Problem based learning (PBL) - An introduction
Reading prospectuses and medical school websites you can quickly become overwhelmed with medical school jargon and acronyms such as PBL, CBL, integrated and systems based teaching. One that comes up a lot is PBL or Problem Based Learning.
So what is it?
PBL is a style of small group teaching in which learning is stimulated by a “problem”, typically a clinical scenario. It was initially developed by a group of doctors at McMaster University Toronto in the 1960s. Since its inception it has been adopted by medical schools across the world, including many in the UK. Problem based learning can take many different forms but the principles remain the same: learning is contextualised by scenarios or case studies, students derive their own learning objectives from the scenario, and self-directed learning is consolidated by group discussion.
All this talk of self-directed learning and student lead discussion might seem like a whole lot of work, but it’s important to remember that every PBL curriculum in medical education (that I know of) is supported by at least some lectures and small group teaching as well as clinical skills sessions.
My first two years at medical school were based on PBL, so much of what I’m going to describe in this blog is based on my own experiences at the University of Exeter.
The PBL process
*DISCLAIMER* - all medical schools will use PBL in slightly different ways and the learning process might be slightly different, as an example, I’ve described my experiences of the PBL process at the University of Exeter:
In my first two years at Exeter, our timetable was based around a new case-unit every two weeks. Our PBL groups were made up of 8 students and a facilitator. At the beginning of the fortnight, we would have our first PBL session…
Session 1: In this session, we would read through the PBL scenario for that week (see the example below) as a group. We would then go through and highlight any of the terms we didn’t understand or weren’t sure about. Most of the time at least one person in the group would know what it meant or we would ask our facilitator.
An example PBL scenario
The next step is to ‘activate prior knowledge’ – basically to discuss what you already know. Looking at the example below you might think about what you already know about asthma. Does anyone know what the blue and brown inhalers are? What do you know about smoking and asthma? It might seem like a bit of a tedious step but most of the time, between the group you find that you know a surprising amount already!
The final part of the first session will be spent setting your learning objectives. These learning objectives should include things like anatomy, physiology, pharmacology as well as social aspects of the scenario. The facilitator will be there to guide the group, ensuring they cover all the key aspects of the case scenario.
Self-directed learning (SDL) time…
So now you’ve got your key learning objectives, it’s time to learn them. Self-directed learning or SDL as the name suggests just means that it's more active learning and you can direct how you study. It might also mean trips to the library for learning resources.
At Exeter, we also had small group teaching sessions, lectures and clinical skills sessions related to our case-unit scheduled during the fortnight.
Sessions 2 & 3: Sessions 2 and 3 would both take place in the second week of the fortnight (so you’ve got a bit of time to work through all the learning objectives!). Both of these sessions are set aside for feeding back, problem solving and discussing your learning objectives. Different members of the group will have learnt different aspects of your objectives to varying depths – and this is the whole point of discussing and consolidating as a group. The final step is to evaluate your learning objectives – were they appropriate? Were they specific enough? What would you differently next time?
And that’s a wrap! Next case unit starts the following week.
Why do PBL at medical school?
So why do medical schools do it?
The biggest argument in favour of PBL is that it will challenge students as problem solvers and set you up for with the knowledge and skills for life as a doctor, dealing with real life situations. Being able to motivate yourself for self-directed learning, and work collaboratively in a team with good communication skills is essential for life as a doctor. Personally, the thought of sitting in a lecture theatre all day filled me with dread, and I looked specifically at PBL universities for that reason.
However, if you’re someone who struggles to self-motivate PBL may not be for you, as a teaching method it does take a bit of effort to get the most from it. Working in a group can also have some downsides; it can quickly become frustrating if some members of the group don’t pull their weight. With traditional, lecture-based courses you will have a clearer idea of what material you are expected to know. If you learn best by sitting and listening to lectures, PBL might not be for you.
Problem based learning - summary
As a final year medical student at Exeter, I survived two years of PBL and have now seen how that translates across to real world problems in the clinical environment. At times it can feel like you’ve got an overwhelming amount of SDL to do, and you might have no idea how much depth to go into. But ultimately, if you put the effort in, you can come away not just with the medical knowledge you need but also some essential problem solving skills for your future career.
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