Problem-based learning

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Medical students present a case, lead peers in debate, and a tutor facilitates
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Last Update

  • Updated.jpg 15 March 2015

Introduction

See also Case-Based Reasoning | Cognitivism | Constructivism | Instructional design models | Medical education in Canada 800px-Flag of Canada.svg.png | | Teaching library users

Problem-based learning (or PBL as medical students call it) is a student-centered pedagogical theory of classroom learning where small groups of students study (and discuss) complex problems, and work together to formulate suitable solutions to cases. By working with others in groups, medical students can identify what they know, what they need to know and where to find "best evidence" to understand pertinent issues. It is a widely-used teaching-learning method in medical education and increasingly in other areas of health education also. Its main tenets are to help learners develop problem-solving skills, improve self-directed learning and build peer-to-peer collaboration skills.

The instructor or tutor's role in PBL is to facilitate and mentor students during the learning process. He or she provides intellectual and emotional support while modelling best medical practices. Sometimes the practices can be as disparate as understanding basic science concepts, how they apply to clinical work, and bioethics and professionalism. Acting as role models and mentors, tutors are charged with building confidence in students and encouraging them to find their own solutions to clinical problems.

The PBL model began at McMaster University in Hamilton, Ontario in the late 1960s. The curriculum was developed to stimulate learners, assist them to work with peers and sustain high intrinsic motivation (Barrows, 1996). In the last few decades, the PBL model has been adopted by medical school programs around the world, and subsequently adapted for a number of undergraduate programs (Boud and Feletti, 1997; Duch, 2001; Amador, 2006) and college programs (Barrows, 1996). The use of PBL has expanded outside medicine to law, education, economics, business and engineering (Barrows 1996). Like other student-centered pedagogies, PBL acknowledges the limitations of traditional didactic teaching, and the value of constructivist interactive approaches to learning.

Clinically-based learning

Problem-based learning (PBL) is an educational format that is centred around biomedical research questions as they might arise in the clinic or as medical students might engage with patients. Its simulation of the cognitive, emotional and psychological factors that arise in decision-making in the clinic is a very powerful learning tool, and prepares medical students for their actual work on the wards with patients. It helps that PBL provides students with a lot of practice (what might be called cognitive apprenticeship) in finding answers, defining gaps in their knowledge and arriving at suitable solutions for the clinical problem at hand. It is a widely-held view that PBL encourages deeper understanding of medicine than either listening to lectures or engaging in rote memorization would ever afford. The McMaster model of PBL has been incorporated into curricula in medical schools around the world. Many schools in the United States and Canada use it, or a variation of it. The evidence clearly shows that PBL is just as effective as conventional didactic learning. Small PBL groups encourage inquisitive and detailed examination of clinical issues, concepts and principles around patient-oriented problems. Further, the time spent outside of groups in PBL facilitates the development of skills such as information and literature retrieval, critical appraisal of medical information and the exchange of opinions with peers and experienced clinicians. PBL encourages students to become more involved in their own learning; the research says that students and faculty feel that PBL is a highly enjoyable way to learn and teach.

PBL is student-centred

Pbl.gif

PBL actively engages the student in building their own understanding of complex issues, which places it in the tradition of constructivism. The use of PBL techniques means that how a problem is approached will likely result in a variety of viable solutions; its premise is that some complex problems will in fact have more than one solution. In any case, the types of complex problems that patients are likely to present to physicians are the focus. In selecting appropriate cases, however, the medical tutor must select clinical problems that are authentic and meet medical students' levels of prior knowledge. Cases in medicine should engage all learners in discussion and are, at their core, a more creative way to approach the vagaries and uncertainties of human health and clinical medicine.

The main characteristics of PBL are that:

  • it is student-centred and begins with a case or problem
  • interrogation of ideas results in knowledge; learning occurs in small groups
  • tutors act as facilitators and guides to help learners
  • clinical problems are the basis of and stimulus for the learning process
  • problems stimulate development and use of problem-solving skills
  • new knowledge is obtained through self-directed questioning and information-seeking
  • finally, a reasonable course of action is developed in order to "solve" the problem(s)

Medical library support of PBL

  1. Librarian assistance in the physical library (ie. reference services in person and online)
  2. Assistance locating the Top Information Sources in Biomedicine, 2012
  3. Leading medical students through the steps of PICO and evidence-based health care
  4. Instruction and consultations; teaching library users at the reference desk or by appointment
  5. Course-integrated instruction, information literacy and online tutorials
  6. Liaison - face-to-face & digital with faculty and students; group facilitation
  7. Information management, citation management and efficient, ethical use of mobiles & social media

Within PBL groups, various tests, treatments, and alternatives may be under consideration by the medical student, including what outcomes might be measured. The acronym PICO - Patient, Intervention, Comparison and Outcome is often used to remember these steps, and questions, and to provide forward impetus to learning. Most medical librarians use the PICO framework to teach aspects of information retrieval to medical students.

Reference services on the go

Health and medical librarians are charged with providing a range of information and reference services to medical students and faculty via face-to-face interactions and via digital services. Increasingly, virtual reference services are being provided to support students in PBL programs by having the librarian communicate via remote chat and instant messaging technologies. Other on-demand reference services are being investigated all the time, and may focus on providing information to individual students as well as groups via mobile devices. Typical questions in this setting include how to find specific print and digital resources, using biomedical databases effectively and accessing a range of electronic and digital collections, images and streaming video. The instructional services provided to medical students can range from one-on-one to consultation where medical students are trying to meet their own learning needs. Occasionally, appointments are made with subject librarians to work on research projects such as systematic reviews.

Print / digital collections

Academic libraries provide print and electronic access to collections. However, the trend favours electronic access (i.e., EBooks and eReaders) over print. Most PBL librarians collaborate with collections librarians in building their undergraduate medical collections; other specialized librarians are available to support the acquisition of medical texts, electronic journals and biomedical databases. As a related, complementary activity, librarians working within medical schools are engaged in teaching medical students about searching for information in medical databases such as PubMed and Medline. More recently, health librarians are using the iPhone and iPad to provide instructional support to medical students.

PBL instruction & medical librarians

The computer lab is an efficient and effective method for teaching library and information skills to PBL students. However, medical librarians have increasingly extended their teaching into online spaces (i.e., social media), instant messaging and via research consultations and one-to-one teaching. Health librarians are also embedded as informationists and clinical librarians in medical programs (see embedded librarianship). The "curriculum-integrated" mode of teaching is desirable as it encourages librarians to design classes based on student need. Information literacy is an effective modality to engage faculty in collaboration over a longitudinal program. Some PBL programs in medical schools actively integrate librarians into team-teaching alongside medical faculty. Still others make use of web-based tutorials and integrating librarians occasionally into PBL cases and medical informatics projects. Online tutorials can be tailored to new courses (i.e. accessible anywhere, anytime). Follow-up hands–on teaching can be offered and scheduled to reinforce the learning objectives in medical informatics. New PBL programs in medicine offer unique opportunities for health librarians to collaborate closely with faculty. Medical librarians can support PBL programs by participating on committees as the librarian can listen closely to the needs of learners, and find ways to meet them.

For more information, see teaching library users.

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