Title: Problem-based Learning in Healthcare
Author Name: Keagan Moss
Selected Case (Published Article):
Gwee, M. C. (2009). Problem‐Based learning: A strategic learning system design for the education of healthcare professionals in the 21st century. The Kaohsiung Journal of Medical Sciences, 25(5), 231–239. https://doi.org/10.1016/s1607-551x(09)70067-1
1. Introduction
McMaster University medical school first began using problem-based learning (PBL) in 1969 as a brand-new tool to assist in medical education. PBL is described as a student-centered system used in instructional practices. PBL in 1969 was daunting and wasn’t often used as an instructional practice over others that were widely used. This was noticed as a “radical, innovative, and alternative pathway to learning in medical education” (Gwee, 2009.) Problem-based learning is learner-centered and is no longer in the typical teacher-centered educational platform. This requires trainings on the front hand of the roll out of a PBL, from teachers and students. When implementing a PBL, after training, it requires careful planning to ensure the problem is matching the content wanting to be taught. PBL also uses real-life problems, and the problems are place in a small group where the peers are responsible for teaching themselves using the group they are in. Problem based learning is meant to be collaborative while using the context in which the problem will be solved, and the students will be able to reflect on their learning after the problem has been solved. PBL in the medical education field required a shift in the teachers and students thinking. The teachers and students had to step away from the idea that there will be a teacher lecturing in the front of class but instead think of group skills and working with peers to achieve a common goal while teaching one another. Problem-based learning requires the correct resources as the teacher is typically a guide rather than informative, so the students need to have the materials to research assistance to problems as a group.
2. Overview of the Case
McMaster University medical school noticed students were having difficulties retaining information, information overload, development of poor learning skills such as memorization, codependency on teachers for knowledge and the outcomes not having a strong focus on student behavior. A solution was needed to the very strong teacher-led classroom which at the time, had very little focus on the students and their outcomes. “Predominately lecture-based and subject-centered courses in higher education were criticized for their lack of relevance to the future practitioner. Concerns were expressed about limited use of teamwork, the poor development of inquiry skills and the gap between theory and practice.” (Frost, 1996.) The classrooms primarily had teachers teaching/lecturing without the students working through problems on their own or using any real-life situations. Since noticing lacking student retention, the university decided to implement a curriculum that was innovative and something that hasn’t been done before. “Indeed, in 1969, McMaster University Medical School implemented its new medical curriculum, which set a new, radical and innovative trend, and offered an alternative pathway for learning in medical education.” (Gwee, 2009.)
When discussing PBL, there are many pieces going into the new innovative tool in the university’s medical school. A tutor is especially important when implementing it, which can be referred to as the teacher. Since the teacher is not technically “teaching” they are referred to as a tutor. A tutor’s role in the classroom is vital, they need to be committed to the PBL and in charge of making sure the students are excited about the project. “In fact, the tutor usually creates a “mirror effect”, because the enthusiasm of students in tutorials often reflects the enthusiasm of the tutor in his/her role as the facilitator of the learning process.” (Gwee, 2009.)
The case goes on to explain other features that are heavy in the planning and consideration of the PBL implemented at McMaster University, these include, curriculum options (is this right for most of the students, or is another method better suited), sustainment, culture of students participating in PBL, and how assessment will look within the designed PBL. The benefits of a PBL are great in comparison to the teacher-directed classroom where information is overloaded, instead it teaches many skills to young medical students. “PBL incorporates the principles of adult learning, with the main objectives to achieve, for a truly problem-based approach, structuring of knowledge for better recall and application in clinical contexts, developing effective clinical reasoning and self-directed learning skills, and increased motivation for learning.” (Tsou, Cho, Lin, Sy, Yang, Chou, Chiang, 2009.)
3. Solutions Implemented
After research, this program that they implemented to correct the problems in the classroom turned out to be problem-based learning (PBL) which still to this day proves to be “the most significant innovation in education for the professions for many years.” (Gwee, 2009.)
The PBL implementation consisted of using two sessions that each consisted of two hours each. The first session is based on the students that are in a group, looking at a case-problem and developing a hypothesis. The students will then identify facts within the case and assign roles. Once roles are assigned and the group is clear on the task at hand, the session will end. Once session has concluded, students will have about four or five more days before having the second session. The break in between session is defined as a self-study period, “The self-study period creates opportunities for students to undertake self-directed learning” (Gwee, 2009.) The second session is meant for students to analyze their case, share the new evidence discovered during their four-to-five-day study time and reanalyze with their total findings. After reanalyzing, students should be able to solve the case.
When students finish each session, the group takes about 10-15 minutes to give one another feedback. The feedback is important in a PBL because self-reflection is a crucial part of a learner’s development. “self-awareness (metacognition) is an important attribute of critical thinkers. “(Gwee. 2009.) The feedback mainly discusses points that increased their achievements and things that they noticed hindered their progress and aren’t a good plan for the next PBL. The feedback portion of the PBL involves the tutors (facilitators or teachers) and the small groups. The tutors are helpful in guiding students but not teaching a lesson, only answering questions.
4. Outcomes
The outcomes projected in the article are varying, depending on the facilitator/tutor and their engagement with the content. The outcomes expected would be the students are learning real life skills to take to the medical field after the schooling. Prior to implementing the PBL, the author described certain items that were a result of a teacher-directed classroom. Based on the article, the outcomes would be students learning through interaction with peers and having to create their own knowledge based on research. “…students learn through social interaction in which they are required to co-construct their own meaning and understanding of knowledge that needs to be learned…” (Gwee, 2009.) Other outcomes I found would be improving cognitive processes within the participants of the small group. “Peer teaching and learning is recognized as a powerful pedagogical strategy to enhance higher-order cognitive processes among members of a group.” (Gwee, 2009.) While in the PBL setting for the lessons, students are engaged in small groups where learning is combined as a group, but students will be tasked with finding their evidence separately and bringing it back to the group for a collaboration. This is an outcome of creating collaborative conversation and brainstorming with others to narrow down steps to take in a medical decision or to solve the entire case. “…then mutually reach consensus to explain or resolve a problem.” (Gwee, 2009.) Peer involvement is such a crucial part of the PBL, an author mentions, “In other words, learners should be stimulated to interact with each other because these interactions may positively influence learning.” (Dolmans, Grave, Wolfhagen, Van Der Vleuten, 2005.) The peer involvement is important because they are learning from one another, this can be shown as an outcome to the process. During the assessment phase, it can be used as a peer review to “grade” one another based off the engagement within the group.
5. Implications
The article did not imply specific evidence of outcomes, but it did mention specific things that should come out of the PBL in the medical school setting. However, an outcome found from an article shows that students stopped participating as heavily in the group work when receiving the midterm grade of pass rather than seeing the project through and solving the entire case. “Facilitators observed that about half of the students applied effort until they reached a pass level at mid-term, at which point no further improvement was noted.” (Morales-Mann, Kaitell, 2000.)
Based on the information the author provided, there are some limitations to the PBL in the classroom. One of the top limitations would be the tutor/facilitator not implementing the content in the way that a PBL is designed to be implemented. “Initially, some facilitators expressed trepidation at their ‘lack of expertise’ in the content presented in the problems.” (Morales-Mann, Kaitell, 2000.) When teachers are often in a place of a teacher, it is hard to release the reigns and have the students do the learning and step back from a teacher-directed platform. “a dominant tutor causes tension and conflict in groups which leads to lack of commitment, cynicism or student absenteeism.” (Dolmans, De Grave, Wolfhagen, Van Der Vleuten, 2005.) Another problem that would hinder the learning outcomes would be the students not fully understanding the concept and not taking the research for evidence seriously as well as the debrief session after the sessions.
When students are understanding of the grading process of the assessment, it need to be evident that the assessment taking place at the end of the PBL would be satisfactory for the students to see the entire process and appreciate the real-life model to learn from. “Several recommendations for change and improvement are offered to support and enhance PBL. These include the use of PBL in other seminar courses, a reduction of group size to nine or less, improvement of the preparation of students and facilitators, adoption of a grading system that is more appropriate than pass-fail and the maintenance of a roster of competent facilitators.” (Moreles-Mann, Kaitell, 2000.)
Overall, the implications that can be found from the case study shows the implementation of PBL was successful when used correctly. It is important the tutor is efficiently trained on PBL and how to assist students without teaching the students information. It is also important to note that the students who have no experience with PBL will need some sort of training or information session prior to the beginning of a unit. As noted above, students will also need an adequate grading scale to base their research off and what their participation needs to look like. PBL can be implemented in a way that boosts the achievement of students in the medical field by immersing the students in real-life problems in which they will learn off one another’s information and knowledge. Not only learning from one another, the students will gain collaboration and communication skills that are extremely important in the medical field when handling the needs of patients.
References
Dolmans, D. H., De Grave, W., Wolfhagen, I. H., & van der Vleuten, C. P. (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
Frost, M. (1996). An analysis of the scope and value of problem‐based learning in the Education of Health Care Professionals. Journal of Advanced Nursing, 24(5), 1047–1053. https://doi.org/10.1111/j.1365-2648.1996.tb02942.x
Gwee, M. C. (2009). Problem‐Based learning: A strategic learning system design for the education of healthcare professionals in the 21st century. The Kaohsiung Journal of Medical Sciences, 25(5), 231–239. https://doi.org/10.1016/s1607-551x(09)70067-1
Morales‐Mann, E. T., & Kaitell, C. A. (2001). Problem‐based learning in a new Canadian curriculum. Journal of Advanced Nursing, 33(1), 13–19. https://doi.org/10.1046/j.1365-2648.2001.01633.x
Tsou, K., Cho, S., Lin, C., Sy, L. B., Yang, L., Chou, T., & Chiang, H. (2009). Short‐term outcomes of a near‐full PBL curriculum in a New Taiwan Medical School. The Kaohsiung Journal of Medical Sciences, 25(5), 282–293. https://doi.org/10.1016/s1607-551x(09)70075-0