Problem Based Learning

What is problem based learning?
Developed by Howard Barrows and associates at McMaster University for medical education, problem-based learning (PBL) has been implemented in a number of health care professional educational programs. Problem-based learning is a rigorous, highly structured teaching methodology which places the student in a position of active responsibility for learning and mastering content. In a group of peers, the student learns new material by confronting and solving problems in the form of a clinical patient case.

How is PBL structured at Chatham?
Students work in tutorial groups (8-10 students) in which a faculty member serves as a tutorial facilitator. Rather than listening to a lecture on a given topic (teacher-centered learning), students are presented with a patient case which typically integrates previously learned information with a great deal of new content. The group must come to consensus about what they would need to know in order to manage the patient case. They do this by developing “learning issues” or topics which represent questions about the case. Sample learning issues might be: “What impairments typically occur following a middle cerebral artery stroke?” “What is the anatomy and function of the lymphatic system?” “How does the patient’s weakness relate to his gait dysfunction?” “What is the relationship between prolonged sitting and low back pain?” On an individual basis, students then research the topics by using textbooks, review articles, peer-reviewed research, and electronic data bases.

Later in the week, students regroup to discuss their findings and apply them to the patient case at hand. Rather than lecturing, the faculty member facilitates discussion and asks questions to ascertain that students are learning the material to the appropriate breadth and depth required of an entry level physical therapist.

How does PBL fit in with the rest of the curriculum?
Chatham University’s physical therapy program employs a modified problem-based learning format in its clinical arts and sciences course work. Five to 12 carefully crafted cases are the “anchors” around which other content is taught. The curriculum includes extensive laboratory experiences as well as special topic seminars which complement and reinforce content learned in PBL sessions. Other courses at Chatham, including the basic science courses, are taught in a more traditional, lecture-based format.

What are the benefits of PBL?
An ability to apply information to real-world situations
Research indicates that PBL embodies a learning approach that effectively helps students to develop scientific thinking about patients’ problems and to acquire both basic science and clinical information in a manner that ensures retention and transfer [of learning] to the real-life task of the clinician. (Barrows) Recent studies indicate that graduates of problem-based health care educational programs perform well (most studies indicate better than students from more traditional educational programs) on board exams and exhibit secure clinical learning and reasoning skills to the betterment of their patients.

Problem-solving skills
Since the acquisition of new material revolves around a patient case, students constantly learn and apply information in the context of solving a patient problem. For example, students might be required to answer the following questions posed by the tutor: based on the pathophysiology of his disease process, what precautions would be important when treating this patient? How would you handle the patient’s emotional affect in order to accomplish your treatment? How might the patient’s medications influence the outcome of today’s intervention? What tests and measures might be appropriate for the patient given their current status?


Research skills
As Chatham physical therapy students are learning how to ask questions through the pbl process, they also learn to research the answers. Our students become quite skillful at database searching, critiquing journal articles, and synthesizing information from a variety of sources.

Communication skills
Since group members are dependent on each other for enriching discussion and subsequent learning, each student must participate in pbl sessions, whether by volunteering information, asking questions, seeking clarification, confirming the thoughts of a peer, or relating information to the patient case. Inherent in the pbl process, Chatham students learn how to function as individual members of a team, conferring for the greater good (learning the material/treating the patient).

Students also have an opportunity to evaluate the participation skills of their classmates (preparation, clinical reasoning, quality of learning resources, team skills, respective listening) and themselves, in written and oral formats. This teaches critical reflection and the skills of providing/receiving constructive criticism.

PBL Bibliography
Barrows HS, Tamblyn RM. Problem-based learning: an approach to medical education. New York: Springer Publishing Company; 1980: xii.

Antepohl W, Herzig S. Problem-based learning versus lecture-based learning in a course of basic pharmacology: a controlled, randomized study. Medical Education. 33(2):106-13, 1999 Feb.

Dyke P, Jamrozik K, Plant AJ. A randomized trial of a problem-based learning approach for teaching epidemiology. Academic Medicine. 76(4):373-9, 2001 Apr.

Saarinen-Rahiika H. Binkley JM. Problem-based learning in physical therapy: a review of the literature and overview of the McMaster University experience Physical Therapy. 78(2):195-211, 1998 Feb.

Williams B. Developing critical reflection for professional practice through problem-based learning. Journal of Advanced Nursing. 34(1):27-34, 2001 Apr.

Enarson C. Cariaga-Lo L. Influence of curriculum type on student performance in the United States Medical Licensing Step 1 and Step 2 Exams: problem based learning vs. lecture-based curriculum. Medical Education. 35: 1050-55, 2001

Lycke KH. Inside PBL groups: observations, confirmation and challenges. Education for Health. 15(3): 326-334, 2002.