PBL

Minimum Essentials for PBL

THE MINIMAL ESSENTIALS FOR PROBLEM-BASED LEARNING IN MEDICAL EDUCATION

In reviewing these essentials it is important to keep in mind the principle objectives of the method. The acquisition of an extensive, integrated knowledge base that is readily recalled and applied to the analysis and care of patient problems.

The development of effective and efficient:

• Problem-solving or clinical reasoning skills
• Clinical skills
• Self-directed learning skills
• Team skills.

MEDICAL EDUCATION ESSENTIALS

1. Students must have the responsibility for their own learning.
   As the students in a problem-based learning curriculum work with a problem they should be able to identify what they need to learn and what resources they are going to use to accomplish that learning. In this way students can design their learning to meet individual needs (as they all have differing knowledge and experience) and career aspirations. Allowing students to have the opportunity to assume this responsibility, under faculty guidance, prepares them to become effective and efficient life-long learners-an absolute essential in a profession where new types of problems and new information surfaces with almost logarithmic expansion. The old educational truism states that half of what the students learn in medical school will be wrong or outdated by the time they are in practice, and no one knows which half that is. This means that the teachers working with the students should not provide the students with what they feel is the information students need in their studies nor give them reading or study assignments. The students must learn how to decide on what they need to learn and to seek out appropriate learning resources, using the faculty as consultants (often called "resource faculty" in problem-based learning) as well as books, journals, online resources and other experts. This means that problem-based learning is not teacher-centered, the teacher does not direct what students should learn or what resources they should use. Instead the teacher designs and provides the problem simulations and patient experiences that challenge the students to learn what is needed in their preparation for a career in medicine. Using facilitatory teaching skills, the teacher guides them in their work with the problem as they develop problem-solving skills, identify what they need to learn and develop self-directed learning skills. The teacher in this role is usually referred to as a "tutor" and needs to be well trained for this role.
2. The problem simulations used in problem-based learning must be ill-structured and allow for free inquiry
   As with patient problems in the real world, problem-based learning problems must present as ill-structured problems, with just the initial presenting situation stimulating learners to generate multiple hypotheses about their cause and possible solution. These ill-structured problems must be designed to allow students to freely inquire through history, physical examination and the ordering of laboratory tests in order to obtain information needed to support or verify their hypotheses. Although many problems designed for problem-based learning are single patient problems it is important that problems are designed that represent other problems that will be faced by graduates such as community health problems and problems associated with managed care systems.
3. Learning should be integrated from the wide range of disciplines that are related to understanding and treating patient problems are basic to the science of medicine.
   Problem-based learning should not occur within a single discipline or subject. Information should be integrated from the many disciplines that are basic to the practice of medicine such as; anatomy, biochemistry, clinical medicine, epidemiology, ethics, human behavior, immunology, pathology, pharmacology, physiology, psychology, etc.. During self-directed learning, students should be able to access, study and integrate information from all the disciplines that might be related to understanding and resolving the particular problem they are working with-- just as the physician must recall and apply information integrated from these diverse sources in patient work. This allows the patient problem to be the organizing focus for student learning better ensuring the recall and application of that valuable and important basic science information in their subsequent patient problem encounters in clerkship, residency and practice.
4. Collaboration is essential
   Student collaboration occurs naturally during the group's discussions with the tutor. However, the students must be encouraged to collaborate during their self-directed study. Collaborative work among the students in the group at this time can be the most rewarding and productive part of their learning as the students work together helping each other to gain an understanding of what they are learning and its application to the problem. It is this collaboration that allows the students to develop the security and authority they need to be responsible for their own learning. Collaboration is an essential skill the students must have in their careers as they will be invariably working as members of teams.
5. What students learn during their self-directed learning must be applied back to the problem with reanalysis and resolution.
   On return from self-directed study the students must apply, through their interactive discussions what they have learned. They must do this in a way that will provide a deeper understanding of the problem and insure the recall of that information when they are faced with similar patient problems in the future. This discussion is triggered by a review of the hypotheses that were generated by the students in their work prior to going off for self-directed study. Any suggested changes in the hypotheses will reflect what was learned during self-study and opens an interactive discussion of what was learned.
6. A closing analysis of what has been learned from work with the problem and a discussion of what concepts and principles have been learned is essential.
   Before completing their work with a problem, the students should reflect on what has been learned and determine if there are any things missing in their overall understanding of the problem and the basic mechanism responsible. In addition, they must reflect on how their new learning relates to prior problems and prepares them for future problems. In doing this they can determine and discuss what important overall concepts or principles have been learned. This important step helps convert procedural knowledge gained through problem solving into declarative knowledge for use and recall with other problems in the future. Concept maps are very useful providing an armature for this process.
7. Self and peer assessment should be carried out at the completion of each problem and at the end of every curricular unit.
   The students must become proficient in assessing their individual learning progress and that of their peers. The ability to accurately monitor the adequacy of personal performance is essential to developing life-long self-directed study skills. The ability to provide colleagues with accurate feedback is an important skill in medical practice.
8. Continual opportunities must be provided for clinical skills to be learned.
   The opportunity to develop effective clinical skills must be embedded within the problem-based learning curriculum. Many of the problems in the curriculum can be presented as standardized or simulated patients allowing the development of these skills along with problem-solving, self-directed study and team skills. In addition, recurrent opportunities should be provided for students to work in clinical settings applying what they have learned in their problem work to real patients and developing their clinical skills.
9. The sequence of activities carried out in problem-based learning, and problems employed in problem-based learning, must accurately reflect medical practice.
   In problem-based learning students must go through the same activities, as they learn, that as they will go through in their professional work with patient problems. The problems used must be those that are prevalent and important in practice. This ensures that the activities undertaken by the students and the skills and knowledge acquired are relevant to effective practice as a physician.
10. Student examinations must measure student progress towards the goals of problem-based learning.
    Although a major component of the assessment of students' progress comes from self and peer assessment that occurs at the end of every problem, additional formal assessments must assess the students' problem-solving skills, self-directed learning skills, clinical skills and ability to recall and apply an integrated knowledge base in work with a problem.
11. Problem-based learning must be the pedagogical base in the curriculum and not part of a didactic curriculum.
    Problem-based learning should not be episodic, added on to or mixed in with more traditional, didactic, teacher-directed, passive, memorization-based and lecture-based educational methods. Problem-based learning requires that students are active learners, responsible for their own learning and have adequate time for self-directed learning. The contrasting and conflicting curricular and time demands of didactic teacher directed learning diminishes the value of problem-based learning and confuses and frustrates both teachers and students. It prevents full realization of the value of problem-based learning and the excitement and enjoyment the method can provide students preparing for a career in medicine. It must be an independent curricular undertaking.

A more accurate title might be "student-centered, problem-based, inquiry-based, integrated, collaborative, reiterative, learning."

GENERIC PROBLEM-BASED LEARNING ESSENTIALS