Medical Teacher, Vol. 18, No.

2, 1996

AMEE Medical Education Guide

No. 7.
Task-based learning: an
educational strategy for
undergraduate, postgraduate and
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continuing medical education,

Part 2
For personal use only.

R. M. HARDEN, JENNIFER M. LAIDLAW, JEAN S . KER & HELEN E. MITCHELL

Centre for Medical Education, University of Dundee, Scotland, UK

SUMMARY Task-based learning (TBL) supports the notion Define the aims and objectives of the training programme
that learning in medicine can occur most effectively when
The usual first step in the development of any education
related to the tasks undertaken by the healthcare profession.
This applies in undergraduate, postgraduate and continuing programme is to define aims and objectives (or learning
education. In undergraduate education, TBL facilitates ver- issues) for that programme. How can we start a journey
tical integration of the curriculum, introducing relevance and unless we know where we are going? What content should
the application of theoy to practice in the early years of the be included? What is the breadth of experience required
curriculum, and providing a strategy for continuing a study by the end of the programme? Identification of the
of the basic sciences in the later stages. In postgraduate learning issues is important in ‘scoping’ any educational
education, T B L enhances the value of on-the-job learning programme.
and can help resolve the conflict between training the doctor Much of the work may already have been done. Medi-
and providing a service. In continuing education, TBL can cal schools, colleges and other postgraduate bodies contin-
assist the doctor to build repertoires of skills, knowledge and ually publish statements of what they see as the aims and
understanding based on continuing practice. Eight aspects of objectives of their training programmes. If available state-
implementing TBL merit consideration: determination of the ments do not form a suitable basis and the thought of
course aims and objectives; speca$ication of the tasks; prep- undertaking the work seems too daunting, the medical
aration of a grid charting aims and objectives for each task; teacher may find it easier to go to the second step and
appraisal of the options for introducing TBL in the curricu- specify the tasks, returning at a later stage to look at the
lum; provision of learning opportunities; determination of the learning issues.
role of staff in TBL; the development of study guides; and A range of approaches can be used to determine the
organization of student assessment. educational needs for a training programme (Harden,
1986). Three aspects should be considered.

Are the objectives core, where all students should dem-

Implementation of task-based learning
onstrate mastery, or are the objectives optional, where
Having considered the concept of TBL and its rationale in students have a choice?
Part 1 of this guide (Harden et al., 1996) we will now look Are the objectives in the knowledge (cognitive), skills
at how it can be implemented in practice. Our examples (psychomotor) or attitudinal (affective) domains?
come in undergraduate, postgraduate and continuing edu-
cation, from a range of sources. There are eight steps in the Correspondence: Professor R. M. Harden, Centre for Medical Education, Tay
implementation of task-based learning. Park House, 484 Perth Road, Dundee DD2 lLR, Scotland, UK.

0 1996 Journals Oxford Ltd

0142-159W96/04/020091-08 91
 R. M. Harden et al.

Are the objectives subject specific, relating to mas- Table 1. ‘Tasks’ used in TBL for vocational
tery of the subject, or general, involving transferable training in general dental practice.
skills such as management, team work and problem
solving? (1) Patients with a caries problem
(2) Orofacial pain
(3) Endodontic problems
Spec& the tasks (4) A periodontal problem
(5) The patient requires minor oral surgery
Tasks should be chosen to reflect the real or expected
(6) Full dentures
workload of the trainee or student. When specifymg or
selecting the tasks that will be used as the focus for
the learning, consider three things: access, focus and How does the task provide a good focus for learning? A task
context. should provide a focus around which the student or trainee
acquires:
Does the student or trainee have access to the task? It is the specific knowledge, skills and attitudes in the
pointless to select a task the student is unlikely to encoun- area of study;
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ter and to which he or she cannot relate. In the develop- general principles relating to the topic;
ment of a TBL programme for vocational training in a basic understanding of the topic, including the
dentistry, an early assignment was to identify those tasks basic medical science;
encountered regularly in day-to-day work by trainees generic or transferable skills, e.g. communication
in general dental practice. Six tasks were identified skills, management skills.
(Table 1).
Table 2 lists the tasks identified as a focus for students’ For example, in the dental example (Table 1) the tasks
learning in undergraduate programmes in obstetrics and provided a focus not only for the development of the
gynaecology, paediatrics and ophthalmology in medical dentist’s competence in the topic covered by the task but
schools in Bangladesh. All reflect the activities that the also more general competences-such as health
For personal use only.

students encounter as part of their undergraduate promotion, communication skills, practice management,
programme. management of emergencies and teamwork.

Table 2. The tasks selected in Bangladesh as the focus for the curriculum in three subjects: obstetrics and gynaecology,
ophthalmology and paediauics.

Obstetrics and gynaecology

(1) The management, at a primary healthcare level, of a normal delivery
(2) The management of a patient with pre-eclampsia
(3) A general and local examination in a patient with symptoms of pregnancy
(4) The appropriate investigations in a woman who is bleeding in early pregnancy
(5) The initial management of a patient with bleeding in late pregnancy
(6) A vaginal examination to assess cervical dilation level of presenting part caput and moulding
(7) The recording of labour progress on a partograph
(8) The assessment of foetal condition in labour using auscultation and observation of liquor

Ophthalmology
(1) The initiation of treatment for conjunctivitis
(2) Minor surgical procedures affecting the eye, e.g. stye or chalazion
(3) Relevant investigations at primary healthcare sites for common eye conditions
(4) Relevant records of patients with ophthalmic conditions
(5) General and local examination of the eye
( 6 ) Obtaining an appropriate history from a patient with an eye complaint
(7) Advice for a patient with conjunctivitis about adequate preventive measures

Paediatrics
(1) The diagnosis and management of a child with loose motions
(2) The management, in a primary-care setting, of a child with an acute respiratory infection
(3) The initiation of the management of a child with febrile convulsions
(4) Examination of the newborn child
(5) The management, at a primary healthcare level, of the initial stages of treatment of a child with protein-energy
malnutrition
(6) Advice for mothers on the appropriate measures to avoid recurrent problems of diarrhoea

92
 Task-based learning, Part 2

Table 3. The three tasks designated as a basis for the cardiovascular system course in Year 2 of the undergraduate medical
curriculum at Dundee University.

Week 1 task
You are appointed the Cardiovascular Disease Prevention Officer for the second-year class of students. How are you going
to go about this?

You should consider screening your colleagues (for what?), devising a health education campaign, issuing
recommendations for adopting healthier lifestyles, follow-up to assess impact and success of the programme.

Week 2 task
It is reported at a meeting of the Tayside Health Board that the mortality in patients with myocardial infarction is higher in
Tayside than in other regions in Scotland. It is suggested that, as the effectiveness of therapy in myocardial infarction is
related to how soon it is given, delay in receiving treatment may be a factor.
You are asked to investigate and make recommendations for the public, the primary care services and the hospital services.
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Week 3 task
You are contacted via e-mail by a 48-year-old journalist who is currently on a South Sea Island. He would like you to give
an opinion about his recent complaint of chest tightness and to assess his risk-factor profile for heart disease.
Devise a questionnaire written in plain English that could complete and transmit back to you to allow you to give him the
opinion he has requested. Also provide a commentary for him on the value and limitations of this approach.

Many of the tasks chosen in the Bangladesh example Table 4. Tasks selected for hospital ward and outpatient
(Table 2) emphasize the practical requirements of training clinic, as a learning focus for senior house officers in child
For personal use only.

currently expected in that country. In areas such as obstet- health.

rics, paediatrics and ophthalmology, referral for specialist
opinion may be less available than in the UK. Hospital ward Outpatient clinic
Table 3 lists the tasks chosen as a basis for the student’s
work during three weeks in the cardiovascular system Acute abdominal pain Asthma
course scheduled in Year 2 of a five-year curriculum at the Acute oncology Behavioural disorders
University of Dundee. Each task reflects the key aims and Acute poisoning Constipation
objectives of the week’s programme. The first week, for Breathlessness Diabetes
example, has lifestyle and prevention of coronary artery Convulsions Epilepsy
disease as a major theme. Later weeks look at the investiga- Dehydration Failure to thrive
tion and management of cardiac problems. The tasks are Injured child Headache
specified in some detail, in contrast with the specifications Moribund child Malignancy
in the examples in Table 1 and 2. Pyrexia (and rash) Short stature

W%at is the context of the education and training? It is

important in implementing TBL to consider the context.
natal unit and in the community. The tasks for the first two
TBL may be implemented in a variety of contexts includ-
of these settings are set out in Table 4.
ing clinical settings such as the hospital ward, the hospital
outpatient department or the community, or the practical
laboratory.
Use grids to match learning issues with tasks
The tasks in the dental example (Table 1) and, to a
lesser extent, in the example from Bangladesh (Table 2) In planning a course and preparing a coherent learning
reflect an emphasis on the trainees’ clinical environment. plan, it is often helpful to prepare a grid on which the
The dental trainees did, however, have a day-release pro- learning issues (aims and objectives) are related to the
gramme; in Bangladesh, the students had classroom teach- specified tasks. This makes clear how the tasks will meet
ing in the format of lectures. In the example from the course objectives. Some objectives may be addressed
cardiovascular course (Table 3 ) , the tasks were not based through more than one task. An example from the grid for
directly on the ward experience of the students but were vocational training in dentistry is given in Table 5.
developed for work by the students in time set aside for An alternative form of grid has been used in undergrad-
this, through working in small groups. uate programmes, particularly when these are integrated.
A study of TBL in the training of senior house officers, The tasks identified are listed on the chart vertically, and
being undertaken for the Scottish Council for Postgraduate the major themes of the course are arranged horizontally.
Medical and Dental Education, identified tasks as a focus At each intersection, the learning issues to be covered
for learning in the clinical situation: the SHO was working under each theme as the task is studied are noted. Exam-
in the paediatric wards, in outpatient clinics, in the neo- ples of the themes are given in Table 6.

93
 R. M . Harden et al.

Table 5. First two parts of the objectiveshasks mastery grid for vocational training in dentistry.

Tasks performed by the trainee*

Acute Partial or Minor

Canes A periodontal dental An endodontic complete surgical
and restorations patient pain problem denture procedures

General
Critically appraise and
assess his or her own work + + + + + +
Keep up to date and continue
with his or her education + + + + + +
Understand not only what he
or she is doing, but why it is
being done + + + + +
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Communication with patients

History taking + +
Explanation of the clinical
condition + +
Explanation of suggested
treatment plan and alternatives + +
Explanation or cost and obtaining
consent to pay + +
Explanation of preventive aspects
of the patient’s problem + +
For personal use only.

Explanation of recognized
complication related to
treatment + - + +
Explanation of appliance
inconvenience or failure - - + -

Explanation of necessary
appliance adjustment or
modifications - - + -

Note: *Applies + j may apply 2 j does not apply - .

Such grids may help course planners, teachers or train- It covers themes related to the task, in the form of
ers implement TBL. They may also aid students or presentations and small-group discussions.
trainees. At the other end of the spectrum, TBL is added to, and
complements, an established programme. Information
Determine the role of TBL in the curriculum about the task is given to the student for private study,
supplementing the programme of lectures, practicals and
A decision (which need not remain eternally fixed) has to clinical work.
be taken about the role of TBL in the curriculum. TBL In the middle of the spectrum is a curriculum where the
can be adopted wholesale as the strategy for a new innova- student receives the task for the week early in that week.
tive curriculum or more gradually as part of the evolution Time is scheduled during the week for the student to work
of a more traditional curriculum. The question is not on issues related to the task. Lecture and clinical
whether one wishes to adopt the strategy but, as in the programmes are organized in parallel to this.
SPICES model (Harden, et al, 1984), where on the TBL TBL can be adopted in both integrated and discipline-
continuum one wishes to be. based curricula. The way in which T B L is introduced will
At one end of the spectrum, the curriculum is built also be influenced by the degree of integration in that
round a TBL approach: the timetable, learning methods curriculum. TBL is itself a powerful tool to facilitate
and learning opportunities all directly relate to TBL. The integration.
task for the week becomes the focus for the student’s work
during the week. All activities are planned round this. In
the dental example (Table 1) each of the six tasks in turn
Review the learning opportunities
becomes the major focus for the trainee to study on the job
that month-although he or she will of course also see It is important to consider the learning opportunities that
patients with other problems during this time. The will be available to support the student or trainee in TBL.
programme of more formal instruction through the In the undergraduate curriculum, as with problem-based
day-release classes is designed to support this focusing. learning, small-group work is likely to be the foundation of

94
 Task-based learning, Part 2

Table 6 . Themes considered in relation to each have been reviewed recently by Des Marchais & Chaput
of the tasks identified in the system-based (1993).
undergraduate programme. However, many teachers, and trainees, will have little
previous TBL or indeed PBL experience. The introduction
Clinical methods of TBL must therefore be accompanied by a staff
Investigative procedures development programme.
Normal structure and function
(a) specific to system under consideration
(b) general principles
Abnormal structure and function Ensure appropriate communication by the provision of study
(a) specific to system under consideration
guides
(b) general principles
Biochemistry An essential aspect of TBL is communication with staff
Microbiology and students. All concerned should become familiar with
Genetics programme aims and objectives, and how these will be
Age-related factors achieved. It is not enough to give the students a list of tasks
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Public health and tell them to ‘get on with it’. Guidance is needed to
Health promotion and disease prevention maximize learning round the tasks. The amount of assist-
Pharmacology ance required will vary with the experience of the learner in
Surgery the area and with his or her approach to study.
Emergency care Reference has already been made to the role of a grid in
Other aspects of patient management communicating the objectives of the programme. An ex-
Ethics tremely valuable, additional, tool in TBL is a study or
Self-audit training guide. Experience has shown that, if properly
Computers and information handling developed, such a guide will be of great assistance to staff
and students alike. The guide may be in print (Laidlaw &
Harden, 1990) or in computer format (Harden & Smyth,
For personal use only.

1995). Examples of the type of information in a study

TBL. In postgraduate education, trainees may work on guide assigned to support TBL are given in Figure 1. The
their own.
Other learning opportunities will include whole-class
Helping You Get Along With the Guide
sessions. These may be lectures, where material is pre-
sented, or more interactive sessions, giving greater oppor-
tunity for discussion and for students or trainees to assess Six symbols are used in this guide to facilitate your reading
their own competence. Planned practical classes and clini- _ you
and help _ -predict what the next part of the text is about
cal sessions-in the wards, at outpatient clinics, in a clini- Recommended reading in a book or journal.
cal skills laboratory or in the community-also have a role
to play. Important too are learning resources materials for
independent study-in the form of books, journals,
videotapes, computers and multimedia applications. These
help the trainee or student explore the learning issues

El
related to the tasks. Respond to a question.

Clarify staff role and organize appropriate staff development

The role of staff in TBL should be clarified. Are staff to be
concerned with planning the TBL programme (including
the first four steps described above)? Have they to help
develop resource material relating to the task? Is their role
‘6-1 Watch your trainer in action.

to provide student support and to facilitate the work of the Embark on some sort of Activity, Assignment, or Analysis.
student, individually or in small groups? Are they to act as
a resource or subject specialist in a selected area, such as
microbiology or genetics? Are they to monitor the students’
progress and to assess the students’ achievement of the Figure 1. Categories of material in training guide for dental
course objectives? vocational trainees to support a TBL programme, each
Inevitably, there will be a switch of emphasis-many identified throughout the guide by an icon. Each task was
would argue a welcome switch--from the teacher as a covered in the guide as described in Table 1, after an
provider of information to the teacher as a manager of the introductory section about the approach adopted. The final
students’ learning. The tasks of the teacher in TBL have sections listed the learning resources indicated and
much in common with tutors’ tasks in problem-based reproduced the grid of objectives and aims for each task
learning (PBL) (Barrows & Tamblyn, 1980). These tasks (Table 5).

95
 R. M . Harden et al.

student can also include in the study guide a record of the unify clinical skills and basic sciences. Pate1 et al. (1988)
work they have done. have demonstrated that basic science information, when
provided without context, is not utilized in diagnostic
reasoning.
Design a reliable and valid student assessment procedure
Problem-based learning attempts to overcome this
In the introduction of any new approach to teaching and difficulty. In a problem-based curriculum, the focus for the
learning, assessment is critical (Harden, 1992). TBL is no students is usually a written problem relating to the week’s
exception. The assessment process should reflect, as does programme. It could be argued, however, that for the
the learning strategy, the aims, objectives and content of junior student with no clinical experience or understanding
the curriculum. Higher-level objectives, rather than only of medicine, this provides an inadequate clinical context in
factual recall, and the student’s application of theory to which to learn the basic science.
practice should be assessed. Portfolio assessment and per- In TBL, the context for learning is more closely related
formance-based assessment, through tools such as the to medical practice. Students may be expected, for exam-
OSCE (objective structured clinical examination), have a ple, to talk with a patient who has chest pain and to
role to play. undertake a few simple procedures, such as taking the
patient’s blood pressure. A list of learning objectives will
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include an understanding of the normal structure and

Task-based learning in the three phases of education
function of the heart. A study of the case, with associated
As a strategy, TBL is equally applicable in all three phases reading, and completion of the assigned practical work
of education: undergraduate or basic, postgraduate or vo- provide the student with an overview of normal structure
cational, and continuing. The previous section looked at and functions of the body-in the context where he or she
the eight steps in implementing TBL. Those steps are will later have to apply it.
applicable in all three phases of education. This section Much undergraduate medical training in the later years
looks more closely at aspects of TBL in each of the three is based on a clerkship model. Students are attached to a
phases. medical or surgical unit or to a family practice in the
community. This can be a powerful learning experience-
but has four main problems:
For personal use only.

Undergraduate or basic education

In undergraduate medical education, the emphasis has
progressed over the last four decades: from a student-cen-
There may be major gaps in the student’s experience.
wed approach, through integration among disciplines and
Students may not have the range of experiences expected
on through problem solving to relevance and the problem
of them by their teachers.
of information overload (Figure 2). TBL is a response to
Emphasis is placed on the individual cases of patients
this challenge, focusing on the tasks undertaken by health-
being investigated and treated. The student may not be
care professionals and on the learning related to these
able, or may not find time, to generalize what he or she
tasks.
has experienced to other situations.
The student may find it difficult to relate his or her
I Relevance clinical experience to formal courses, for example in,
I Problem clinical pharmacology, medicine, medical ethics.
I Integration solving
The development of the student’s knowledge and
Student
centred understanding of the basic sciences may not take place.
learning

1960s 1970s 1980s 1990s

Figure 2. Development in medical education since the This last point is a matter of particular concern. The basic
1960s. sciences are crucial to the practice of medicine, yet the
time allocated to their study in the early years of the
Traditionally, in the early years of a medical course, the curriculum has decreased. The promised integration of the
student is introduced to the basic medical sciences through basic sciences later in the curriculum has been found to be
a systematic study of these subjects. Occasionally, this difficult to deliver in practice.
study is illuminated by clinical examples presented by the TBL offers a solution to these difficulties. Lofaro &
lecturer. Over 30 years ago, Miller (1961) described stu- Abernathy (1994) have described ‘contextual learning’ in a
dents’ poor retention of basic science information pre- course in surgical critical care for junior medical students.
sented in this way. He claimed that any basic science The central concept was that “clinical experiences can
information retained will decrease at the same rate as provide a foundation on which basic science facts can be
nonsense syllables will. The challenge of integrating back- built, resulting in a solid understanding of medical sci-
ground medical knowledge with patient care, suggests ence”. TBL is an extension of this philosophy. In the later
Lockyer (1992), is often a real hurdle for students: most of years of the undergraduate curriculum, a TBL approach
their early years have been spent learning the appropriate allows the student to benefit fully from the rich learning
knowledge, skills and attitudes in isolation from the prac- experiences of the clinical situation. It also ensures learning
tice setting. She suggests it is important that curriculum is planned and supervised in a way that makes practical the
designers continue to develop tools and techniques which achievement of the programme’s objectives.

96
 Task-based learning, Part 2

Postgraduate education time available for formal education is limited. The extent
to which the doctor’s work experience can act as a learning
The continuum of undergraduate, postgraduate and con-
resource will depend on what the doctor makes of the
tinuing education is now well accepted. After qualification,
experience. TBL, used appropriately, helps ensure that
however, the pattern of training changes dramatically.
continuing professional education is more than technical
Education now has to compete with the doctor’s service
updating. A deep approach to learning requires a deep
commitments. These usually have the higher priority. The
approach to every working experience (Usher, 1986). This
model of education is one where the junior doctor or
can be provided through T B L the doctor can be encour-
trainee is an apprentice. He or she learns by watching
aged to think not only about what he or she is doing, but
seniors practising medicine and by practising under super-
also why they are doing it.
vision. Scholarly activity must complement the service
Practice-linked continuing medical education (CME)
component of the programme, suggests Lockyer (1992), to
can be a powerful tool in lifelong learning (Hoftvedt &
ensure junior doctors continue to develop a conceptual
Mjell, 1993). Using a TBL approach, where doctors are
framework and knowledge base for independent practice.
encouraged to use their own experiences and problems as
In postgraduate education, TBL can achieve this. The
a starting point for their learning, CME can be more
training guide (or study guide) can help ensure the doctor,
effective. The importance of relevance in education has
in relation to the tasks performed, further develops under-
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been acknowledged previously (Harden & Laidlaw, 1992).

standing of basic processes and mechanisms of disease.
Usher and Bryant (1987) have suggested that “the aim of
The guide can also help ensure that the knowledge and
continuing professional education courses is generally con-
skills gained in the apprenticeship model are not situated
sidered to be that of helping the practitioner improve
only in the particular context but are generalized to other
practice. Yet in emphasizing the transmission of theoretical
situations.
knowledge, the improvement of practice often becomes
The development of a TBL curriculum for postgradu-
ineffective.” They suggest a reformulation of the theory-
ate education increases uniformity of training, whether in a
practice relationship, in an attempt to avoid these prob-
teaching hospital or a district general hospital. On-the-job
lems. The relationship they propose is one of practice
training can be integrated with off-the-job training through
reviewed through theory. An essential aspect would be “to
attendance at courses or other educational opportunities.
create situations where practitioners, in the relative safety
For personal use only.

TBL, with the training guide, can form a basis for curricu-
of the classroom, come to see their practice as problematic,
lum planning. If used appropriately, it can lead to better
and are supported in subjecting it to serious scrutiny and
planned postgraduate education, with aims and objectives
theoretical review”.
shared between trainers and trainees.
TBL achieves just that. Senior doctors learn in a self-
Postgraduate education in the UK, and elsewhere, is
directed way through a personalized approach. They may
changing. There are new demands for greater effectiveness,
need assistance, however, in identifjmg the learning issues
efficiency and openness about education and its results.
relating to the tasks they are doing, and in having access to
TBL can help: in meeting these demands and in imple-
resource materials which will allow them to explore the
menting the frequently ambitious programmes of training
issues further. Bligh & Harden (1 990) described how TBL
set out by the Royal Colleges and other postgraduate
can be applied in the continuing education of general
training bodies. TBL offers the much needed structure and
practitioners.
focus for postgraduate education that previously was all
too often lacking. In its application, the different players-
from postgraduate dean to educational supervisor-each
The continuum of education
have a role which should be defined. Experience demon-
strates that TBL is particularly effective in allowing the The General Medical Council (1993) has recommended a
supervisor, through the use of a training guide, to support dialogue between those providing undergraduate and those
and monitor training. providing postgraduate education. “The concept of a con-
As the TBL approach is applied increasingly in post- tinuum of learning-uniting the educational experience of
graduate education, we must ensure training is not viewed the physician from admission to medical school through a
as conflicting with or competing with service but rather professional lifetime-has featured increasingly in the dis-
enriching it-through delivering improved competence in cussions we medical educators have about professional
practice and improved education. education” (Mann, 1994). Mann continues, “Making that
In postgraduate education, TBL should be designed to concept a reality has proven less easy to accomplish”.
allow the individual trainee to undertake activities that are Curriculum developers, planners and teachers have tended
progressively more independent. They may confront the to concentrate on specific phases of the continuum.
same clinical situations on a number of occasions, but on TBL in continuing education offers a focus for further
each occasion they should be guided to extend their work. By planning TBL throughout the continuum, tasks
responsibilities and their learning. first encountered in undergraduate or postgraduate studies
can offer the necessary continuity.

Continuing education
Discussion and conclusion
Postgraduate TBL can enhance the educational potential
of the doctor’s service commitments. This is even more Task-based learning, like any other educational approach,
important in continuing education, where the amount of is no panacea. TBL does offer a focused and structured

97
 R. M. Harden et al.

approach to learning. TBL supports the notion that leam- References

ing in medicine can occur most effectively when related to BARROWS, H.S. & TAMBLYN, R.M. (1980), Problem-based Learning.
the tasks undertaken by a healthcare professional. The aim A n Approach to Medical Education (New York, Springer).
of medical education is improved care of patients by a BIRCH,W. (1986) Towards a model for problem-based learning,
reflective practitioner. TBL offers a powerful tool to Srudies in Higher Educatirm, 11(1), pp. 73-82.
achieve this aim. BLIGH,J.G. & HARDEN,R.M. (1990) Bridging the gap between
hospital experience and general practice during vocational
It has become apparent that students and trainees have training, Medice Teacher, 12, pp. 169-173.
a wide range of learning styles. These are accommodated DESMARCHAIS, J.E. & CHAPUT,M. (1993) Validation by Network
by the flexibility inherent in TBL. This educational and Sherbrooke tutors of problem-based learning tutor tasks, in:
strategy can respond to different cognitive styles. P.A.J. Bouhuijis, H.G. Schmidt & van Berkel, H.J.M. (Eds)
Problem-based learning has been described as central Problem-based Learning as an Educational Srrategv (Maastricht,
to the purpose and value of higher education (Birch, Network Publications).
GENERALMEDICAL COUNCIL (1993) Tomorrow's Doctors: Recommen-
1986). Like problem-based learning, TBL offers an
dations on Undergraduate Medical Education (London, General
attractive combination of pragmatism and idealism: prag- Medical Council).
matism in the sense that learning with an explicit sense HARDEN, R.M. (1986) Ten questions to ask when planning a course
of purpose is seen as an important source of student or curriculum, Medical Education, 20, pp. 356-365.
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motivation and satisfaction; idealism in that it is conso- HARDEN,R.M. (1992) Assessment feedback and learning, in:
nant with current theories of education as described in Approaches to the Assessment o j Clinical Compeience (Dundee,
Part 1. Centre for Medical Education).
HARDEN,R.M. & LAIDLAW, J.M. (1992) Effective continuing edu-
Do we want to improve dramatically undergraduate, cation: the CRISIS criteria. AMEE Education Guide No.4,
postgraduate and continuing education? Do we wish to Medical Education, 26, pp. 408422.
respond adequately to increasing demands? It is uncertain HARDEN, R.M. LAIDLAW,J.M., KER,J.S. &MITCHELL,H.E. (1996)
whether further development and implementation of exist- W E E Medical Education Guide No. 7. Task-based learning: an
ing methods and approaches alone will allow this. What we educational strategy for undergraduate, postgraduate and con-
need is a new approach-ne that can accommodate all of tinuing medical education, (Part l), Medical Teacher, 18(1),
pp. 7-13.
the current challenges to education. That approach is
HARDEN,R.M. & SMYTH, J.J. (1995) Computer-based study guides
task-based learning. Its further exploration and adoption is
For personal use only.

11: educational components and advantages, Medical Teacher, 16,

merited. In this guide we have suggested how this can be 309-3 14.
done. HARDEN,R.M., SOWDEN,S. & DUNN,W.R. (1984) Some educa-
tional strategies in curriculum development: the SPICES model.
ASME Medical Education Booklet No. 18, Medical Education,
18, pp. 284-297.
Acknowledgements HOFWEDT,B.O. & MJELL, J. (1993) Referrals: peer review as
We are grateful to Neil Stamper for his assistance with the continuing medical education, Teaching and Learning in Medicine,
5(4), pp. 234-237.
preparation of the manuscript, and to all the members of LAIDLAW,J.M. & HARDEN,R.M. (1990) What is a ... study guide?
staff who developed the examples we have used to illustrate Medical Teacher, 12, p. 7-12.
the guide. LOCKYER, J.M. (1992) Physician performance: the roles of knowl-
edge, skill, and environment, Teaching and Learning in Medicine,
4(2), pp. 86-96.
UFARO, M.J. & ABERNATHY,C.M. (1994) An innovative course in
Notes on contributors surgical critical care for second-year medical students, Academic
R. M. HARDEN is Director of the Centre for Medical Education, Medicine, 69, pp. 241-243.
University of Dundee. W ,K.V. (1994) Educating medical students: lessons from
JENNIFER M. LAIDLAW is the Associate Director of Postgraduate research in continuing education, Academic Medicine, 69, pp. 41-
Medical Education in the Postgraduate Centre, Ninewells Hospital 47.
and Medical School, Dundee. MILLER,G.E. (Ed.) (1961) Teaching and Learning in the Medical
School (Cambridge, MA, Harvard University Press).
JEANKERis a previous Principal in General Practice with an interest PATEL, V.L., GROEN,G.J. & Scorn, H.M. (1988) Biomedical
in Women's Health and her main activity is co-ordinating the ODA knowledge in explanation of clinical problems by medical
funded Further Improvement of the Medical Colleges in students, Medical Education, 22, pp.398406.
Bangladesh Project at the Centre for Medical Education, University USHER,R.S. (1986) Adult students and their experience: develop-
of Dundee. ing a resource for learning, Studies in the Education of Adults, 18,
HELENE. MITCHELLdesigns task-based learning materials for pp. 24-35.
Senior House Officers in the Postgraduate Office, Ninewells USHER,R.S. & BRYANT,I. (1987) Re-examining the theory-practice
Hospital & Medical School, Dundee. relationship, Studies in Higher Education, 12(2), pp. 201-262.

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