CORE Metadata, citation and similar papers at core.ac.uk Provided by Elsevier - Publisher Connector AN EDUCATIONAL APPROACH TO PROBLEM-BASED LEARNING Nan-Chieh Chen Department of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. This paper provides an analysis of the educational framework of problem-based learning (PBL). As known and used, PBL finds its root in the Structuralism and Pragmatism schools of philosophy. In this paper, the three main requirements of PBL, namely learning by doing, learn- ing in context, and focusing on the student, are discussed within the context of these two schools of thought. Given these attributes, PBL also seems ideally suited for use in learning bioethics. Key Words: pragmatism, problem-based learning, situated learning, structuralism (Kaohsiung J Med Sci 2008;24(3 Suppl):S23–30) In simple terms, problem-based learning (PBL) is The most important characteristic of PBL is its a curricular design and pedagogical method which emphasis on individual independence and commu- focuses on the learner, using real-life problems and nication and discussion skills among group mem- situations to stimulate students’ learning. It is usu- bers. While quantitative research has shown PBL also ally carried out in small group discussions wherein changes the characteristics of a group, the changes specialized knowledge pertaining to the problem brought about by PBL in the students who apply it is derived. This teaching method was first used in should be studied using qualitative research. If we McMaster University in Canada, and it is most widely focus too much on quantitative research on PBL, then used for teaching clinical cases in medical schools. we would not be able to explain the fundamental Reviewing papers and articles that discuss PBL, the changes in learning methods. Strictly speaking, such bulk of the research performed on PBL is quantitative. an emphasis goes against PBL’s characteristic of em- The results of these studies clearly indicate students phasizing the individual. However, well-rounded who learn by PBL show obvious differences from qualitative research must also start from theoretical those who learn by more traditional means in terms discussions, using these to clearly establish the research of learning attitude, learning motivation, and learn- category; that is the purpose of this review article. ing methods. However, quantitative research results There have been many articles written about the fail to clearly explain what causes the obvious sequence of steps in the PBL process or the principle changes, and how the use of PBL fundamentally of teaching how to write cases, but this paper pro- changes students’ learning methods and cognitive vides an analysis and discussion of the deeper level processes. of the educational framework. There have been vari- ous debates on what school of thought PBL belongs to, but most discussions suggest it belongs to one of Address correspondence and reprint requests to: two schools. One is the Structuralism school of thought, Dr Nan-Chieh Chen, Department of Internal Medicine, College of Medicine, Kaohsiung and the other is the Pragmatism school of thought. Medical University, 100 Shih-Chuan 1st Road, The ties to pragmatism came about because one Kaohsiung 807, Taiwan. of the pillars of PBL is John Dewey (1859–1952); yet E-mail: [email protected] many important theories of learning are linked to Kaohsiung J Med Sci March 2008 • Vol 24 • No 3 Suppl S23 © 2008 Elsevier. All rights reserved. N.C. Chen the Structuralism school of thought. The US-born realistic “problems” or “subjects.” Small groups serve Dewey’s thinking was greatly influenced by a fellow as the basic unit in which students discuss a problem American, William James (1842–1910), a doctor by with group mates, coming up with a hypothesis and profession. As known by most, William James is the attempting to solve the problem. father of the Pragmatism school of thought, and his Yet in the whole process of finding answers and Philosophy of Action greatly influenced American liter- solutions, the roles of the participants are limited to ature, art, and theater. Due to the influence of Dewey’s that of supporter and discoverer, and throughout the thinking, some articles classify Dewey’s learning theo- learning process, the main focus is on the learner. The ries under Pragmatism. purpose of PBL is to train students to look for an- However, many articles classify PBL under the swers themselves, and through this process to develop Structuralism school of thought. Both schools em- the ability to transform abstract concepts and knowl- phasize the learner’s role in building their own knowl- edge into practical and workable solutions, and be edge base, and formulating their own views of the able to formulate strategies that will solve the prob- world. However, our main goal is not to determine lems. All of these goals can be achieved with the which school of thought PBL belongs to; because PBL support of a tutor. was first introduced by Barrows, Moust, Bouhuijs and Aside from what has been mentioned above, there Schmidt, aside from vague references that its theories are articles suggesting PBL learning methods can also can be linked to Dewey’s views on education, it was help students build their social and communication also influenced by Structuralism. However, they did skills [1]. One good example is Germany’s Humboldt not go into detail regarding how Dewey’s views on University of Berlin Charité School of Medicine. In the education or structuralism are related to PBL. modern era, with its emphases on patient’s needs and Although the three main requirements of PBL— the doctor-patient relationship, this medical school learning by doing, learning in context, and focusing on started its PBL program in teaching medical commu- the student—repeatedly appear in different articles, nication, with remarkable results. Unlike most schools the backgrounds of these frameworks are not suffi- which teach Medical Communication Skills as a tradi- cient. Aside from these, we can clearly see the influ- tional theoretical subject starting from the fifth semes- ences of Pragmatism and Structuralism in the practice ter, Charité’s curriculum includes the subject as a of PBL, the framework of which is actually based on required course starting from the first semester and a combination of principles from both schools. This is continuing for nine semesters. Charité thinks establish- obviously related to North American education’s em- ing relationships and communicating with patients phasis on practical labor, and the tendency to over- can best be learned by students if they do in-depth look the theoretical sources of education. Due to this, research on the subject, and simulate interacting with this article will examine the theoretical framework of patients and applying what they learned [2]. PBL, so as to help students using PBL to develop PBL’s many functions and applications are not learning methods and understand the causes of fun- limited to medical education. Other disciplines like damental changes in the cognitive process, as well as mechanical engineering, law, business administra- offering theoretical explanations for these changes. tion, information systems, and education and special education widely use PBL. The main learning meth- ods of PBL, namely learning by doing, learning in INTRODUCTION TO PBL TEACHING context and learner as the main focus, are what cause METHODS PBL methods to be widely applied in different disci- plines. However, before discussing the framework of In recent years, PBL has become the driving force PBL, we need to first discuss Situated Learning, because behind changes in teaching methods in medical edu- it is an important interim phase in the formation of cation, and has brought about a shift in the teaching PBL teaching methods, especially of important PBL paradigm, becoming synonymous with fostering views like learning by doing and learning in context, independent thinking among students. Its main prin- both of which originated from the methods of situ- ciple is “problem-solving”, structuring teaching con- ated learning. If we want to talk about PBL, then we tent based on scenarios, but not veering away from have to discuss its predecessor, Situated Learning. S24 Kaohsiung J Med Sci March 2008 • Vol 24 • No 3 Suppl An educational approach to PBL In addition, this section will discuss the significance (the tutor) to do a ‘cock-eye’ to test his physiological of problem-solving and doing, two concepts that are functions. But the tutor cannot imitate the cock-eye, PBL’s main driving forces. so he just said, ‘I cannot do a cock-eye, but patients can. We used this technique to get to the main points of the case, and this greatly helped me to remember SITUATED LEARNING the learning goals and processes of this case study.” In this example, we can clearly see the tutor’s PBL was greatly influenced by Situated Learning, role-playing and his inability to act out the patient’s which is based on the belief that the generation of illness displayed a theater-like appeal and showed knowledge, its significance and the spreading of its the whole context of the situation, which strengthened significance are the responsibilities of society and the learner’s impression of the case; his interaction culture, because every area of knowledge is strongly with his peers in diagnosing the problem enhanced linked to culture; at the same time, the transmission the process of learning by context, and also improved of knowledge and absorption of knowledge by peo- the effectiveness of learning. We may find there are ple, as well as the process of demonstrating and two different learning contexts in this example. First transferring knowledge, will result in new contexts is the context already mentioned, learning in context; and situations.