You may have heard the term Problem Based Learning (PBL) before but not know what it refers to. The student guidelines at Bond University's Medical Program give a detailed explanation and here is the brief version which will help you understand exactly what PBL refers to.
Background of PBL
Over the last 4 decades, there has been substantial research into areas of cognitive and social psychology which has contributed to the understanding of how learning takes place. The change in focus in medical education has thus moved from the traditional didactic, teacher-centred approach to a flipped learning approach where the student needs to take responsibility and ownership, often in collaboration with other learners.
In such a learner-centred approach, the educator moves from a position as the source of information to that of a facilitator/over-looker, guiding students to develop skills that allow for critical thinking and independent research. Learning thus becomes an active process on the part of the student, often as a team or group member.
PBL actually began at McMaster University, Canada, in the 1960s and revolutionized the study of medicine. Instead of learning vast amounts of information from one source (usually textbook) and then applying it to a clinical problem, PBL is the opposite; it starts with a problem (which is what happens in life and in clinical practice) and medical students need to explain the underlying causes of the clinical presentation in order to “solve” or diagnose the problem (i.e. working backwards).
Learning in the context of future professional practice has been a motivating factor for many students. So, in a PBL approach, from the outset of their studies, medical students learn the relevant cell and molecular biology, the structure and function of the body and the psychosocial determinants of health and disease in the context of real patients.
The aim is to mirror what happens when we graduate medical school as newly appointed doctors and enter the real world of medicine.
Example Case in PBL
This case and reasoning was taken out of the Guidelines and reflects the process of PBL. More details in the next post about what PBL in different Medical School years entails!
A patient visits the doctor complaining of “chest pain”. The doctor has to work out what is causing the chest pain. Learning all the symptoms of myocardial infarction (MI) from a textbook might help to recognise that a patient may have an MI, but this is not how a doctor problem-solves in real life.The doctor needs to consider all possibilities as the patient’s chest pain may not be due to a cardiovascular problem. Could it be caused by an infection in the respiratory system? Could it have a musculoskeletal aetiology? Perhaps it is a problem with the gastro-intestinal system? PBL trains learners to think like doctors from the outset: to brainstorm and hypothesize about all possible causes and the underlying mechanisms and by collecting appropriate information, students can validate or refute the hypotheses. In clinical practice, these hypotheses become the working diagnoses or the differential diagnosis.
Outcomes of a Problem Based Learning Approach
Authentic’ PBL is generally characterised by:
- Ill-structured patient ‘problems’ that mirror what students might encounter or be faced with in real life in medicine
- A particular process (underpinned by theories and evidence, e.g. 8-step process)
- A group of learners who work within specific rotating roles, and
- A Facilitator who operates at a metacognitive level and who helps students to think about how they learn rather than providing content
The outcomes of PBL are:
- The acquisition of an extensive, integrated knowledge base that is readily recalled and applied to the analysis and care of clinical problems. This is achieved through the development of hypothetic deductive reasoning.
- The development of
- Efficient problem-solving, critical thinking and, eventually, clinical reasoning skills
- Self-study skills, including generic skills such as information-handling and communication
- Team work
- Clinical skills, and
- Ethical and professional behaviour expected of medical professionals
Summary
So during the PBL process, the student identifies what they need to learn to explain the “phenomena” or key features presented in the case. Their reasoning should be backed by the content taught through lectures, laboratories, workshops and tutorials. Collectively, through collaboration during PBL tutorials and the self-study between PBL sessions, students acquire the knowledge and develop the skills that they will use later during the clinical phase of the program and as medical professionals in the future.
Check out the next post to see what Year 1 of Medical School PBL contains!
