November 20, 2011

Problem-Based Learning in Pharmacy Education: Effective or Problematic?

by Kelly Parsons, Pharm.D., PGY1 Pharmacy Resident, Union Memorial Hospital

Problem-based learning (PBL) is a teaching strategy used among many pharmacy and medical schools that strives to teach students using realistic scenarios. The purpose behind this educational approach is to increase retention of learning by having students think independently and problem solve. There are two key features of PBL. The first feature is student-centeredness. Learning takes place in small groups and is facilitated by instructors. The second feature is problem solving.  The goal is to have students solve specific problems and thereby enhancing the skills necessary to perform well throughout the curriculum (and in life). When PBL is successfully implemented, the presentation of clinical material serves “as the stimulus for learning” and this “enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice.” 1

Many research studies have analyzed PBL and compared this teaching strategy to more traditional approaches such as a series of didactic lecture. Leslie Nii and Alfred Chin compared PBL to lecture-based instruction by randomly assigning students to these two forms of instruction during their third year of pharmacy school and assessing the mean grade point averages (GPA) of each group.2  The goal of the course was to help students acquire the skills necessary to manage patients’ drug therapy.  Faculty members served as resources for students during PBL class sessions and facilitated meaningful discussions, with emphasis on skills necessary for pharmaceutical care. Students assigned to the traditional didactic lecture group were taught via presentation-style lectures. At baseline the GPA of two groups was not statistically different during the first two years of school when all students received traditional didactic lectures.  However, there was a significant difference in GPA during the third year of school when PBL was implemented.  Students who received PBL instruction had significantly higher GPAs during fourth year rotations than students received traditional didactic instruction. This suggests that PBL gives students a set of skills that enable them to more quickly become competent and self-sufficient, and may be more effective than traditional lectures. 2

Robert Cisneros and his colleagues completed a systematic review of PBL in pharmacy education based on research articles published between 1980 and 2000.3 In their review, several examples of PBL were described including the use of PBL in an introductory pharmaceutical care course, a therapeutics course, as well as throughout the second and third years of a pharmacy curriculum.  Most examples in the systematic review incorporated PBL after students had completed introductory science courses where they received didactic instruction.  In only one case, where PBL was used in an introductory pharmaceutical care course, that students were introduced to PBL early in the pharmacy curriculum prior to receiving other forms of instruction.  The results of these studies indicated that PBL was an effective method of instruction and could be successfully implemented during any year of pharmacy education.3  Given these positive findings, it is not surprising that PBL continues to be implemented in many pharmacy school curriculums today. Pharmacy education programs have placed more emphasis on patient care and PBL is well suitable to teaching students the skills needed in practice.

When considering Grasha’s Five Teaching Styles, PBL is best matched with the facilitator teaching style.4 Instructors guide students through the learning process while encouraging independent thinking and responsibility.  Students are perhaps more engaged because “real life” scenarios are presented.  Students are expected to consider the “whole patient” as opposed to one specific issue.

As a recent pharmacy school graduate, I have experienced PBL first-hand during a therapeutics course.  My experience was similar to the one described by Calvin Meaney in the “Creating a Critical Learning Environment” blog.5  Students were divided into groups of ten and each group was given several patient case scenarios to research, identify pertinent medical problems, and develop a therapeutic strategy. This approach fostered critical thinking and was an effective teaching method when group members reviewed material prior to attending the group sessions and actively participated during scheduled class times. However, in my experience, attendance was poor at many sessions and many students worked independently on the case studies.  Thus, the opportunity to capitalize on the strengths of PBL were often lost. Many students elected to forego attending PBL sessions when exams were scheduled in close proximity. Students wanted to use the time to study. In order to overcome this problem, it’s important to schedule PBL sessions at least two or three days apart from exams to encourage student attendance. As an alternative, teachers could make attendance a requirement.  In general, I found that pharmacy students appreciated the PBL sessions and benefited from the learning experience when they were focused on the material.

PBL is an instructional method that can, should, and does play a significant role in pharmacy education.  It fosters strong critical thinking skills.  Although initial findings seem to have positive, there is need for more research to evaluate the effectiveness of PBL in pharmacy education. Challenges will arise as PBL is more frequently used, but these can be overcome as educators become more experienced in this teaching strategy.

1.  Novak S, Shah S, Wilson J, Lawson K, Salzman R.  Pharmacy students’ learning styles before and after a problem-basedlearning experience.  Am J Pharm Educ  2006; 70: 1-8.
2.  Nii L, Chin A.  Comparative trial ofproblem-based learning versus didactic lectures on clerkship performance.  Am J Pharm Educ  1996: 60: 162-164.
3.  Cisneros R, Salisbury-Glennon J, Anderson-Harper H.  Status of problem-based learning research in pharmacy education:  a call for future research.  Am J Pharm Educ 2002; 66: 19-26.
4.  TeachingStyles and Instructional Uses of the World Wide Web [Internet].  Terre Haute (IN): Indiana State University; 2011.
5.   Meaney C.  Creating a critical learning environment [Internet].  Educational Theory and Practice Blog.  Baltimore (MD): University of Maryland; 2011.

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