Problem-based learning (PBL) is an educational approach used in medical and health sciences education that focuses on real-life clinical scenarios to develop critical thinking, problem-solving, and decision-making skills.

PA programs utilize an element of problem-based learnig (PBL) in their curriculum.

This involves small group, problem-based learning style which is very different than traditional, lecture-based learning that students in undergraduate study at a university are accustomed to.

This approach to problem-based learning was developed in 1969 at McMaster University’s medical school.

PBL is designed to help students connect theoretical concepts with practical applications and to develop their clinical reasoning skills. It also emphasizes lifelong learning and encourages students to continue seeking knowledge and resources beyond the classroom.

In medicine, PBL is often used in conjunction with other teaching methods, such as lectures, case discussions, and practical skills training, to provide a comprehensive and well-rounded educational experience.

Traditional Learning vs. PBL

What is Traditional Learning?

Traditional learning is what most undergraduate students are used to.

It involves rote memorization and the transmission of information from teacher to student, without necessarily linking that information to practical applications.

Here the teacher or instructor is the source source of information and students are passive learners.

How PBL is different

Problem-based learning (PBL) is an educational approach that focuses on real-world problems as the driving force for learning. These “real word problems” would be “real patient cases” (or close to real patient cases) used as the trigger for learning.

Students work in small groups alongside a faciliator. They take an active role in their own learning, applying what they have learned to the solution of different clinical scenarios.

In PBL, students are presented with a clinical problem or scenario and work in small groups to research and discuss possible solutions. The goal is to actively engage students in the learning process, rather than relying on passive lecturing. Students are encouraged to ask questions, contribute their own knowledge, and collaborate to arrive at a solution.

Skills that are helpful to excel in Problem Based Learning

Critical thinking: The ability to analyze and evaluate information, identify problems and generate potential solutions.

Collaboration: The ability to work effectively with others, communicate your ideas and listen to others.

Research skills: The ability to find, evaluate and use information from a variety of sources.

Time management: The ability to prioritize tasks and manage your time effectively.

Adaptability: The ability to change direction and approach the problem in new ways when needed.

Initiative: The ability to take charge of your own learning and be proactive in seeking information and solutions.

Communication: The ability to clearly and effectively communicate your ideas, both in writing and verbally.

Creativity: The ability to think outside the box and generate innovative solutions to problems.

Reflectiveness: The ability to reflect on your own learning and the problem-solving process.

Self-directedness: The ability to take responsibility for your own learning and work independently when necessary.

What does the PBL process look like in PA school?

The goal is for the PBL tutorial group to work collaboratively, leveraging each other's strengths, to diagnose and treat a simulated patient in the ‘case study’, while also gaining knowledge and skills that will be useful in real-world practice as a PA.

Step 1: A new case is given to your PA tutorial group

PBL begins with a well-defined problem or case-study (provided by the PA program as a ‘trigger’ for learning). The problem is relevant, challenging and open-ended. It will help you and your PA classmates stay focused and motivated.

An example PBL scenario:

“A 28-year-old female patient comes to the emergency department with a sudden onset of severe abdominal pain. The patient has a history of appendicitis and had her appendix removed 10 years ago.”

Step 2: PA students analyze the case study and set learning objectives.

Here the students decide what they want to learn. Students begin by reading the case studyand identifying the key concepts and skills that will be needed to solve it.

During the discussion of the case, the students can generate meaningful and relevant learning objectives from a PBL problem that will guide their work, study and mastery of knowledge.

Step 3: Students research the problem

This step in PBL involves gathering information to better understand the problem and to identify potential solutions.

Identifying sources of information: PA students will need to determine where they can find the information they need to solve the problem. This could include online resources (e.g. UptoDate), consulting medical literature, textbooks (e.g. Toronto Notes/Essential Med Notes), clinical practice guidelines, experts, and other sources.
Conducting research: PA students will need to gather information from a variety of sources, taking notes and organizing their findings in a way that makes sense.
Evaluating the reliability of sources: It is important for students to determine the reliability of the sources they are using. This can involve checking for biases or considering the credibility of the author.
Synthesizing information: After collecting information from a variety of sources, students will need to synthesize that information and determine how it relates to the problem at hand.

Step 4: Come back together and discuss findings

The group comes back together after the research phase to plan the steps they will take to assess, diagnose and treat the patient.

Step 5: Reflect & Feedback on the Process

PA students then reflect on the problem-solving process and what they learned. They consider what worked well and what could have been done better.

The role of a facilitator in Problem Based Learning

In PA school, each PBL tutorial group has a faciliator assigned. This facilitator or “PBL tutor” is often someone who is an expert in the field or specialty that is relevant to the specific case study.

The role of the facilitator in PBL is to guide and support the learning process of the group.

PBL tutors of facilitators work to:

Create a supportive learning environment: The facilitator helps create a safe, supportive, and inclusive environment where students feel comfortable asking questions and sharing ideas.
Guidie the process: The facilitator guides the group through the PBL process, helping students stay on track and ensuring that all members of the group have an opportunity to participate.
Encouraging critical thinking and problem-solving: The facilitator encourages students to think critically and creatively, to ask questions, and to generate solutions to the problems presented in the scenario.
Supporting research: The facilitator provides support and guidance as students conduct research, helping them find and evaluate relevant information and evidence.
Facilitating reflection: The facilitator facilitates reflection and debriefing sessions, helping students to reflect on their learning, identify areas for improvement, and plan for future learning.
Encouraging collaboration: The facilitator encourages collaboration and teamwork among the students, helping to build a supportive learning community.

The facilitator plays a key role in ensuring that PBL is an effective and enjoyable learning experience for all students. They help PA students to develop their critical thinking, problem-solving, and clinical reasoning skills, and to apply what they have learned in a meaningful and relevant way.

Tips for Excelling during PBL Problems

Here are some tips on how to excel in PBL scenarios:

Preparation: Come to each PBL session well-prepared by reading the scenario, reviewing relevant background information, and thinking about potential questions and solutions.
Active participation: Engage actively in the PBL process by asking questions, contributing ideas, and listening to the perspectives of others.
Teamwork: Work well with your PBL group by collaborating, communicating effectively, and taking a cooperative approach to problem-solving.
Data gathering and analysis: Be systematic and thorough in your data gathering and analysis, evaluating different sources of information and considering the relevance and quality of each source.
Critical thinking: Apply critical thinking skills to the problems presented in the scenario, evaluating different options, considering different perspectives, and making informed decisions.
Reflection: Take the time to reflect on your learning, considering what you have learned, what you could have done differently, and how you can apply your learning to future problems.
Continual learning: Continuously seek out opportunities to learn and expand your knowledge, incorporating new information and insights into your problem-solving process.

Through this you can develop your critical thinking, problem-solving, and clinical reasoning skills, and can gain the confidence and expertise to help you excel in your future career as a PA.

What is DEEPICT and how does it apply to PBL?

DEEPICT refers to a structured framework that breaks down the PBL process into 7 manageable steps

This can be a helpful tool for PA students as they work through complex clinical scenarios.

Data gathering and interpretation: This step involves gathering all relevant information and data about the problem scenario, including patient history, physical examination findings, and test results. The goal of this step is to understand the problem and gather all relevant information needed to make a diagnosis and develop a treatment plan.
Evaluation of options: In this step, students evaluate all possible options for diagnosis and treatment, considering the strengths and weaknesses of each option, and evaluating the risks and benefits of each option.
Exploration of concepts: In this step, students explore the concepts and theories that are relevant to the problem, gaining a deeper understanding of the underlying causes and mechanisms of the problem.
Planning: In this step, students develop a comprehensive treatment plan, considering all relevant information and options, and deciding on the best course of action.
Implementation: This step involves carrying out the treatment plan, including ordering tests, prescribing medications, and making any necessary referrals.
Closure: In this step, students reflect on the outcome of the treatment and evaluate its effectiveness, considering what worked well and what could have been done differently.
Transfer: In this step, students apply their learning from this problem to other related problems, making connections between the current scenario and their broader understanding of the subject.

Resources for PBL

PA students often use a variety of resources to help them solve clinical problems in Problem-Based Learning (PBL) scenarios. Some of the most popular resources include:

Clinical guidelines and protocols: These provide evidence-based recommendations for the diagnosis and management of common clinical conditions. See the CMA Clinical Practice Guidelines Database.
Medical textbooks and journals: PA students often use textbooks and peer-reviewed journals to gain a deeper understanding of the underlying concepts and theories related to the problem scenario.
Online databases and resources: Students can access a range of online resources, including patient information websites, professional associations, and educational websites.
Clinical experts: Students can seek out the advice of clinical experts, including practicing PAs, physicians, nurses, and other healthcare professionals, to help them make informed decisions.
Case studies: PA students can use case studies to see how similar problems have been solved in the past and to gain insights into best practices and clinical decision-making.

Final notes

What learning style are you accustomed to - traditional classroom learning or small group PBL? Which style do you prefer? Let us know in the comments!

References

Jones, R. W. (2006). Problem-based learning: description, advantages, disadvantages, scenarios and facilitation. Anaesthesia and intensive care, 34(4), 485-488.
Lee, R.M., & Kwan, C.Y. (1997). The Use of Problem-Based Learning in Medical Education. 1 (2): 149-157
McMaster Health Sciences [PDF] An introduction to PBL in the Faculty of Health Sciences at McMaster University.
Neville A. J. (2009). Problem-based learning and medical education forty years on. A review of its effects on knowledge and clinical performance. Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 18(1), 1–9.
Saarinen-Rahiika, H., & Binkley, J. (1998) PBL in Physical Therapy: Literature Review and Overview of the McMaster University Experience. 78 (2): 195-207.
Servant-Miklos, V. F. C. (2019). The Harvard Connection: How the Case Method Spawned Problem-Based Learning at McMaster University. In Health Professions Education (Vol. 5, Issue 3, pp. 163–171). Elsevier BV.

Guide to Problem-Based Learning (PBL) in PA School