September 26, 2012

Problem-based Learning …Does It Work?

by Omayma Kishk, PGY1 Pharmacy Practice Resident, University of Maryland Medical Center

As the field of pharmacy has shifted towards patient care, re-structuring of pharmacy curricula has occurred.  What once seemed like a foreign concept, problem-based learning (PBL) has become a common theme in not only pharmacy education but in the curricula for many other health professionals.

PBL is a teaching strategy in which the teaching and learning is focused around a specific problem (usually a patient case).  There are six main characteristics of PBL:1

1.   Learning is student-centered
2.   Learning occurs in small groups
3.   Teachers act as facilitators
4.   The problem (or case) is the base for organized focus and learning
5.   The problem helps to develop and use problem solving skills
6.   New knowledge is gained through self-directed learning.

The beauty of problem-based learning is that it helps portray what a student pharmacist will encounter in the real world.  PBL allows students the luxury to develop and fine-tune their skills; to practice how they would approach these problems without risking patient harm.  Some may argue that students may not be ready for PBL because they will not know where to look or what to focus on.  I personally have a great deal of experience with PBL because my entire pharmacotherapy year as a P3 student at the  University of Mississippi School of Pharmacy used the PBL methodology.  I had a lot of these same concerns and couldn’t understand how I was supposed to teach myself subjects I was not yet familiar.  I was skeptical.  It seemed the student was forced to assume the teacher’s responsibilities.

Student-centered learning is a key characteristic of PBL. PBL is very flexible and can cater to many different learning styles.  Each student can learn in the manner that works best for the individual.  For instance, I enjoyed lectures and liked to hear the teacher talk about things.  I was terrified of PBL because I didn’t think I would get to hear the information.  But, I was mistaken. I soon realized that I could learn about the disease state by listening to my classmates.  I gained so much from our conversations.  I didn’t feel intimidated to ask questions.  Together we shared charts, resources, and ways to better understand the material.

Having a facilitator to help guide the discussions is important to keep the group focused and help direct the students with the case, especially the first part of the case.2  Only when the group is going in a completely wrong direction or developed a significant misunderstanding about the topic or the problem should a facilitator step in. Without this guidance, it would be difficult for students to know where to focus their efforts. In a study examining PBL learning strategies and outcomes among second year medical students at the University of Nebraska, student performance on examinations did not differ when students or faculty members served as facilitators.  However, students said they took more short cuts when a student facilitated the group.3  I recall some of my facilitators that “kept” the group for the entire two hours, forcing us to discuss every detail.  These were some of the group sessions where I learned the most.

PBL can be a daunting experience for students because the student really has to push him/herself to locate the material and study it.  You have to become a more skilled self-directed learner.  Students that have gone through PBL have said it is much harder than conventional didactic instruction.  But it is also more stimulating, engaging, and relevant than those boring, passive conventional lectures.4 PBL helps the student, early on, learn interpersonal skills and how to keep the patient’s needs in mind when developing treatment and monitoring plans.

For me, PBL was difficult but now that I have done clinical rotations both as a P4 student and as a PGY1 pharmacy resident, I truly appreciate all of the tools and skills I gained from PBL.  PBL cannot prepare students for every case or problem they will encounter, but it does build the skills needed to help solve problems.

1.   Kilroy DA. Problem based learning. Emerg Med J. 2004; 21:411-3.

2. Ross LA, Crabtree BL, Theilman GD, Ross BS, Cleary JD, Byrd HJ. Implementation and refinement of a problem-based learning model: A ten-year experience. Am J Pharm Educ. 2007;71: Article 17.

4. Nandi PL, Chan JN, Chan CP, Chan P, Chan LP.  Undergraduate medical education: comparison of problem-based learning and conventional teaching. Hong Kong Med J. 2000; 6:301-6.