Problem Based Learning

The instructional design principles, implemented within the framework of the values outlined by Lebow
(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.