(1993), can lead to a wide variety of learning environments. A number of environments reflecting these
principles are described in Duffy and Jonassen (1992) and Duffy, Lowyck, and Jonassen (1993). Further,
the elaboration and application of these principles to specific contexts is described in Brooks & Brooks,
1993; Fosnot 1989; and Duffy (in press). In our own examination of learning environments, however, we
have found one application that seems to us to almost ideally capture the principles -- the problem-based
learning model of Howard Barrows (1985; 1992).
Problem-Based Learning (PBL), as a general model, was developed in medical education in the early
1970's and since that time it has been refined and implemented in over sixty medical schools. The most
widespread application of the PBL approach has been in the first two years of medical science curricula
where it replaces the traditional lecture based approach to anatomy, pharmacology, physiology etc.. The
model has been adopted in an increasing number of other areas including Business Schools (Milter &
Stinson, 1994), Schools of Education (Bridges & Hallinger, 1992; Duffy, 1994); Architecture, Law,
Engineering, Social Work (Boud & Feletti 1991); and high school (Barrows & Myers, 1993).
As with any instructional model, there are many strategies for implementing PBL. Rather than
attempting to provide a general characterization of PBL, we would like to focus on Barrows’ model
(Barrows, 1992) to provide a concrete sense of the implementation of this process in the medical school.
First we will present a general scenario, using the medical environment as the focus, and then examine
some of the key elements in some detail.
When students enter the medical school they are divided into groups of five and each group is
assigned a facilitator. The students are then presented a problem in the form of a patient entering with
presenting symptoms. The students' task is to diagnose the patient and be able to provide a rationale for
that diagnosis and recommended treatment.
For example, the students begin the problem "cold" -- they do not know what the problem will be until it is
presented. They discuss the problem, generating hypotheses based on whatever experience or knowledge
they have, identifying relevant facts in the case, and identifying learning issues. The learning issues are
topics of any sort which are deemed of potential relevance to this problem and which the group feels they
do not understand as well as they should. A session is not complete until each student has an opportunity to
verbally reflect on their current beliefs about the diagnosis (i.e. commit to a temporary position), and
assume responsibility for particular learning issues that were identified. Note that there are no pre specified
objectives presented to the students. The students generate the learning issues (objectives) based on their
analysis of the problem.
After the session, the students all engage in self directed learning. There are no assigned texts.
Rather the students are totally responsible for gathering the information from the available medical library
and computer database resources. Additionally, particular faculty are designated to be available as
consultants (as they would be for any physician in the real world). The students may go to the consultants
seeking information.
