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Problem Based Learning: An introduction and overview of the key features of the
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Article  in  Journal of Veterinary Medical Education · February 2005

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Featured Article

Problem Based Learning: An Introduction and

Overview of the Key Features of the Approach
Mark J. Newman

ABSTRACT
Problem Based Learning (PBL) has been adopted in educational programs in a variety of disciplines, including veterinary
medicine. There is a voluminous literature on the subject, but it often remains unclear just what is being done in the name of
PBL, and different accounts highlight different, often contradictory, positions on the key features of the approach. Similarly,
despite the many claims made for the advantages of PBL, the evidentiary basis of such claims is often questionable. This
article provides an introductory overview of what appear to be the key features of the approach and a brief summary of
empirical evidence on its effectiveness.

INTRODUCTION procedures first systematized by Howard Barrows.16

Problem Based Learning (PBL) has been introduced into Central to this system is a conception of learning as an
education in many professional fields and appears to be of integrated process of cognitive, metacognitive, and personal
growing interest to veterinary medical educators. development. Barrows argues that a more accurate title
Cambridge Veterinary School in the United Kingdom,1 for the model he and his collaborators developed might
Cornell University’s College of Veterinary Medicine,2 and be ‘‘student-centered, problem based, inquiry-based,
the newly created Western University of Health Sciences integrated, collaborative, reiterative, learning.’’17 However,
College of Veterinary Medicine in the United States3 all the label ‘‘Problem Based Learning’’ has stuck. And it is this
report using a form of PBL in their pre-clinical veterinary uppercase PBL that is the focus of this article.
medical curriculum. In its modern guise, PBL started to
It is not my intention to describe the many different theories
become a feature of educational programs during the 1960s.
of learning and teaching that appear to provide the
Since then there has been steady growth in the number of
principles that underpin PBL. The relationship between
programs and institutions that have adopted PBL around
some of the concepts (grey boxes), theories from which they
the world. This transformation has been encouraged by an
derive (clear boxes), and key features of PBL (black boxes)
almost evangelical PBL movement that has published a
are illustrated in Figure 1. It is worth noting that when
wealth of anecdotal material extolling the virtues of the
Barrows and his colleagues designed the original Problem-
approach.4 PBL has been endorsed by a wide variety of
Based Learning Curriculum at McMaster University’s
national and international organizations,5 and, in recent
medical school in the late 1960s, they did so with a view
years, the advantages claimed for PBL have become part of
to overcoming what they perceived as the practical
the generally articulated outcomes for education at all
problems of student boredom, students’ inability to apply
levels.6
what they learned in medical school to clinical practice, and
However, it is not always clear what exactly is being done in the lack of ‘‘professional’’ skills of new graduates.18 The
the name of PBL.7, 8 There are a growing number of explicit links with various theories of learning and educa-
references in the literature to ‘‘adapted’’ or ‘‘hybrid’’ PBL tion came after this as various disciplines analyzed and
approaches and approaches labeled ‘‘Inquiry-based learn- developed their own versions of PBL.
ing,’’ which are apparently based on but not the same as
PBL.9–11 For example, a recent article in this journal
described Inquiry-based learning and contrasted it with WHAT TYPE OF LEARNING IS PBL INTENDED
Problem Based Learning,12 but the description given of TO PROMOTE?
Inquiry-based learning would match many definitions of Dolmans and Schmidt19 state that the aim of PBL is to help
Problem Based Learning. There is no single unanimous students develop rich cognitive models of the problems
position about the theoretical basis for, or practice of, PBL. presented to them. Similarly, Savin-Baden20 argues that the
There is not even agreement about whether there is, or often unarticulated aim of teachers who use PBL approaches
should be, one type of PBL or many variants.11, 13 The is to develop in their students ‘‘criticality,’’ that is,
wide dissemination of PBL has de facto spawned many emotional, intellectual, and practical independence. Bailey
variations.14 et al.21 emphasize enhancing enculturation into a commu-
nity of practice as an aim of PBL. A summary of the ways in
A distinction that does appear useful is made by Bereiter which these aims have been operationalized, derived from
and Scardamalia15 between PBL and problem-solving the work of Engel13 and Woods,22 is given in Box 1.
learning. They distinguish between PBL (upper-case) and
pbl (lower-case). Lower-case pbl refers to an indefinite range
of educational approaches that give problems a central place WHAT IS PROBLEM BASED LEARNING?
in the learning activity. Practitioners of upper-case PBL, on Engel13 describes the essential characteristics of a problem-
the other hand, tend to adhere to the structures and based curriculum as follows: it is cumulative (repeatedly

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Theories of self Social constructiv- Schema

regulation and ist theory theory
meta cognition

Knowledge is Activation of prior

socially constructed learning and
in communities of subsequent knowledge
practice use facilitated by
learning in context

Succsssful Importance of
learning Use of ‘Problems’ Internal/Episte Motivational
requires Learning in to stimulate, mic motivation theory
adoption of small groups contextulize and to learn
particular integrate learning
attitudes and
strategies

Teacher as
facilitator of Curriculum
process of learning Appropriate theories
for which students Assessment
themselves are
responsible

Use of explicit tutorial process to stimulate

reflection, active participation and
application

Use of knowledge requires communica- Learning is an

tive action students must also learn active process of
these skills reflection and
investigation

Theories of professional practice and of

learning

Figure 1: Summary of the key features and conceptual basis of Problem Based Learning

BOX 1: ‘‘CAPABILITIES’’ THAT PBL DEVELOPS

. Awareness (active listening) . Personal learning preference . Defining real problems
(goals, mission, vision)
. Problem solving . Learning skills . Look back and extending experience
(laws, theories, concepts, etc.) (recognizing fundamentals in a given
situation)
. Strategy (planning) . Creativity . Decision making
. Stress management . Time management . Group and chairperson skills
. Managing change . Interpersonal skills . Coping creatively with conflict
. Reasoning critically and creatively . Adopting a more universal . Practicing empathy, appreciating
or holistic approach the other person’s point of view
. Collaborating productively in . Self-directed learning . Self-directed lifetime learning
groups or teams
. Self-assessment . Obtaining criteria

reintroducing material at increasing depth), integrated and argues that the important differentiation is the way in
(de-emphasizing separate subjects), progressive (developing which knowledge, learning, and the role of the student are
as students adapt), and consistent (supporting curricular conceptualized and manifest in the curriculum. Based on
aims through all its facets). Others describe a continuum of the argument that the key variables in PBL are ‘‘the
PBL models. Savin-Baden11 proposes six dimensions of PBL problem’’ and ‘‘the information gained,’’ Harden and

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BOX 2: GENERIC PBL ESSENTIALS

. Students must have responsibility for their own learning.
. The problem simulations used in Problem Based Learning must be ill structured and allow for free inquiry.
. Learning should be integrated from a wide range of disciplines or subjects.
. Collaboration is essential.
. What students learn during their self-directed learning must be applied back to the problem with reanalysis and
resolution.
. A closing analysis of what has been learned from work with the problem and a discussion of what concepts and
principles have been learned is essential.
. Self- and peer assessment should be carried out at the completion of each problem and at the end of every curricular
unit.
. The activities carried out in Problem Based Learning must be those valued in the real world.
. Student examinations must measure student progress towards the goals of Problem Based Learning.
. Problem Based Learning must be the pedagogical base in the curriculum and not part of a didactic curriculum.

Davis23 propose a continuum of 11 ‘‘types’’ of PBL, cognitive or metacognitive development and/or encultura-
depending on the way in which the key variables are tion. The PBL literature suggests a number of techniques
employed to facilitate learning. Charlin et al.24 developed a that PBL teachers may adopt in their interactions with
10-dimension model of PBL which they used to compare students. These techniques include the adoption of
PBL programs in three Canadian medical schools. particular role personae and forms of communicative
Notwithstanding the considerable differences between action (see Box 3).27 Teachers require preparation and
these schools on the 10 dimensions, the authors argue support for both the change to and maintenance of these
that each program was ‘‘true PBL.’’ Perhaps a more role personae, in particular visible institutional support in
practical approach for teachers and curriculum develop- the form of recognition of the high level of skill required and
ment teams is that provided by Barrows,17 who proposes a adequate time to prepare for and carry out their role.
list of ‘‘essentials’’ or principles for the design of PBL (see
Box 2). 2. The Use of an Explicit Process to Facilitate Learning
The tutorial process is used as a framework to assist in the
development and practice of affective, cognitive, and
KEY FEATURES OF PBL CURRICULA metacognitive skills. There are different models of the PBL
As noted above, there is little agreement about the key tutorial process. The process referred to in many medical
features of PBL and little high-quality research evidence school PBL programs is largely derived from the seven-step
upon which to distinguish the relative effectiveness of model developed at Maastricht.26 This version is explicit in
different designs (see below for discussion). Arguably, its adherence to a classical hypothetico-deductive approach,
across the various PBL literatures, five key features of a which can appear to overemphasize problem solving rather
PBL curriculum can be distinguished. than learning. An alternative description of the tutorial
process provided by Wolff27 appears to give greater
1. Teacher as Facilitator emphasis to identifying gaps in knowledge and self-
Different terms are used to indicate the role played by a directed learning strategies to ‘‘fill’’ these gaps (see Box 4).
teacher in the context of a PBL program, including ‘‘tutor’’24
and ‘‘facilitator.’’20 However, the widespread use of such These models of the PBL process act as guides for the tutor
terminology does not necessarily indicate agreement or a and students to help them through the learning process.
great depth of understanding of the practices and disposi- In the first meeting of a cycle with a new scenario,
tions required for successful facilitation.20 Different aspects the students work through steps 1 to 4. Between meetings
of the role are emphasized in different accounts and models the students engage in self-directed learning. The second
of PBL. A common thread in descriptions of this role is that and third meetings in a cycle are devoted to getting
the tutor or facilitator is a ‘‘more knowledgeable member of feedback on what the students have learned from the
the community.’’ Sociocultural approaches emphasize the research they have undertaken between the meetings,
teacher’s role in enculturating the learner into the specific synthesizing this information, and applying it to the
community of practice through, for example, internalization scenario. At the end of each cycle, the group reviews its
of the language, attitudes, and values of the community.21 performance as a learning group and learning goals are
Cognitive approaches emphasize the teacher’s role as identified for improvement.22
facilitator of cognitive development in the knowledge and
The stages may be worked through sequentially, but often
skills of the community.25
the students will move backward and forward between the
In the classroom, the PBL teacher employs his or her stages during each cycle as they spend more time thinking
knowledge of the ‘‘subject’’ area to support the processes of and discussing the issues. There appears to be little

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BOX 3: TEACHING TECHNIQUES FOR THE PBL TEACHER

––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
Communicative actions Role personae
––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
. Staying silent . Learner

. Probing questions: Why? What do you mean? What does that mean? . Creator
. Reflecting questions: How does this idea help you? . Director
. Involvement questions: Who else has ideas on this? . Challenger
. Physical positioning in group . Evaluator
. Educational diagnosis questions: How do you feel about the way you formulated your ideas? . Negotiator
. Stimulating interest . Modeler
. Decreasing challenge where there are signs of boredom or ‘‘over challenge’’ . Designer
. Helping students to address issues with interpersonal dynamics . Facilitator
(e.g., by asking questions about dysfunctional group behaviors) . Supporter
––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––

BOX 4: THE EIGHT TASKS OF PBL

1. Explore the problem: clarify terms and concepts that are not understandable, create hypotheses, identify issues.
2. Identify what you know already that is pertinent.
3. Identify what you do not know.
4. As a group, prioritize the learning needs, set learning goals and objectives, allocate resources; members identify which
task they will do.
5. Engage in a self-directed search for knowledge.
6. Return to the group and share your new knowledge effectively so that all group members learn the information.
7. Apply the knowledge; try to integrate the knowledge acquired into a comprehensive explanation.
8. Reflect on what has been learned and the process of learning.

discussion in the PBL literature about the student feedback existing relevant knowledge into appropriate semantic
stage. Personal experience of observation in a number of networks.30
different PBL programs suggests that feedback is often
limited to the ‘‘mini-lecture’’ type identified by Hadwin.28 3. Use of ‘‘Problems’’ to Stimulate, Contextualize and
While this is recognized as a kind of first ‘‘stage’’ in the Integrate Learning
student’s development in the PBL literature,29 according In the literature on PBL the terms ‘‘problem,’’ ‘‘trigger,’’ and
to Hadwin28 it is the least effective at promoting self- ‘‘scenario’’ are used to refer to the material presented to
regulation and fostering critical thinking. The issue of students in initiating a specific learning cycle. Often these
feedback is also linked to the way in which the learning terms are used interchangeably, even when, in practice,
objectives are divided among the students. Barrows argues there appear to be significant differences in the material
that from all the possible learning objectives identified in presented. To avoid confusion, the term ‘‘scenario’’ will be
each problem, students should prioritize a small number used here. In the PBL literature, scenarios play at least three
that they will investigate, as this will facilitate greater roles in the construction of the learning environment:
recognition of the complexity of any issue and deeper discussion of the scenarios serves to encourage students to
learning.17 The aim of feedback, therefore, should be for the activate relevant prior knowledge, stimulates students’
students to share all the information they have obtained in interest and thus their intrinsic motivation to learn, and
order to make in-depth analysis and synthesis of ideas sets a context for the learning of knowledge similar to that
possible. The importance of the stage of applying the in which future use of the knowledge will be required.31
knowledge back to the scenario is emphasized in the For example, from the scenario given in Box 5, students in a
PBL literature. It is argued that this attempted application nursing education program that uses PBL identified four
of the knowledge facilitates the elaboration of ‘‘new’’ and broad learning issues:

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BOX 5: EXAMPLE OF SCENARIO FROM A PBL CURRICULUM IN NURSING

Nurse Sue Downs

Joy Chen is the newly appointed F Grade in charge of Blue team. She has been in post two months. Sue Downs is a D
Grade nurse in Joy’s team and has worked on the ward part-time for 10 years. Sue is popular with other members of staff
and with the patients. Joy feels that the team’s documentation of patient assessments, care plans, and evaluation could be
improved. She perceives that when Sue is the named nurse, documentation is particularly poor. She also notices that
when Sue has been looking after a group of patients on a shift she frequently leaves work incomplete. Sue is quite open
about this, often reporting that ‘‘she has not had time to do such and such’’ in the handover meeting. Although nobody
complains about this, Joy feels it may cause resentment among the other team members, who have to ’’do her work
for her.’’

Resources
Adair J. Effective Team Building. London: Pan Books, 1986.
Douglass LM. The Effective Nurse: Leader and Manager, 4th ed. St. Louis, MO: Mosby—Year Book, 1992.
Sullivan MP. Nursing Leadership and Management. Springhouse, PA: Springhouse Corp., 1990.
Tappen RM. Nursing Leadership and Management: Concepts and Practice, 3rd ed. Philadelphia: Davis, 1995.
Driscoll J. Practising Clinical Supervision: A Reflective Approach. Edinburgh: Bailliere Tindall, 2000.

Core Concepts: Nurse Sue Downs

. Nursing Role: Aesthetics: *Management of change, Leading and motivating a team, Role modeling

. Ethics: Leading a team, Dealing with staff

. Professional Role: *The nurse as a change agent, *Reflective practice, Risk management, Clinical supervision,
Leadership, Performance management
. Sociology: Role theory, Management of change theories, Organizational and occupational culture
. Education/Psychology: Motivation theory, Theories of reasoned action, Learning styles, Learning theory

1. What are effective styles of leadership? In some models of PBL, the small group process includes
the requirement that at each session a different student
2. How best to implement change?
‘‘facilitate’’ or ‘‘chair’’ the session. It is argued that this
3. What are current National Health Service Guidelines reinforces the message that students must take responsib-
on patient documentation? ility for the learning process and for the functioning
4. What is clinical supervision and preceptorship?32 of the group. It is also argued that ‘‘facilitation skills’’ are
an important part of the professional repertoire. Taking on
the role of facilitator in a supportive environment helps
4. Learning in Small Groups students to practice and develop these skills.29 Learning to
The small group is an integral part of the PBL approach, ‘‘perform’’ in this role, therefore, becomes part of the goal
used consciously and conscientiously to achieve the learn- and process of learning. There are differences of opinion
ing outcomes.29 It is argued that purposefully designed and about the ideal size for a PBL small group, but it is argued
successful small group learning facilitates learning through that the development of skills for communication, the
the development of a learning environment that supports development of knowledge, and collaboration are best
and promotes both cognitive and metacognitive develop- fostered in groups with between five and 10 members.29, 33
ment. The links between the structures of small group
learning emphasized in PBL, the processes these structures 5. Assessment and Problem Based Learning
facilitate, and the learning outcomes that are claimed to There is a shared view among PBL advocates that assess-
result from these processes are illustrated in Figure 2. ment drives learning and that there should be alignment
Implicit in the design of the PBL small group is the idea that between the goals of a PBL program and what is assessed.
many of these ‘‘positive actions’’ (e.g., cooperation) do not However, the consequences of this view are interpreted
just happen by themselves, whereas many of the ‘‘negative differently. Some writers suggest that both the response
actions’’ (e.g., conflict) are a routine and inevitable part of format and the content of the test must be appropriate to
working in a group. The ‘‘structures’’ in small group PBL, PBL.34 Others argue that response format is of less
along with the tutorial process and the use of scenarios, help consequence than content and test design.35 Multiple-
the students learn how to learn in groups and learn how to choice questions have often been rejected for use in PBL
anticipate, prevent, cope with, and deal with the difficulties programs, for various reasons including the belief that they
that they will experience working in this way. This is not to are suitable for measuring only lower levels of taxonomic
say that these structures are present in the organization of cognitive functioning.36 Others argue, however, that there is
all PBL small group learning environments. no reason why multiple-choice questions cannot be used in

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Structures in small Processes facilitated Products:

group PBL: by small group
Valuing of different
Small group is the only environment:
perspectives
‘scheduled’ learning Sharing ideas
Development of group
environment
Sharing knowledge process/teamwork/
Students have to control interpersonal skills
Working together
the process of learning -
Providing support Individual reflection
Tutor will only facilitate
Conflict Enhanced enthusiasm
Students have to take
and motivation
turns to act as a ‘Chair’ Competition
or ‘Scribe’ in a session Increased ability in self
Challenging of views directed learning
Follow tutorial process
Active participation Learning becomes more
Students identify
Monitoring meaningful and is thus
learning goals
retained
Students required to Elaboration
Increased ability in
evaluate each others Critical feedback self-evaluation
performance
Exclusion Developing knowledge
Testing out of as part of ‘community of
ideas/theories practice’
Modelling
Evaluation
Recognition of the
different learning
opportunities afforded
by the scenario

Figure 2: Structures, actions and products of small group learning

PBL assessment, as the key issue is the quality of the design the Triple Jump Exercise is a very time-consuming,
and administration of the test rather than the method costly method of assessment with poor measurement
itself.37 The ‘‘Progress test,’’38 used with slight variation in characteristics.44
the PBL programs in a number of medical schools, uses the
multiple-choice question format.
EVIDENCE ABOUT THE EFFECTIVENESS OF
A number of assessment formats are claimed to provide a PROBLEM BASED LEARNING
more valid measure of the learning developed by PBL Problem Based Learning is no exception to the debates and
programs. Modified essay questions (MEQs) have been arguments about appropriate methods of evaluation that
used to assess PBL in both clinical and pre-clinical courses. characterize the field of education research.45, 46 PBL has
It is argued that the properly designed evolving MEQ opens arguably been one of the most scrutinized innovations in
up possibilities for exercising ‘‘intelligent guessing’’ that professional education.7 However, as Woodward47 points
mirror the realities of clinical work and can thus measure out, empirical evidence that supports the theories that
abilities and attitudes that other assessment methods underpin PBL is not the same as empirical evidence to
cannot.39 Although the reliability of the MEQ method has support the claim that it produces practitioners who
been established,40 caution has been expressed about its maintain consistently high levels of performance through-
misuse and overuse in PBL programs.41 Studies have also out their professional careers. Block and Moore48 argue that
suggested that the MEQ measures nothing different from despite the fact that many useful studies of PBL exist,
the multiple-choice question.42 selection bias and the absence of control groups limit the
conclusions that can be drawn from them. Colliver49 has
The Triple Jump Exercise is a learning process measure
reignited the debate about the effectiveness of PBL by
widely used as an assessment tool in PBL programs.43 This
claiming that studies have erroneously claimed effects for
exercise consists of three steps (jumps): a structured oral
PBL when it was more likely that these effects were due to
examination based on one or more patient problems, a time-
differences in selection and philosophy of care.
limited study assignment in relation to the patient problems
in the first oral examination, and a repeat oral examination To obtain a clearer picture of what high-quality research
in which the quality of self-learning around the assigned studies indicate about the effectiveness of PBL, a research
topic is assessed. The Triple Jump Exercise is currently used project involving secondary data analysis in the form of a
in a number of PBL programs around the world, including ‘‘review of reviews’’ was carried out as part of the Project on
the problem-based BSc Nursing program at McMaster the Effectiveness of Problem Based Learning (PEPBL).8
University in Ontario. Critics have argued, however, that Readers are advised to refer to the study report for details of

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is given here. Five previous reviews of PBL were used.50–54 Rideout E, ed. Transforming Nursing Education through
Ninety studies cited in these reviews were identified as Problem-Based Learning. Sudbury, MA: Jones & Bartlett,
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6 Hmelo C, Evensen D. Introduction to problem based
reviews.’’ Three of these 15 studies did not include any data
learning: Gaining insights on learning interactions through
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the quality criteria. The results regarding cognitive devel- eds. Problem Based Learning: A Research Perspective on
opment, as measured by assessment of one kind or another, Learning Interactions. Mahwah, NJ: Lawrence Erlbaum,
varied. Of the 39 outcomes reported, 16 favored PBL and 23 2000:1–18.
the control group. A pilot meta-analysis carried out as part
of the review found a mean effect size estimate of d ¼
0.3 7 Maudsley G. Do we all mean the same thing by
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should be treated with caution, as the outcomes included and formulation of the ground rules. Acad Med 74:178–185,
are not independent.55 1999.

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12 Powell V, Steel C. Search for the woolly mammoth:
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54 Smits P, Verbeek J, De Buisonje C. Problem based

learning in continuing medical education: A review AUTHOR INFORMATION
of controlled evaluation studies. Brit Med J 324:153–156,
2002. Mark Newman, PhD, is a Senior Research Officer in the
Evidence for Policy and Practice Coordinating Center (EPPI-
55 Hedges, L. The basics of meta-analysis. Stockholm: 3rd Centre), Social Science Research Unit (SSRU) of the Institute
Campbell Collaboration Colloquium, 2003. of Education, University of London, 18 Woburn Square,
56 Moore GT, Block SD, Style CB, Mitchell R. The London WC1H 0NR UK. E-mail: m.newman@ioe.ac.uk. He is
influence of the New Pathway curriculum on Harvard one of a team coordinating a major UK-government-funded
medical students. Acad Med 69:983–989, 1994. research project to produce systematic reviews on
educational topics. His major interest is evidence-based
57 Lewis KE, Tamblyn RM. The problem-based learning practice in health care and education, including the
approach in baccalaureate nursing education: How effective development of effective student-centered learning environ-
is it? Nurs Papers 19:17–26, 1987.
ments. He was the Principal Investigator on the Economic &
58 Grol R, Mokkink H, Helsper-Lucas A, Tielens V, Social Science Research Council–funded Project on the
Bulte J. Effects of the vocational training of general practice Effectiveness of Problem Based Learning (PEPBL).

20 JVME 32(1) ß 2005 AAVMC

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