See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/11962814 Problem-based learning: Challenges, barriers and outcome issues Article in Saudi medical journal · June 2001 Source: PubMed CITATIONS READS 47 4,876 1 author: Samy Azer The University of Sydney 290 PUBLICATIONS 1,754 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: Research Methods View project SOCIAL MEDIA RESEARCH View project All content following this page was uploaded by Samy Azer on 27 May 2016. The user has requested enhancement of the downloaded file. Review Articles Problem-based learning Challenges, barriers and outcome issues Samy A. Azer, MB, PhD (Syd). ABSTRACT Although many recent studies have discussed specific issues related to problem-based learning in medical education, a comprehensive review of the literature on the consequences of its use and the outcomes of curriculum based on problem- based learning have not been accurately looked at. Furthermore, there is no available review that critically evaluates challenges and barriers to the implementation of problem-based learning curriculum in medical schools. The purpose of this part is to highlight the major challenges and barriers reported during curriculum preparation and implementation and to critically evaluate the consequences of problem-based learning introduction and its educational outcomes. Keywords: Problem-based learning, resistance to change, medical education, new curriculum, challenges and barriers, integration, problem-based learning tutors, cognitive skills, basic and clinical sciences. Saudi Med J 2001; Vol. 22 (5): 389-397 ithout major changes in the social context of to learning and views of teaching; educational and Wmedical practice, efforts to improve academic background; and personal ambitions and performance through curriculum reform will be career prospects. The openness to change of staff futile.1 A change to a problem-based learning (PBL) members in a department can vary dramatically and curriculum may be viewed with strong institutional staff wishing to lead educational changes must be constrains and even antipathy. The literature reviews aware of the potential threats to such change and mention a host of reactions to PBL. For example, those factors which influence it, as outlined by doubts about claiming educational benefits of PBL, Fullan.4 Individuals who are very well established in anxiety that the outcomes of PBL will not be very their habits can find it difficult to consider or adapt to tangible, a disruption of habitual and comfortable patterns of work, as well as emotionally charged change, particularly if they feel elements of coercion reactions and general fear of change.2,3 Emotionally operating. Even when the decision made to make a charged reactions, however, are not the only source major shift in education is free of coercion and based of resistance to problem-based learning. It is on responses to positive influences, there remains important to guard against one-factor explanations. uncertainty and potential stress associated with the Other contributing factors should be considered. unknown.5 Personal factors. Personal factors can influence Organizational issues. Any of these personal an individual’s attitude to any kind of change. factors may interact with the particular characteristics Examples of these factors may include interest in, of the institution in which an individual works. beliefs and attitudes towards education; approaches Universities, for example, differ in their organization, From the Faculty of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia. Address correspondence and reprint request to: Dr. Samy A. Azer, Faculty of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia. Tel. 61 (3) 8344 8035. Fax. 61 (3) 8344 0188. Email: [email protected] and [email protected]. 389 Problem-based learning ... Azer Table 1 - Application of PBL in professional sciences: Challenges/barriers experiences during implementation. Sciences Location Type of the course Challenges reported Study type Reference Architecture University Integrated PBL - Difficulties in Qualitative Ostwald and Chen (1995)8 of integration Newcastle, -Difficulties in creating Ostwald (1994, 1994)9,10 Australia problems. - Polictical and professional challenges Mechanical Imperial College of Non-integrated PBL - Time consuming Qualitative Cawley (1989)14 Engineering Science and - Required changes in Technology, UK assessment Ryan and Little (1991)7 Nursing University Integrated PBL - Substantial change in Qualitative of Western Sydney management and organisational structure Optometry Queensland Non-integrated PBL - Time consuming Qualitative Lovie-Kitchin (1991)15 University of - Student asked for more Technology, feedback Australia - Disagreement within some groups Social Work University of New Non-integrated PBL - Resource intensive Qualitative Heycox and Bolzan (1991)13 South Wales, - Time consuming Australia Physiotherapy University of Integrated PBL - A number of stressors Qualitative Soloman and Finch (1998)66 McMaster, were unique to adapting Canada to PBL Occupational Brunel University Non-integrated PBL - Students were less clear Qualitative Sadlo (1997)61 Therapy College, UK about the goals/ objectives of curriculum. Veterinary University of Subject-based PBL - Extra-time required Qualitative Rand and Baglioni (1997)67 Science Queensland from students compared to traditional lecture- based subjects. operation and ethos. Differences are multiplied Educational views. Nickles recounts the decline across national boundaries. There are also major of the notion of a "logic of discovery" by the mid- differences across cultures and political systems. The 19th century and the separation of discovery from nature of the enterprise, the distribution of power and justification.11 This separation was significantly influence, the degree of external political control and reinforced during this century by the distinction the outlooks of the professionals involved will all between "the context of discovery" and "the context interact to limit the styles and types and the outlooks of justification" made by Reichenbach in 1903. It of the professionals involved will all interact to seems that education has inherited the separation view and this has been reflected in beliefs about limit the styles and types of change that are possible. education. Nickles criticizes the separation of The change is seldom a simple logical process and is discovery from justification, arguing that the process 2,6 not necessarily a smooth linear process. Several of discovery and justification are closely linked.11 studies have raised the issue of organizational PBL is consistent with Nickles’ criticism of the rigid resistance to the introduction of problem-based separation of discovery from justification. The learning and the need for substantial change in the implication of Nickles’ argument on education is management system and organizational structure of clear. Students will be ill served. They are given their organization.7-11 only the products of enquiry without learning how to 390 Saudi Med J 2001; Vol. 22 (5) Problem-based learning ... Azer actually pursue enquiry. Solving problems is a implementation, a new curriculum will be rather process of discovery that is much more open and more demanding than the old, but that is a temporary linked to reasoning. In fact the separation of problem. Furthermore, the individuals teaching in a discovery from justification could inhibit education. PBL curriculum allows increased tutoring by junior What are the major challenges and barriers that staff or even senior students, rather than senior staff. we might face during the preparation and This will allow junior staff to benefit from their tutor implementation of a problem-based learning role in their own professional development. Junior curriculum? Since the potential value of PBL in staff will less likely tend to start lecturing in the medical education was highlighted by Barrows and group discussion. This strategy will enhance small Tamblyn,12 its educational strategy has attracted group function. The educational efforts of senior increasing attention. Medical and professional staff would be more profitable in curriculum schools have adopted PBL as a major feature of their development, in case construction and in lecturing. programs, established schools have incorporated it in Difficulties in integration. As discussed before curriculum revisions and reports on higher education one of the major objectives of PBL program is have featured PBL among recommendations as to integration. However, integration is not an easy task. good practice. For example, PBL has been adapted For example, Boshuizen et al found that behavioral in the fields of Nursing, Social Work, Engineering sciences knowledge is less integrated in PBL 7,8,13,14 and Architecture, as well as Law, Teaching, curriculum, and can hence play a role of its own.21 Optometry and Management.15,16 However, the These findings are consistent with that of Hobus et al implementation of PBL was associated with several who found that behavioral sciences knowledge was challenges. Table 1 summarizes the major not yet integrated with the clinical knowledge of challenges/barriers experienced during the doctors who had recently graduated, but was implementation of problem-based learning in a wide integrated with the