Medteal Education, 1983, 17, 1-16 Problem-based learning: rationale and description H. G. SCHMIDT Depariment of Eacational Development and Research, Faculty af Medicine, Riksunverlt Linburg, The Netherlands Summary Problem-basey ‘order to test this assertion the process of problem-based learnini ecilily. Some empirical evidence regarding the approach is presented. Key words: Teacuino/*methods; *PRosLeM soLv- No; LEARNING; EDUCATION, MEDICAL, UNDERGRA- Introduction In the QEAAUEMEEDDiterature the concept of problem-based learning is presented as a useful instructional alternative to conventional procedures. It has been suggested that problem-based learning Gomes wi students have to eequire in tradi Cae ine ae e ednion Correspondence: H. Development and Resorch, Rksoniversst Limburg, PO. Box 616,c200 MD Manse, The Nehetands. Seint, Deparment of Eucaons 10/85/1200. doo) $02.00 © 1983 Media Eaton residents of a large general hospital were in S0% of cases unable to perform critical screening activites fon patients that were suspected to have pyelone- phritis. When tested on this subject by means of ‘multiple-choice questions this same group performed quite well. Their mean score on this (est was equal 10 82%. Other examples can be drawn from the non ‘medical educational literature, Driver & Easley (Anderson, 1977) conducted research among high school physics students, Interviews were conducted regarding the movements of balls along a horizontal track, According to Driver é& Easley many of the students manifested ‘an Aristotelian notion that constant force is required to produce constant ‘motion ....while they used the language of Newto- ‘nian mechanies, such as force, momentum, impulse, ete. These students were acquainted with the con- cepts of modem mechanics, but were unable to use them in understanding real-world phenomena, Wil- lems and his co-workers (Willems, 1978; 1981) established essentially the same phenomenon in investigations among studenis of law, social geo- raphy, planaing science and sociology. When writ- ing a report on some lopie or solving problems, these students seem to be unable to use the knowledge they had acquired. ‘The main conclusion that has to be drawn from these results is that people can possess knowledge which they seem unable to apply. They know information but cannot use it. This conclusion is in accordance with findings in educational psychology. Mayer & Greeno (1972) for instance, show that ifferent instructional methods produce different Teaming outcomes. The way in which a topie is aught determines what students can do with the information acquired. In shor, conventional instruc-2 4H. G Schmidt tional procedures do not always enable students to make appropriate use of their knowledge, ¢ to solve problems, ‘The question arises whether problem-based learn- ing, as an instructional method that evolved out of the needs of professional practice (Barrows & Tam- blys, 1980), is more suitable for this task than ‘radiional education. In order to be able t give a provisional answer to this question, comment will first be made in general about conditions that foster human learning. Next the process of problem-based learning will be described in some detail with reference to the preceding remarks. Finally some of the effects of the problem-based learning approach will be reported, In order to be able to evaluate the characteristics of problem-based learning a frame of reference is needed. It can be provided by the information processing approsch knowledge. he role of prior knowledge in oy its nature, has Tt presupposes earlier knowledge that is used in understanding new information. For in- stance, by studying an article about defence mecha- nisms against infections, he already possesses in o information. A. first-year st, While reading and interpreting the article, will probably make use of his secondary-school knowledge of biology. perhaps supplemented with common sense knowledge on bacteria, viruses, influenza and vacei- nations. A fourth-year student, in studying that article, will use his immunological and microbiolog! cal knowledge, acquired earlies. This structure in which it will determine what is unde sood from the article and this, in tura, will define what is learned fiom it (Rumelhart & Ortoay, 1977). ‘This relationship between prior knowledge and learning could be demonstrated with first- and fourth-year medical students, who read the same article and have the same amount of reading time available to process it The fourth-year students will show better learning results because theit more elaborated prior knowledge will enable them to process the new information more easily. Experimen- {al evidence for this assertion is provided by Dooling & Lachman (1971) and Bransford & Johnson (1972), Instructional methods, however, differ in their eapa- city to induce activation of relevant prior knowledge (Mayer & Greeno, 1972). Only in as far as they help students in activating relevant knowledge they will facilitate the processing of new information (Mayer, 1982), (2) The second condition that facilitates learning ‘lance between the situation in which something is learned and the situation in which itis applied, the better the performance, This phenomenon is called specificity. It is practiced during clinical Tectures or clerkships, where students acquire know- ledge related to patient problems that have character- istics in common with what students will encounter in later professional lie Cie ti oi ts 5 AED of knowledge. Only recenlly cid psychologists die Mayer, 1978), 65 learned _with ‘other students (Rudduck, 1578), by jwhat they have first learned them elves (Bara (Wittrock, ul, 13 (Schmidt, 1982) ‘According to Reder (1980) elaborations provide redundancy in the memory structure. Redundancy can be viewed as a safe-guard sgainst forgetting and an aid to rapid retrieval In conclusion, in order to help students i ‘one or more of these conditions are not met, the quality of instruction will suffer.Problem-based learning To assess the extent that problem-based learning meets the requirements stated above, itis necessary 10 take a closer look at it. That will be done using an ‘example borrowed from Schmidt & Bouhuijs (1980) “The proces of problem-based learn GRID suchas the totowing: ‘A plumber sz is sor wth he following complaint: ‘Dring shard coh ths morning T suddenly ated blood in ay ‘nous As this has occured more often thes past ew weeks coming aos jon of the process ‘would they order, what they perform and what treatment would they sug ‘est? This task is secondary to that of explaining the ‘symptoms, because understanding precedes rational 3, both in ed i soa fe ile cn il ee se nlonatewinigr Tnvono name Pinoy bafta wicbasivoten hele aep pee eae es ice ‘Tas 1 Step inated ry students dealing with the ‘oral blood Loss’ problem should be unfamiliar with @ plumber’s duties, the dictionary will inform them that he engages in the “installation and maintenance of water-conduits and sewerage systems in and about the buildi SEE Ne oie ercect phenomena should be explained. More often than not problems do not present difficulties in this respect. Occasionally, however, a problem is inten- tionally structured to tax students about the recogr tion of symptoms. Some problems consist of a series of secondary, independent problems; these must be ‘identified as such before further completion is possible, Le, the question to be answered in order to define the problem is: Which phenomena have to be explained? iA STEER os pera oc hetat te pine sett imprestion of he sation described, which results in ideas and suppositions ‘about the structure ofthe problem. These ae either ‘based on students’ prior knowledge or ae the result of rational thought. Hence, analysis of the substantially consists members about the underlying processes and mechanisms. The ‘group does not confine itself to activation of prior knowledge (Te read somewhere that.) but also tries to formulate relevant hypotheses by sound reasoning (Could it be that...) Most athe time a kind of fee asociation-round is held, in which each individual i allowed to verbalize ideas freely before the ideas, knowledge and supposi- tions are scrutinized, accepted, complemented of modified This pocedare i often refered to asthe Ceres "Application of analytical efforts af tisKindt he oral blood es problem nay Yield the flloving line of thought, stated by & verbatim transcript of an actual problem-analysis by 1 group of Dutch first-year medical students. tn probenased ng Sep 1 Sep2: Sip Sup & Sip 5 Sep 6 Sep? Define ihe proble. ‘Anus the probien, Formal lesan abesies Syathedse ant i ‘Clas trms a eoneeps not edly competes ‘Brae a syncmatsinyentary of the explanations afer fom wep 3 Collet auton intarmation ousie the group seq inemation“ HG. Schinidt ‘Could we hve ace fang ceser hee? The se foi fhe (rar lod acd not eth longs at al aj he haat rhe (mow ef may base onesered at how? Coughirgsbjes Bed euch to pute ines’ people nho cough siprusy ote armed i the fe Does that not point fo art vee? For ‘hat mater does are cough? The reason maybe the psec oF Sion i the si postage. am ile pean or pale Cohen efexinehunte arclearng he reir tact and npeing Trig Dosen ‘Foon suing fom herculass sometimes eowgh up bod “rhe umber handel sft 2 wees he eal load ls. imran wonder ithe ns seul been coupe uch lo Fens te rs ser, Eat wy tos ioe? Teas agin fades ealasecxpelion os ean of ae ress sucha igh rps ta ometing ges damaged ame? Wale wall be lhe obemtion cesing be coin stile. Being plume he equ mais Ogi ooo ad pcs ie ouy ao hake Canta sewe eld heute intamtion of he neous Stemtrae fe ripnty ste ened by itso something SIs fo mp opinion eral glnds ie the mucous membrane ‘Sct n sbpormal ant of macs 0 pote ie Body sgt thats Bu via tert he Rood? iy th way cancer af he lng is 2 growth of maioant cell natn Tag tse, expands inthe longs sata they can 20 wer teh proper; Wel {ara oot sue aboot the stat procs Tuberalos Tint a= esse brought bot BY (he {iit tac A peo taeatin ofthe rg 4) In the fourth se is mad the above analysis, several general descriptions o} biological phenomena were advanced. The first one relates (0 the studen's' ideas about the origin of the ‘coughing (reflex mechanism activated to clear the respiratory tract and expel obstructions’. The second covers the possible connection between coughing and 1 bleeding (ean imagine that the sudden explosive expulsion of a stream of air results in such s high air pressure that something gets damaged’), The other descriptions refer wo the many obstructions that may affeet the air passages (inflammation of the mucous ‘membrane’, ‘cancer ofthe lungs’, tuberculosis’). The systematic inventory might yield the scheme shown ig. ‘An inventory such as this acts as a kind of Fa. Schema presentation ofthe or bd as prob. summary and structures the product ofthe problem- analysis. ‘The point is now reached when the assumed processes and mechanisms referred to in the analysis are to be studied more extensively, To what degree can the expressed knowledge and ideas be considered correct and complete? Study priorities have 10 be established because, as a rule, there is not enough lime to pay adequate attention to all aspects in- volved. ° eclie es rion hee ae temmner ote (Gis see relia he proces the following questions might arise: ‘What physiological mechanisms are involved in the coughing reflex? In what way does draught affect the air passages? How does bleeding result from coughing? ‘What causes mucous membranes to become inflamed and what does the membrane look like in this state? ‘What isthe effect of smoking on the respiratory tract? ‘What is lung cancer? ‘What is tuberculosis? Th il ind, if necessary, agrees ona distribution of tasks, Finally it ries to find out which learning resources might supply the required an- plored a ‘other tools may also mut their individual findings, supplement this knowledge, and correct it where necessary. It is then established whether the group is now capable of aiving more detailed descriptions ofthe fundamental processes, in the problem. Often new questions are proposed in the course of this exchange of informa- tion. In that ease the group may decide to take up again the process of problem-based learning—now at 4 decper level of understanding—starting with the fourth step. However, it may prove equally effective in that phase to exploit the newly acquired know-Problem-based learning Is ledge by tackling a different, though related, problem in order to find out whether the group can now perform the analytical and explanatory task in a faster and better way. Discu When the conditions that facilitate human learning thee principles were discussed, i was concluded that ‘[Link] the requirement that problem-based rior knowledge Written students are asked (0 study “the regulating mechanism of the human body’, this task will not lead to activities such as described in the preceding section. But the following problem will do so: You have been playing a game of tennis. You've red face and are wet all over your body. How can tis no use trying to solve i ‘esd on ye Tamblyn (1980) and Neame (1981) further specily ‘or morbidity or mortality, in which intervention— preventive or therapeutie~can make a significant difference in prognosis they ate sot mee) reper docmg Knowledge toyed at some pia inthe pa. They are wing this ktowedge ast for inking” In doing se, peviouly unread concep toenac toneced ia’ memory, newly produced nights change ite srutre of hr copton and infra tion supplied by pen is edded The nme applies 0 the la sep ofthe problem: bse ering paces where newly acted infomation ir exchange, Trica) assed and eventually applieg. These sre the activites That can be veWed. ns elaboration proses So i oly eID protien based eaming appromh ase stcina method fave been dasa The question is wheter hte a Teenage eecuvenes of the approach Ove eta ask whether problbesed learning relly promote the acquson of know ledge tha applenble, Research on tis pie proses at he Department of Educational Develop. met and Research at Massena one inves ton Bashen & Caeoen (1981 compere Brows of siudens at Maaseh (where the poblenebased Ieaming appronch has been adopted) wih students from a tediuonal medial tut in number of problnslvng tsk Each student ws sven ease Ristori of two pains string om pancreas tnd pratt Escho thee ase hisses Was preset on ater of cad tach ard containing apy ness eer nestor rodent ad (eed these cards an comment on he information, Afr prowrsing the cae istry i it pene apres aes rue downs dilfntal dlagnes to ‘ale information on the ces in lms eis importance, td to real the information, Some small bute6 HG. Schmide differences were found in favour of the Maastricht ‘medical students. This suggests that a problem-based curriculum may provide better opportunities for learning to solve medical problems. In another investigation the present viiter tested the problem- based learning hypothesis more directly (Schmidt, 1982), Small groups of students analysed a written problem on osmosis. Subsequently, they studied @ Text contsining new information relevant (o this topic. As compared with control subjects that only studied the text, the experimental subjects were better in recogaizing the information from the text and in tsing it in order to solve small problems. ‘The conclusion is that the available theoretical views and empirical evidence suggest that problem- based leaming, in the least: be considered a useful addition to conventional instructional methods, and can perhaps be used as an alternative approach. ANDERSON KC. (197) The ation ofseemata andthe educational ates genera cession of the soofeente. It RC. [[Link] & W.E. MoNtaGUe (2c) Suen od ‘ioscan ftw, Bib, ls ANDEGOLEC &Biboxe WE. 1975}On eslag people questions ‘how! What thoy are vedio nt O. #H. Bown (ol) The Poche of Cem and Moran, Vol. 9, Academe Pres, Now York ANDERSON. REDE LM. (1979) An elaborate progesing ‘plano of eh of poeung Ie L-S. CaRwak & PL (Gta et) Let of Proce tv Hanae Memory. Eabivs Hide Bake FA. & Sent ¥. 1960) On he eoguive benef of Teclig, Jeena of Eacatnl Poyhlog, 1, S93-604 Baanovs HS. & Tasers, RM (8D) Problem uted lara ‘Spiga Pie's, New Yor, Bogus. HA. & CLAESEN, HEA. (1982) Cogateve ver. ‘edge onthoden van panlgegevs (Commie processing {nd eal of pain dats) ec HG. 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