Overview

Problem-based learning (PBL) is an instructional method that was originally developed by Howard Barrows at McMaster University in the 1980s to teach diagnostic skills using patient problems. As the problem (case) is explored, more information is revealed such as patient laboratory results or radiographic images. In the classroom, the problem unfolds over several days or in several stages. In each stage, through the use of whiteboards and other research resources, learners engage in a defined set of activities related to the problem.  Students extract, discuss, identify, and record the details of the case with the following organizing headings:

1. Facts
2. Hypothesis
3. More Information Needed
4. Learning Issues

Instructor Role

The instructor in PBL is often referred to as a tutor or facilitator. The facilitator has a limited role in that facilitation is comprised of ensuring students follow the PBL process, asking students probing questions, and keeping the students on track working through the facts, hypotheses, identifying information needed, and recording new learning issues. The instructor may have responsibility for the design of PBL case problems. 

The instructor does not lecture, provide information or answers when students get stuck or, perhaps, as students explore potentially incorrect diagnoses. If PBL occurs over multiple meetings or class sessions, students walk away with topics they have to research “learning issues."  When they return for the next class, these topics are presented orally (with or without supporting materials); thus, adding to the group’s understanding.  At the end of the case, the students and faculty debrief on the group process, and review and discuss “expert” case summaries.  The final case summary provides the “expert” physician’s treatment plan, and also may clarify any remaining gaps in knowledge. Finally, students may be directed to additional resources related to the case topic, or problem.  On a continuum of instructional guidance from low guidance to high guidance, PBL is an instructional method that, if implemented as designed, requires a low level of active instructional guidance (Figure 1).

Figure 1. Instructional Guidance Level Needed

Low guidance                                                                            High guidance

Learner Role

In a typical PBL case, students are assigned different roles such as reader, scribe or recorder, and PBL monitor. The reader (or readers, if students rotate this responsibility) read the case materials out loud, while other members of the group actively listen. Students may follow along the reader viewing text on paper, on screens, or on a projection from a device.

Once the reader completes reading aloud, a scribe or recorder will go to the board and begin writing down the facts of the case, as students call them out. For example, Student A states, this is a “12 year-old, Hispanic female, 72 pounds, a fever of 102 degrees, coughing, brought to ER by mother.” When all relevant facts available in the case materials are recorded, the monitor may ask students “What are the initial hypotheses?"  Or “Are we ready to move on?”  The step the students take next is often determined by their level of competence or stage in the curriculum. For example, if students are in the second year of a preclinical medical curriculum, then they may be more adept at the process than a first-year, first-semester medical student. On a continuum of engagement and learner activity from low to high, PBL requires students learn differently. Students are very central and active architects of their own understanding and learning (Figure 2).

Figure 2. Learner Activity Level Required

Low engagement                                                                    High engagement

How to do it?

Instructors should clearly determine the learning goals guiding engagement in PBL. For example, medical schools have integrated PBL into an overall curriculum strategy, where many groups of students in many classrooms experience PBL simultaneously. Typically, PBL groups should include six to eight students and a single faculty facilitator. Schools implementing PBL on this scale should be clear on the resources required for such use. Once PBL is selected as a strategy, the classroom experience looks like this: PBL is often used in clinical, education, business, and health professions classrooms, as these professions are most suited to the case problem format.   

Assessment of PBL

PBL assessments may include a variety of approaches. The aim of any assessment of PBL instruction should be geared toward development of several key outcomes: decision-making, critical analysis, diagnostic reasoning skills, collaborative group work and process, and individual research skills.  Schools have approached assessment in a variety of ways, with most often being an independent case assessment where students must engage the diagnostic reasoning skills learned through PBL to complete a paper-based assessment.  Faculty evaluations of group process, presentation skills rubrics (for learning issue presentations), and peer review may also be used. Instructors should avoid a single assessment measure as an indication that learning through PBL has occurred.

Online Options

PBL has been explored in the online and distance education context for about 15 years (2004).  While it can be challenging for the novice instructor to design, those who have face-to-face PBL experience may find this more palatable.  For example, cases can be presented via video and role plays, patient simulations and asynchronous discussion boards follow the same sections over stages of case problems, as in person. See Savin-Baden, M., & Wilkie, K. (2006) for a comprehensive resource.

Instructional Classroom Time

90 minutes to two hours per session

Other resources

1. Albanese, M.A., & Mitchell, S. (1993). Problem-based learning: A review of literature on its outcomes and implementation issues. Academic Medicine, 68, 52-81.
2. Barrows, H.S. (1985) How to design a problem-based curriculum for the preclinical years. Springer, New York.
3. Barrows, H.S. (1986) A taxonomy of problem-based learning methods. Medical Education, 20, 481–486.
4. Dochy, F., Segers, M., Van den Bossche, P., & Gijbels, D. (2003). Effects of problem-based learning: A meta-analysis. Learning and instruction, 13(5), 533-568.
5. Koh, G. C. H., Khoo, H. E., Wong, M. L., & Koh, D. (2008). The effects of problem-based learning during medical school on physician competency: a systematic review. Cmaj, 178(1), 34-41.
6. Norman, G. T., & Schmidt, H. G. (1992). The psychological basis of problem-based learning: A review of the evidence. Academic medicine, 67(9), 557-565.
7. Polyzois, I., Claffey, N., & Mattheos, N. (2010). Problem‐based learning in academic health education. A systematic literature review. European Journal of Dental Education, 14(1), 55-64.
8. Savin-Baden, M., & Wilkie, K. (2006). Problem-based learning online. McGraw-Hill Education (UK).

Problem-based Learning by Christina Cestone is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Overview 

Team-based learning (TBL) is a collaborative, small-group instructional method that helps to integrate active learning into any style classroom as part of deliberately planned instruction and curriculum design (Michaelson, Sweet & Parmalee, 2009). As its name suggests, team-based learning consists of small student teams (five to seven members) working through a defined set of instructional activities before and during class. The structure of TBL enables a high level of student engagement in learning and also applies direct instruction to achieve designated learning objectives.  

The foundation of TBL is in social interdependence theory, which suggests that an individual’s goals are affected by the actions of others (Johnson, 1970 and others). Social interdependence can take two forms, positive and negative (Johnson, 1970; Johnson & Johnson, 1989, 1995; Johnson, Johnson, & Smith, 2007). Social interaction that is positive results in a focus on the members’ mutual interest in success. This positive interaction is characterized by good communication, social support, trust, shared goals, and demonstration of effective conflict management results (Johnson & Johnson, 1995; Johnson, Johnson, & Smith, 2007). Negative interaction stems from self-interest and is characterized by competition and focus on one’s own goals and needs. Because small groups (teams) in TBL are strategically formed and permanent (to the extent possible), the aim is to foster positive social development of the team over time. Effective teams include members who move from a focus on self to a focus on others and the shared performance of the team. 

TBL includes three core components that characterize classroom implementation. These components are strategically formed permanent teams representing a diversity of members, ideas, and backgrounds; the readiness assurance process to check students’ understanding of core knowledge in that unit, and application exercises.  

TBL Stages  

The core stages of team-based learning include advanced preparation for class, in-class completion of an individual readiness assurance testing (iRAT), a group readiness assurance test, appeals of answers, instructor input or clarifying lecture, application activities, and peer evaluation. These stages of TBL are repeated, ideally, five or more times across a semester or course (Sweet, 2011).     

Instructional Guidance Level Needed (Continuum of Guidance Low to High) 

Low guidance                                                           High guidance 

The facilitator enacts a moderate role in providing guidance in the facilitation of TBL in-class activities across each phase of instruction. The facilitator prepares and assigns pre-class and in-class materials, debriefs after group readiness testing, and prompts discussion during the appeals process.  Once gaps in student knowledge are revealed through these phases, the instructor offers input through just-in-time lectures. The instructor is responsible for the development of challenging in-class application exercises.   

Application exercises require planning and forethought by the instructor in order to create and facilitate exercises that meet the four “S” criteria: exercises represent a significant problem (Significant problem), have a specific answer (Specific answer), ensure that all groups work on the same problem (Same problem), and facilitate a simultaneous report of the answer (Simultaneous report).  

The video by Dr. Michael Sweet included in this section helps to elaborate on these activities in more detail.  

https://vimeo.com/51713733    

Student Activity Level Required (Continuum of Engagement and Activity Low to High) 

Low engagement                                                       High engagement 

In a typical TBL classroom, students are responsible for intellectual engagement for their group mates (e.g. preparing advance materials or reading), contributing to group work (offering answers and rationales for an answer during the gRat process), writing appeals if group answers depart from the answers of the class, and engaging in course activities during the application exercises. 

How to do it?  

Instructors should clearly articulate the course learning goals in order to determine if TBL is the right instructional choice. For example, medical schools have integrated TBL into an overall curriculum strategy, where many groups of students in many classrooms experience TBL simultaneously in the basic science phase of the curriculum (see Thompson, et al., 2007). More than 50 percent of medical schools use TBL for some form of instruction (AAMC, 2018); however, any discipline or style classroom can, including law, history, medicine, engineering, or art.   

For a view of the TBL classroom experience, please view this video by Dr. Michael Sweet: 

https://vimeo.com/51713733 

Typically, TBL groups should include six to eight students and a faculty facilitator. TBL sessions should repeat five to seven times during a semester, with more than one opportunity for peer evaluation and formative feedback. Class size for use of the TBL approach may include 25 or several hundred students. Schools implementing TBL on this large of a scale should be clear on the resources required for support, preparation, and execution of TBL in this way. 

Assessment in TBL 

Assessment in TBL comes from a variety of sources such as individual readiness testing, group readiness scores, peer evaluation, course examinations, and in-class application exercises.  The weights afforded to each type of assessment will vary based on the aims of the instructor, discipline, or curriculum. Often TBL instructors allow students to determine the weighting for peer evaluation.  More information on the peer evaluation process and tools can be found here https://teambasedlearning.site-ym.com/page/started; (Cestone, Levine, & Lane, 2008).

Instructional Classroom Time 

90 minutes to two hours per session 

Synchronous

In the synchronous model, the class meets virtually at the same time. Below is an example of how a two-hour synchronous TBL session could be structured (O’Dwyer, n.d.).    

Example synchronous session 

• Introduction (10 minutes) 
• iRAT (20 minutes)
• tRAT (15 minutes) 
• Clarifications (15 minutes) 
• Application Exercises (20 minutes) 
• Facilitated Discussion (25 minutes) 
• Closing (15 minutes) 

Contact

If interested in a tutorial on how to do TBL, please contact Dr. Violet Kulo at vkulo@umaryland.edu or Dr. Christina Cestone at ccestone@umaryland.edu

Other resources  

Association of American Medical Colleges, www.aamc.org, 2018, Curriculum inventory data and research.   

Cestone, C. M., Levine, R. E., & Lane, D. R. (2008) Peer assessment and evaluation in team-based learning. In L. K. Michaelsen & L. D. Fink (Eds.) Team-Based Learning: Small Group Learning’s Next Big Step [Special Issue]. New Directions in Teaching and Learning, (Vol. 116, pp. 69-78). Hoboken, NJ: Wiley Online Library  

Clark, M., Merrick, L., Styron, J., Dolowitz, A., Dorius, C., Madeka, K., Bender, H., Johnson, J., Chapman, J., Gillette, M., Dorneich, M., O’Dwyer, B., Grogan, J., Brown, T., Leonard, Br., Rongerude, J., Winter, L. (2018). Off to on: Best practices for online Team-Based Learning.  

Koles PG, Stolfi A, Borges NJ, Nelson S, Paremelee DX. (2010). The impact of team-based learning on medical students’ academic performance. Academic Medicine, 85: 1739-1745. 

Levine RE, O’Boyle M, Haidet P, Lynn DJ, Stone MM, Wolf DV, and Paniagua FA. (2004). Transforming a clinical clerkship with team learning. Teaching and Learning in Medicine, 16: 270-275. 

Michaelson, L. K., & Sweet, M. (2011). Team‐based learning in New directions for teaching and learning: Small Group Learning’s Next Big Step. New Directions in Teaching and Learning, (128), 41-51.  

Michaelsen, L., Sweet, M. & Parmalee, D. (2009) Team-Based Learning: Small Group Learning’s Next Big Step. New Directions in Teaching and Learning, 7-27  

O’Dwyer, B. (n.d.). Implementing TBL in an Online Environment, Prework Slides. www.intedashboard.com  

Parmalee, D.X. & Michaelson, L.K. (2010) Twelve tips for doing effective team-based learning, Medical Teacher, 32(2), 118-122.  

Thompson, B.M. et al., (2007). Team-based learning at 10 medical schools: Two years later. Medical Education, 41, 250-257.  

http://www.teambasedlearning.org/tbl-online/ 

Team-based Learning by Christina Cestone and Becky Menendez is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.