmans, D. H. J. M., De Grave, W., Wolfhagen, I. H. A. P., & van der Vleuten, C. P. M. (2005). Problem-based learning: Future challenges for educational practice and research. Medical Education, 39(7), 732–741. https://doi.org/10.1111/j.1365-2929.2005.02205.x
  • Dolmans, D. H. J. M., Snellen-Balendong, H., & van der Vleuten, C. P. M. (1997). Seven principles of effective case design for a problem-based curriculum. Medical Teacher, 19(3), 185–189. https://doi.org/10.3109/01421599709019379
  • Hoidn, S., & Kärkkäinen, K. (2014). Promoting skills for innovation in higher education: A literature review on the effectiveness of problem-based learning and of teaching behaviours. Retrieved from Organisation for Economic Cooperation and Development website: https://search.proquest.com/docview/1495410394/fulltext/F55FC485F3224956PQ .
  • Moust, J. H. C., Berkel, H. J. M. Van., & Schmidt, H. G. (2005). Signs of Erosion: Reflections on Three Decades of Problem-based Learning at Maastricht University. Higher Education, 50(4), 665–683. https://doi.org/10.1007/s10734-004-6371-z
  • Nendaz, M. R., & Tekian, A. (1999). Assessment in Problem-Based Learning Medical Schools: A Literature Review. Teaching and Learning in Medicine, 11(4), 232–243. https://doi.org/10.1207/S15328015TLM110408
  • Servant-Miklos, V. F. C. (2019). Fifty Years on: A Retrospective on the World’s First Problem-based Learning Programme at McMaster University Medical School. Health Professions Education, 5(1), 3–12. https://doi.org/10.1016/j.hpe.2018.04.002
  • Wijnia, L., Loyens, S. M. M., & Rikers, R. M. J. P. (2019). The Problem‐Based Learning Process: An Overview of Different Models. In M. Moallem, W. Hung, & N. Dabbagh (Eds.), The Wiley Handbook of Problem‐Based Learning (1st ed., pp. 273–295). https://doi.org/10.1002/9781119173243.ch12
  • Wood, D. F. (2003). ABC of learning and teaching in medicine: Problem based learning. BMJ, 326(7384), 328–330. https://doi.org/10.1136/bmj.326.7384.328

Image source: Education session group discussion 07. https://commons.wikimedia.org/wiki/File:Education_Session_group_discussion_07.jpg

 

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