Problem-based Learning and Theories of Teaching and Learning in Health Professional Education
DOI:
https://doi.org/10.14297/jpaap.v4i1.194Keywords:
Problem-based learning, theories of teaching and learning, health professional education, scoping review methodology, university-based learningAbstract
Although problem-based learning (PBL) has been linked to several theories of teaching and learning, how these theories are applied remains unclear. The objective of this paper is to explore how theories of teaching and learning relate to and can inform problem-based learning within health professional education programs. We conducted a scoping review on current theories of teaching and learning and considered their relevancy to the problem-based learning approach. The findings suggest that no single theory of teaching and learning can fully represent the complexity of learning in PBL. Recognizing the complexity of the PBL environment and the fluidity between theories of teaching and learning, we proposed eight principles from across 11 theories of teaching and learning that can inform how PBL is operationalised in university-based health professional education: 1) Adult learners are independent and self-directed; 2) Adult learners are goal oriented and internally motivated; 3) Learning is most effective when it is applicable to practice; 4) Cognitive processes support learning; 5) Learning is active and requires active engagement; 6) Interaction between learners supports learning; 7) Activation of prior knowledge and experience supports learning; and 8) Elaboration and reflection supports learning. These eight principles provide the foundation for curriculum design recommendations relevant to PBL within university-based education programs. Specifically, our findings suggest that active engagement and interactions should be encouraged, that students should be prompted to activate their prior knowledge and experiences, and that elaboration and reflection on learning is critical. The small group format of PBL can facilitate this engagement if students question each other, consider alternative perspectives, and are actively involved in setting learning objectives. Further research is needed to develop the empirical basis for these principles and examine if PBL is an effective approach for implementing these principles.
References
Abela, J. (2009). Adult learning theories and medical education: A review. Malta Medical Journal, 21(1), 11-18.
Albanese, M. (2000). Problem-based learning: Why curricula are likely to show little effect on knowledge and clinical skills. Medical Education, 34(9), 729-738.
Anderson S, Allen P, Peckham S, & Goodwin N. (2008). Asking the right questions: Scoping studies in the commissioning of research on the organisation and delivery of health services. Health Research Policy and Systems, 6(7). doi:10.1186/1478-4505-6-7
Arksey, H., & O'Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8, 19-32. doi:10.1080/1364557032000119616
Bahn, D. (2001). Social learning theory: Its application in the context of nurse education. Nurse Education Today, 21(2), 110-117.
Baker, C. M. (2000). Using problem-based learning to redesign nursing administration masters programs. Journal of Nursing Administration, 30(1), 41-47.
Beckert, L., Wilkinson, T. J., & Sainsbury, R. (2003). A needs-based study and examination skills course improves students' performance. Medical Education, 37(5), 424-428.
Bergman, E. M., Sieben, J. M., Smailbegovic, I., de Bruin, A. B., Scherpbier, A. J., & van der Vleuten, C. P. (2013). Constructive, collaborative, contextual, and self-directed learning in surface anatomy education. Anatomical Sciences Education, 6(2), 114-124. doi: http://dx.doi.org/10.1002/ase.1306
Bordage, G. (2009). Conceptual frameworks to illuminate and magnify. Medical Education, 43, 312-319. doi:10.1111/j.1365-2923.2009.03295.x
Brandt, B. L. (1996). Cognitive learning theory and continuing health professions education. Journal of Continuing Education in the Health Professions, 16(4), 197-202.
Chikotas, N. E. (2008). Theoretical links: Supporting the use of problem-based learning in the education of the nurse practitioner. Nursing Education Perspectives, 29(6), 359-362.
Copp, S. L. (2002). Using cooperative learning strategies to teach implications of the Nurse Practice Act. Nurse Educator, 27(5), 236-241.
David, T. J., & Patel, L. (1995). Adult learning theory, problem based learning, and paediatrics. Archives of Disease in Childhood, 73(4), 357-363.
Dolmans, D. H., De Grave, W., Wolfhagen, I. H., & Cp. (2005). Problem-based learning: Future challenges for educational practice and research. Medical Education, 39(7), 732-741.
Eames, C. & Cates, C. (2011). Theories of learning in cooperative and work-integrated education. In R.K. Coll & K.E. Zewagwaard (Eds.), International handbook for cooperative education: An international perspective of the theory, research, and practice of work-integrated learning (pp 41-52). Boston, MA: World Association for Cooperative Education.
Eisen, M. (2001). Peer-based professional development viewed through the lens of transformative learning. Holistic nursing practice, 16(1), 30-42.
Fenwick, T. J. (2000). Expanding conceptions of experiential learning: A review of the five contemporary perspectives on cognition. Adult Education Quarterly, 50(4), 243-272. doi:10.1177/07417130022087035
Forbes, H., Duke, M., & Prosser, M. (2001). Students' perceptions of learning outcomes from group-based, problem-based teaching and learning activities. Advances in Health Sciences Education, 6(3), 205-217.
Forneris, S. G., & Peden-McAlpine, C. J. (2006). Contextual learning: A reflective learning intervention for nursing education. International Journal of Nursing Education Scholarship, 3(1), 1-18.
Fraser, S. W., & Greenhalgh, T. (2001). Coping with complexity: Educating for capability. British Journal of Medicine, 323, 799-803.
Hean, S., Craddock, D., Hammick, M., & Hammick, M. (2012). Theoretical insights into interprofessional education: AMEE Guide No. 62. Medical Teacher, 34(2), e78-101. doi:http://dx.doi.org/10.3109/0142159X.2012.650740
Hessler, K. L., & Henderson, A. M. (2013). Interactive learning research: Application of cognitive load theory to nursing education. International Journal of Nursing Education Scholarship, 10(1), 1-10. doi:10.1515/ijnes-2012-0029
Hmelo-Silver, C. (2004). Problem-based learning: What and how do students learn? Educational Psychology Review, 16(3), 235-266. doi:10.1023/B:EDPR.0000034022.16470.f3
Hmelo-Silver, C., Duncan, R. D., & Chinn, C. A. (2007). Scaffolding and achievement in problem-based and inquiry learning: A response to Kirschner, Sweller, and Clark (2006). Educational Psychologist, 42, 99-107.
Hodges, B. D., & Kuper, A. (2012). Theory and practice in the design and conduct of graduate medical education. Academic Medicine, 87(1), 25-33. doi:http://dx.doi.org/10.1097/ACM.0b013e318238e069
Hodges, H. F. (2011). Preparing new nurses with complexity science and problem-based learning. Journal of Nursing Education, 50(1), 7-13. doi:10.3928/01484834-20101029-01
Horii, C. V. (2007). Teaching insights from adult learning theory. Journal of Veterinary Medical Education, 34(4), 369-376.
Hrynchak, P., & Batty, H. (2012). The educational theory basis of team-based learning. Medical Teacher, 34(10), 796-801. doi:http://dx.doi.org/10.3109/0142159X.2012.687120
Jackson, D., Power, T., Sherwood, J., & Geia, L. (2013). Amazingly resilient Indigenous people! Using transformative learning to facilitate positive student engagement with sensitive material. Contemporary Nurse, 46(1), 105-112. doi:http://dx.doi.org/10.5172/conu.2013.46.1.105
Johnson, C. E. (2000). The transformative process of residency education. Academic Medicine, 75(6), 666-669.
Kantar, L. (2014). Incorporation of constructivist assumptions into problem-based instruction: A literature review. Nurse Education in Practice, 14(3), 233-241. doi:10.1016/j.nepr.2013.08.010
Kassirer, J. P. (2010). Teaching clinical reasoning: Case-based and coached. Academic Medicine, 85(7), 1118-1124.
Kaylor, S. K. (2014). Preventing information overload: Cognitive load theory as an instructional framework for teaching pharmacology. Journal of Nursing Education, 53(2), 108-111. doi:10.3928/01484834-20140122-03
Kear, T. M. (2013). Transformative learning during nursing education: A model of interconnectivity. Nurse education today, 33(9), 1083-1087. doi:10.1016/j.nedt.2012.03.016
Khalil, M. K., Paas, F., Johnson, T. E., & Payer, A. F. (2005a). Design of interactive and dynamic anatomical visualizations: the implication of cognitive load theory. Anatomical Record.New Anatomist, 286(1), 15-20.
Khalil, M. K., Paas, F., Johnson, T. E., & Payer, A. F. (2005b). Interactive and dynamic visualizations in teaching and learning of anatomy: A cognitive load perspective. Anatomical Record.New Anatomist, 286(1), 8-14.
Kirschner, P., Sweller, J., & Clark, R. (2006). Why minimal guidance during instruction does not work: An analysis of the failure of constructivist, discovery, problem-based, experiential, and inquiry-based teaching. Educational Psychologist, 41, 75-86.
Kitchenham, A. (2008). The evaluation of John Mezirow's transformative learning theory. Journal of Transformative Education, 6(2), 104-123. doi:10.1177/1541344608322678
Knowles, M. S. (1990). The adult learner: A neglected species (4th ed.). Houston, TX: Gulf Publishing.
Levac, D., Colquhoun, H., & O'Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5, 1-9. doi:0.1186/1748-5908-5-69
Lien, A. D., & Hakim, S. M. (2013). Two approaches, one course: An experience in experiential learning. Journal of Prevention & Intervention in the Community, 41(2), 128-135. doi:http://dx.doi.org/10.1080/10852352.2013.757991
Lin, Z.-C. (2013). Comparison of technology-based cooperative learning with technology-based individual learning in enhancing fundamental nursing proficiency. Nurse Education Today, 33(5), 546-551. doi:10.1016/j.nedt.2011.12.006
Mann, K. V. (2011). Theoretical perspectives in medical education: past experience and future possibilities. Medical Education, 45(1), 60-68. doi:http://dx.doi.org/10.1111/j.1365-2923.2010.03757.x
Maudsley, G., & Strivens, J. (2000). Promoting professional knowledge, experiential learning and critical thinking for medical students. Medical Education, 34(7), 535-544.
McCarlie, V. W., & Orr, D. L., II. (2010). Health science education: reviewing a framework for problem-based learning. Journal of Dental Education, 74(5), 480-488.
Merriam, S. B. (1996). Updating our knowlege of adult learning. Journal of Continuing Education in the Health Professions, 16(3), 136-143.
Mezirow, J. (2003). Tranformative learning as discourse. Journal of Transformative Education, 1(1), 58-63.
Milligan, F. (1999). Beyond the rhetoric of problem-based learning: emancipatory limits and links with andragogy. Nurse Education Today, 19(7), 548-555.
Neville, A. J. (2009). Problem-based learning and medical education forty years on. Medical Principles and Practice, 19, 1-9. doi:10.1159/000163038
O'Connell, C. B. (2010). Enhancing transformative learning in physician assistant education. Journal of Physician Assistant Education, 21(1), 18-22.
Parker, B., & Myrick, F. (2010). Transformative learning as a context for human patient simulation. Journal of Nursing Education, 49(6), 326-332. doi:10.3928/01484834-20100224-02
Piaget, J., & Inhelder, B. (1969). The psychology of the child. London: Routledge.
Pociask, F. D., DiZazzo-Miller, R., & Samuel, P. S. (2013). Reducing cognitive load while teaching complex instruction to occupational therapy students. American Journal of Occupational Therapy, 67(5), e92-99. doi:http://dx.doi.org/10.5014/ajot.2013.008078
Poore, J. A., Cullen, D. L., & Schaar, G. L. (2014). Simulation-based interprofessional education guided by Kolb's Experiential Learning Theory. Clinical Simulation in Nursing, 10(5), e241-247. doi:10.1016/j.ecns.2014.01.004
Potgieter, E. (1999). Relationship between the whole brain creativity model and Kolb's Experiential Learning Model. Curationis, 22(4), 9-14.
Rauk, R. P. (2003). Knowledge integration: Theory to practice in physical therapy education. Journal of Physical Therapy Education, 17(1), 39-47.
Roberts, D. (2010). Vicarious learning: a review of the literature. Nurse Education in Practice, 10(1), 13-16. doi:10.1016/j.nepr.2009.01.017
Rolloff, M. (2010). A constructivist model for teaching evidence-based practice. Nursing Education Perspectives, 31(5), 290-293.
Saarinen-Rahiika, H., & Binkley, J. M. (1998). Problem-based learning in physical therapy: A review of the literature and overview of the McMaster University experice. Physical Therapy, 78(2), 195-207.
Schmidt, H. G., Rotgans, J. I., & Yew, E. H. J. (2011). The process of problem-based learning: What works and why. Medical Education, 45(8), 792-806. doi:10.1111/j.1365-2923.2011.04035.x
Schmidt, H. G., van der Molen, H. T., Winkel, W. W. R. T., & Wijnen, W. H. F. W. (2009). Constructivist, problem-based learning does work: A meta-analysis of curricular comparisons involving a single medical school. Educational Psychologist, 44(4), 227-249. doi:10.1080/00461520903213592
Schumacher, D. J., Englander, R., & Carraccio, C. (2013). Developing the master learner: applying learning theory to the learner, the teacher, and the learning environment. Academic Medicine, 88(11), 1635-1645. doi:http://dx.doi.org/10.1097/ACM.0b013e3182a6e8f8
Sewchuk, D. H. (2005). Experiential learning--a theoretical framework for perioperative education. AORN Journal, 81(6), 1311-1318.
Shreeve, M. W. (2008). Beyond the didactic classroom: Educational models to encourage active student involvement in learning. Journal of Chiropractic Education, 22(1), 23-28.
Solomon, P. (1994). Problem-based learning: A direction for physical therapy education? Physiotherapy Theory & Practice, 10, 45-52.
Solomon, P. (2005). Problem-based learning: A review of current issues relevant to physiotherapy education. Physiotherapy Theory & Practice, 21, 37-49. doi:10.1080/09593980590911499
Solomon, P., Binkley, J. M., & Stratford, P. (1996). A descriptive study of learning processes and outcomes in two problem-based curriculum designs. Journal of Physical Therapy Education, 10, 72-76.
Stagnaro-Green, A. (2004). Applying adult learning principles to medical education in the United States. Medical Teacher, 26(1), 79-85.
Stegmann, K., Pilz, F., Siebeck, M., & Fischer, F. (2012). Vicarious learning during simulations: is it more effective than hands-on training? Medical Education, 46(10), 1001-1008. doi:10.1111/j.1365-2923.2012.04344.x
Svinicki, M. D. (1998). A theoretical foundation for discovery learning. American Journal of Physiology, 275(6 Pt 2), S4-7.
Taylor, D. C., & Hamdy, H. (2013). Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Medical Teacher, 35(11), e1561-1572. doi:http://dx.doi.org/10.3109/0142159X.2013.828153
Terrell, M. (2006). Anatomy of learning: Instructional design principles for the anatomical sciences. Anatomical Record - Part B New Anatomist, 289(6), 252-260.
Torre, D. M., Daley, B. J., Sebastian, J. L., & Elnicki, D. M. (2006). Overview of current learning theories for medical educators. American Journal of Medicine, 119(10), 903-907.
van Merrienboer, J. J., & Sweller, J. (2010). Cognitive load theory in health professional education: Design principles and strategies. Medical Education, 44(1), 85-93.
Vygotsky, L. S. (1962). Thought and language. Cambridge, MA: MIT Press.
Walsh, A. (2004). The tutor in Problem Based Learning at McMaster. Retrieved from Hamilton, ON:
Whitman, N. (1993). A review of constructivism: Understanding and using a relatively new theory. Family Medicine, 25(8), 517-521.
Williams, B. (2001). Developing critical reflection for professional practice through problem-based learning. Journal of Advanced Nursing, 34(1), 27-34.
Yorks, L., & Sharoff, L. (2001). An extended epistemology for fostering transformative learning in holistic nursing education and practice. Holistic Nursing Practice, 16(1), 21-29.
Zigmont, J. J., Kappus, L. J., & Sudikoff, S. N. (2011a). The 3D model of debriefing: defusing, discovering, and deepening. Seminars in Perinatology, 35(2), 52-58. doi:10.1053/j.semperi.2011.01.003
Zigmont, J. J., Kappus, L. J., & Sudikoff, S. N. (2011b). Theoretical foundations of learning through simulation. Seminars in Perinatology, 35(2), 47-51. doi:10.1053/j.semperi.2011.01.002
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