Problem-Based Learning: An Educational Approach

This section provides an introduction to the key features of problem-based learning and the specific pedagogy underpinning the approach. It also explains how it is applied in the context of this research.

The emergence and implementation of PBL in medical education is commonly associated with the opening of McMaster University in Canada in the 1960s (Barrows & Tamblyn, 1980). Dissatisfaction with traditional modes of medical education involving the transmission of knowledge via lectures and rote learning converged with developments in knowledge and understanding of the cognitive processes involved in learning.

The aim of the original model of PBL was to introduce a more student–centred form of learning that reflected the practical skills a doctor needs to acquire and develop for future practitioner life (Barrows, 1986). These were clinical

reasoning skills, problem-solving, an ability to apply knowledge, and self-directed learning. PBL was seen as an educational approach that would help facilitate the development of these skills and at the same time ensure an ability to deal with the ever-growing knowledge in the field. This focus on the

development of skills through practice also highlighted the importance of the process of learning (Barrows, 1994). Given the focus on participation, it obviously privileges speaking as part of the learning process, or “speaking to learn” (Basturkmen, 2016, p. 161).

In support of this active approach to learning, Barrows (1994, p. 25) discusses the problems associated with rote-learning, including lack of recall and the benefits of learning in context, and later issues related to ensuring information is available both as procedural (skills learned during in problem-solving

activities) and declarative knowledge (available for recall) (pp. 71-73).

Intellectually, this approach has been linked to philosophical, psychological and educational developments at the time of its emergence, including the influence of cognitive theories focussing on the mental processes involved in learning, and educationally to the links to experiential learning and constructivism (Savin-Baden & Major, 2004).

1.3.1 Applications of Problem-Based Learning

In its purest form, PBL is fully integrated into the curriculum. The ‘problem’ or scenario is the basis of a cycle of study. Barrows’ (1986) model for

undergraduate medical students mirrors the cycle of work and the clinical

reasoning skills doctors engage in in the following way: after the problem (based on actual patients) is introduced (without prior input or study), students

brainstorm, sharing what they know of the issue, what they need to find out, and then generate initial hypotheses. During the first tutorial one student acts as a scribe, recording ideas (hypotheses), facts learned about the patient related to the hypotheses, and learning objectives (areas for study). At the end of the first session, the objectives for individual study are agreed on and resources to be used are identified. This stage is followed by self-directed learning, which may involve individual or collaborative work. In the second tutorial, students apply what they have learnt, reassessing the problem in light of new information. The final decision-making is based on the evidence they have accumulated.

Barrows includes two final phases where the participants first summarise and then reflect on what they have learnt. This, he states, is necessary in order for the learning to move from procedural to declarative knowledge for it to be available again at a later stage. To enable this, students need to verbalise what they have learned. The cycle finishes with a self- and peer-evaluation to

encourage learners to self-monitor their own performance, another important skill for life-long self-learning (Barrows, 1994, pp. 71-73). As an approach, it is based on the assumption that skilled physicians use deductive reasoning

processes and takes the view that repetition and practice are necessary in order for doctors to develop these skills (Barrows, 1986).

Camp (1996) comments on the widespread adoption of PBL, including its variants. These are primarily concerned with the level of integration of the sessions into the curriculum as a whole, and what and when additional information is provided (for example parallel lectures may be given, fixed resource sessions used; see, for example, Alavi, 1995). Barrows (1999) himself suggests six variations and Savin-Baden and Major (2004, pp. 35-45) describe eight modes.

What most frameworks do have in common is the PBL tutorial, the ethos of collaborative learning, the requirement for student discussion and hypothesising, followed by self-directed work and subsequent reassessment of the problem. In describing the educational basis for PBL, Bligh (1999, p. 6) identifies seven steps in PBL, many of which, if they are in fact evident, may have associated language patterns. These are clarifying terms and concepts, defining problem(s),

analysing the problems, listing possible explanations, formulating learning objectives and setting priorities, reporting back, synthesizing and testing information.

Apart from the stages involved, it is clear that collaboration and interaction are key components of the approach. The role of the student and tutor are possibly very different from that which students may have experienced before. Not only do both tutors and students collaborate in knowledge construction, but the student as the main contributor, certainly in terms of quantity of talk, is frequently the norm.

1.3.2 Evaluating the Effectiveness of Problem-Based Learning

As an educational approach, PBL is not without criticism, not least because variations in implementation make assessment of the effectiveness of PBL problematic. The level of integration into the curriculum, the expertise of tutors, and modes of assessment have all been questioned. Colliver’s review of the literature concludes there is no convincing evidence that it is a superior mode of education overall in improving students’ knowledge base or clinical performance (2000, p. 259). However, more promising investigations have been conducted in a number of areas, including the acquisition of cognitive skills

(Hmelo, 1998), the development of meta-cognition (Downing et al., 2009), the relationship between case quality, group functioning and test results (Nieminen et al., 2006) and on the level of ‘deep’ learning it promotes (Dolmans et al., 2001; Mok et al., 2009).

In relation to implementation, the facilitator and the questions and strategies used to facilitate and scaffold knowledge construction are a key part of PBL. As such, the effectiveness of the facilitator has also been the focus of attention.

Hmelo-Silver and Barrows (2006) discussed the role of the PBL tutor in

scaffolding learning. They identify, for example, “re-voicing”, “summarising”

and “elaborating”, as some of the strategies used. They also considered the opportunities afforded for knowledge construction and the different ways tutors used questions (Hmelo-Silver & Barrows, 2008). For example, short-answer questions were used to focus student attention, long-answer questions to push for clarifications and elaborations and, by far the most common, meta-questions to evaluate hypotheses and check understandings. These studies highlight a number of the roles the facilitator takes and the complexity of the PBL tutorial, and indicate the potential impact facilitators may have on student engagement and active participation. Chapter 3 considers interaction and engagement in different ‘types of talk’ in more detail.

1.3.3 Problem-Based Learning in the Context of this Study

The postgraduate MSc in Medical Genetics that this research draws its data from employs problem-based learning as part of its curriculum, as with many courses within the School of Medicine for both undergraduate and postgraduate students at the University of Glasgow and is a well-established mode of study.

Students on this particular course follow a programme incorporating lectures, labs, ‘problem’ sessions and problem-based learning sessions (PBLs). Although not a fully integrated PBL model, it does have a number of similarities to the McMaster model, as we shall see below. In terms of Savin-Baden and Major’s (2004) suggestion of modes of PBL in curricula, it is most similar to Mode 5 which is a two-strand approach where PBL modules draw from other modules in a mixed approach. PBL “is seen by tutors as a vital component … designed to

maximise the use of both problem-based learning and other learning methods”

(pp. 41-42).

The PBLs play a significant and regular part in the approach to teaching and learning on the programme, with final PBL assessments contributing 30 credits of the 120 credits awarded for the taught component of the degree. Although the School of Medicine does not follow the ‘pure’ PBL McMaster model (Barrows, 1994, 1986), partly due to institutional constraints in module and curriculum design, the model employed is similar in that learners are presented with scenarios, work through a series of stages to share knowledge, identify key terms and issues, and then set learning objectives. The first session (one hour at the beginning of the week) is then followed by independent learning in

preparation for the subsequent class (from one and a half to two hours at the end of the week) where students report back and make final suggestions for courses of action. It differs from the pure Barrows PBL model in that the self-directed learning requires students to look at only one objective each, which can mean that students may have less to contribute and comment on at the

reporting back stage. Also, a number of the PBLs are supplemented with what Alavi (1995) refers to as “fixed resource” sessions, in this case some of the lectures and the ‘problem’ sessions.

In the first two semesters, while the PBL cycles have a key role in the

programme delivery, they are formative in nature and unassessed. The focus is very much on developing skills and learning how to do PBL. Term one has seven PBLs, each delivered in a weekly cycle of work. In semester two, the groups change around. New groups will include some participants from semester one along with students they have not yet worked with. The four PBLs in semester two are followed by a ‘mini-big’ PBL. This PBL cycle is carried out over two weeks, involves more detail and requires each group to compile a report and give a group presentation to the whole cohort. In essence, this is practice for the assessed PBLs in semester three.

In summary, within the context of this study, we see an adaption of the PBL

‘classic’ model. The specific profile of the PBLs to be included in the corpus in this study is provided in Chapter 2.

1.3.4 Linguistic Research into Problem-Based Learning

While the educational value of PBLs and the role of the facilitator have been the focus of research, to date there has been much less investigation into the

linguistic aspects of PBL sessions, nor of the (potentially) differing roles and interaction patterns displayed by participants. Although this is surprising given that at differing points in the cycle participants may engage in longer and shorter turns and with different purposes, a small number of studies have been carried out.

Legg (2007) and Woodward-Kron and Remedios (2007) are the most informative in terms of sequencing and the linguistic realisation of stages. Woodward-Kron and Remedios report on an initial small-scale investigation into sequencing and scaffolding of a first year undergraduate physiotherapy session, offering insights into the corresponding linguistic elements of a PBL tutorial. Using Bernstein’s model for pedagogic discourse and SFL, they first identified generic stages. They found the process more dynamic than guideline procedures for that context suggest, with stages merging or at times emerging earlier than expected and fewer contributions of students from non-English speaking backgrounds.

Remedios et al. (2008) also investigated students’ cultural background and its relationship to collaborative behaviour in undergraduate physiotherapy students in Australia (both Asian background and Australian). The Asian students were identified as “silent participants”, participating by listening and also doing required work, but verbally contributing less. Legg (2007) takes a genre analysis approach to studying seven first year undergraduate PBL tutorials (the second tutorials in a three-tutorial PBL cycle), identifying constituent structure, and the identification of obligatory and optional stages.

Three studies apply CA to study segments of talk in PBLs. Glenn et al. (1999) identify organisational frameworks, while Koschmann et al. (1997, 2000) show how problems emerge, and how tutors guide and help focus topics. These studies, although at undergraduate level and of a limited number of tutorials or only of a part of a cycle, suggest the dynamic unfolding of PBL tutorials. Da Silva and Dennick (2010) are the only study that considers vocabulary use in PBLs, although they only cover one PBL cycle.

In summary, problem-based learning is characterised by interaction and engagement between participants and with the subject matter. This involves learning by doing and actively engaging with content. The research to date has indicated the complexities of the PBL cycle, however there has been little research into whole cycles or into postgraduate groups, and only one (Da Silva &

Dennick, 2010) employing tools from CL. This is also reflected in the lack of teaching resources and guides available to EAP teacher working with students preparing for this type of learning.