PBL
Should we leave the “empty glass” of PBL behind in medical education?
In the May 2007 issue of Academic Medicine, a paper was published written by Dr. Shanley, a professor of pathology from the State University of New York, in which a plea was made to leave problem-based learning (PBL) behind us. The main arguments given were that small groups don’t work, that the facilitator role is a misuse of faculty and that PBL results in an impoverished educational experience for students. A plea was made to introduce a new model called case study in which students first read published cases from the medical literature that are subsequently discussed in large groups led by faculty experts.
I was struck by this paper for several reasons. First of all, because of the way in which the paper is structured. The paper first demonstrates that PBL does not work and subsequently a new model is proposed that is assumed to be better than PBL. In my opinion there is no one right educational strategy in medical education. Although I am a strong advocate of PBL, I do not think that PBL is the only best solution. Mixed strategies should be promoted in medical education and discussing cases by faculty experts should be promoted as well. Second, I agree with the author that problem solving is not the ultimate goal of education but meaningful engagement in discussions. I also agree with the author that students’ self-teaching without providing any structure to undergraduate medical students is inappropriate. But, PBL can not be defined as unguided instruction or self-teaching by students without any structure, as suggested in this paper. Furthermore, I fully disagree with the authors on the arguments that small groups lead to a general low level of discourse. In a paper in ASHE (2006, 11, 321-336) the findings of several studies are reported indicating that high quality interactions take place in tutorial groups. And of course, in this paper several studies are described as well in which problems, like unequal participation and groups just scratching the surface, are reported. But, unequal participation does probably play an even bigger role in the large group setting as proposed by Dr. Shanley and the level of discourse will also differ in large groups led by faculty experts as is the case in PBL tutorial groups. Furthermore, I disagree with Dr. Shanley that content expertise among tutors in PBL is the exception rather than the rule. Since research has demonstrated that tutors should be both experts in the subject matter under discussion and experts in facilitating learning, most medical schools do not hire a team of psychologist to monitor tutorial groups as suggested, but carefully select staff members based on their expertise.
Finally, the two viewpoints that the glass of PBL is half empty or half full, should not only be dependent on a too optimistic mood of the advocates of PBL or a too pessimistic mood of the proponents of PBL, but on scientific evidence. From this perspective PBL as well as other educational formats require more in-depth studies that need a critical analysis, preferably based on a balanced discussion instead of a black and white discussion.
Perhaps other people interested in PBL have read this paper and would like to give their opinion as well on this paper.
Diana Dolmans PhD, Educationalist, Maastricht University, the Netherlands, August 2007
