1. PROBLEM BASED
LEARNING
Professor S. A. Tabish
FRCP (London), FRCP (Edin), FAMS, MD

2. New Horizons in Medical Education
What were the challenges?
• Changes in patient’s expectations
• Changes in HC delivery (style of practice of
doctors)
• Changes in medical knowledge
- traditionally the course was structured as a
progression from basic sciences to the clinical
sciences, with little integration
• Failing to prepare students adequately for the
diversity of problems which they will encounter
as professionals. Student’s expectations of
quality of teaching are higher

3. • The exponential growth of med
knowledge & the greatly increased
content of the scientific aspect of the
curriculum has made the selection of
appropriate core content and the
integration of basic and clinical
sciences important aspects of
curricular design

4. Domains of essential Global Requirements of
ME

5. What was the response to these
challenges?
• The development of new curricula
incorporating new curriculum themes &
different educational strategies
• The introduction of new learning situations
& the use of new tools & aids to learning
• New methods of assessment [OSCE:
objective structured clinical exam. Which
can test performance & competence in a
wide diversity of settings; Formative
Assessment; Portfolio assessment; Workbased assess]

6. New Educational Strategies
• New strategies appropriate for adult
learning (instead of spoon-feeding):
• Self-directed learning
• Problem Based Learning
• Integrated system based approach
• Task Based learning
• Core & Student-selected
Components
• A spiral curriculum

7. New Tools & Aids
• Use of Study Guides
• Use of Computer Assisted Programs
& Internet
• Use of Videos to teach Clinical
Skills/consultation techniques
• Role of Simulators & Simulations in
aspects of physical exam & practical
procedures

8. PBL
• Problem-based learning (PBL) is a method of
learning in which learners first encounter a
problem followed by a systematic, learnercentered inquiry and reflection process.
• PBL is a method designed to help students
learn the sciences basic to medicine at the
same time they develop the reasoning
process used by physicians and other health
professionals in their clinical practice.
• 􀂄 The problem comes first without
advance readings, lectures, or
preparation.
• 􀂄 The problem serves as a stimulus for
the need to know.

9. PBL
• Helps learners build a bridge
between what they already
know and what they need to
know to reach
the next level
• Emphasizing active learning, which has
been shown to be more satisfying than
passive teacher-to-student learning and
to enhance retention and recall
• Emphasizing student-centered learning
in which students are actively involved in
setting their own learning goals

10. Advantages
Encourages:
• effective & self-directed learning
• Critical thinking
• Team work
• understanding rather than
memorization
• Facility with professional language
• Both students & staff enjoy the
process

11. Advantages
In preparing students for professional practice,
PBL:
• Encourages independence as students identify
& meet individual learning needs
• Stimulates reflection & self-direction for lifelong learning
• Supports ongoing self-assessment
• Introduces clinical reasoning
• Enhances critical thinking & evidence-based
decision making
• Ensures that knowledge is transferred, applied
& retained by providing a relevant, integrated
context

12. • A problem initiates the activity
• The Group is stimulated to explore
basic scientific & clinical
mechanisms together with social,
psychological, ethical or professional
issues
• Problem stimulates students to
reason, think critically & weigh
evidence; they seek out & share
relevant info

13. PBL
• Groups do not need prior knowledge to
generate lively ideas as they identify
areas for further collective & personal
learning
• Each student brings individual
experience & makes a distinctive
contribution
• the Tutor’s role is to manage interactions
rather than supply info

14. • An effective Group provides a safe
environment for sharing & testing
new knowledge
• Students practice the language of
science & medicine, evaluate ideas
and receive feedback from peers &
teacher
• When clinical exposure is introduced
concurrently, intellectual & practical
skills develop in parallel

15. Framework for PBL
• A trigger initiates the problem
(paper/computer/video)
• Groups brainstorm to identify key issues
for discussion
• Broad thinking produces a rich array of
mechanisms & ideas
• Hypothesis are critically explored through
reasoning
• The need for additional info is identified
• A Conclusion is reached
• Group reviews the process

16. Framework for PBL - II
• In Breaks between Tutorials,
students identfy Learning Issues to
be pursued
• They are encouraged to adot an
evidence-based approach
• When they reconvene, they share
and review the learning

17. Characteristics of an effective PBL Group
An Effective Group is: Cohesive, motivated,
mutually supportive & actively engaged in
learning
• The Group understands the process &
energetically pursues its task
• Members respect each other’s contribution but
examine them critically
• Discussions flow as students cooperate rather
than compete
• The atmosphere is friendly & good humoured
• Roles are shared; all take turns in scribing,
leading discussion, taking responsibility for
acquiring information

18. Staff Development
• Basic training is mandatory
• Further development may be a requirement
• Initial training may involve observation &
practice with a group from the program
• Effective training ensures that necessary
background, goals & local strategies are
considered, together with info on assessment
& evaluation
• In addition to materials supplied to students,
tutors are usually issued with handbooks,
highlighting issues for each problem

19. Tutor’s Role in Assessment
• Individual Students/Groups may be
assessed Summatively (determining
progression) or formatively (for
feedback).
The GROUP
• At the end of each problem, groups
review their processes, to encourage
self-reflection &enhance their
collective performance

20. Tutor’s Role in Assessment
Individual students:
• Tutors should provide formative feedback
to each member
• Ask students to complete a simple selfassessment questionnaire reviewing
appropriate behaviors; the tutor returns
them with comments
• Students will be a written/oral/clinical
tests that will determine their progression
& ultimate graduation

21. Evaluating PBL Tutorials-II
• At the end of each problem time is allocated
for evaluation
• Both the process & learning in PBL can be
evaluated against explicit goals
• The tutor’s review of effectiveness of group
processes offers insight for the members
• Students normally evaluate their tutor:
helpfulness, support for clinical reasoning,
encouragement for independent learning,
appropriate intervention, provision for
effective feedback

22. PBL
•
•
•
•
•
􀂄 Enabling students to learn in the context in which the
information will be used, which increases the ability to
retrieve and apply information
􀂄 Focusing on important concepts which helps learners
organize and store new information in a way that facilitates
retrieval and application
􀂄 Exploring prior knowledge, formulating inquiries derived
from and defined by the learners’ need to know, and
actively constructing meaning through dialogue and
reflection
􀂄 Utilizing problems designed to simulate students’
perception of their future profession, which serves as a
powerful stimulus for students’ intrinsic motivation to learn
􀂄 Actively involving students in monitoring their own
progress and reflecting on what works and what needs
improvement; frequently assessing student performance
and providing feedback

24. PBL: Starting the
case
• After the introductions and discussion
are completed, the tutor distributes the
first page (only) to each student and the
process begins with one of the
students reading it.
• Reading the case aloud keeps the
group focused
• Before moving on to the second page of
the session, the group should have
formed a clear idea of the problem so
far, what is known, what is needed to
know and where to go from here.

25. PBL Case
(contd.)
• By the end of the session: Before the
end of each session, the students in
the group need to clarify their plans
for their own learning between
sessions by:
– FIRST, identifying all of the
significant issues and settle on a
"do-able" list of learning tasks for
the next session.

26. PBL Case contd.
• SECOND, deciding which issues everyone will
tackle and which will be divided up (some issues
are so fundamental to the whole area that all
students should read about them themselves).
• THIRD, deciding what SPECIFIC questions
individuals will try to answer.
• FOURTH, deciding how they will address these
learning issues (e.g., by looking up notes from a
course, reading a section of a textbook, doing a
literature search, searching the internet or
consulting an expert)

27. The Process of PBL
• What are the issues?
Identify the important
issues in the problem
• How well do you understand the
issues?
• Are there any words or terms about
which you are unclear?

28. The Process of PBL contd.
• Consider the basic mechanisms that might
explain each important aspect of each
problem.
• Assess your current understanding of the
basic structural and/or functional
mechanisms that may contribute to the
presentation of the problem
• Use the collective skills and experiences of
group members to explore or explain these
phenomena. Identify current gaps in
knowledge or understanding.

29. Learn from each other
• Share your own
knowledge, expertise, or
ability to reason and
synthesize information.
Be receptive and
appreciative of the
contribution of your small
group members.

30. Determine priorities for learning
• Consider time, resources and
objectives and set priorities regarding
the relative importance of each
learning issue.
• Remember that the primary task of
each problem is to provide a
springboard to learning, not to
make a quick diagnosis and work
out a management plan.

31. • The problem is a stimulus for
discussion, asking questions, and a
framework for organizing your
knowledge.
• It will encourage the development
of sound concepts and lead to the
establishment of principles which
will apply throughout your medical
career.

32. PBL
• The problem comes first without
advance readings, lectures, or
preparation.
• The problem serves as a stimulus
for the need to know.

33. Learning Issues
• Learning issues are questions that
cannot be answered with
students’ current knowledge and
that can be explored and
answered through systematic,
self-directed inquiry.
• The use of learning issues in
tutorials prepares students to handle
similar challenges in clinical practice
and life-long learning.

34. Learning Issues in PBL:
First Session
1. Getting Started (Introductions, Ground
Rules, Expectations)
2. Identifying Problem
3. Exploring Pre-Existing Knowledge
4. Generating Hypotheses and Explaining
Mechanisms
5. Unfolding the Case Incrementally
6. Re-Evaluating/Reprioritizing Hypotheses
Based on New Information
7. Assessment/Reflection

35. PBL: Second Session
8. Independent SelfDirected Study of
Learning Issues

36. PBL: Third Session
• 9. Discussion of Learning Issues and
Application of New Knowledge to the
Case
• 10. Continued Unfolding of the Case
Incrementally
• 11. Assessment/Reflection

39. During Tutorial Session students will
􀂄 Come
prepared to discuss the case and learning
issues researched since the last tutorial.
􀂄 Actively participate in group discussions and
contribute to the learning process in a manner
that allows for the balanced participation of
everyone in the group.
􀂄 Develop learning issues at each session,
phrase them as full-sentence questions, write
them on the board, and post them on the course
web page.
􀂄 Consider biological, population,
behavior/mental health issues/explanations
and questions of professional attitudes,
values, and ethics related to the patient’s
problem(s) described in the case.

40. Tutorial Session contd.
􀂄 Go to the board to diagram, outline, draw, etc. in
explanation of mechanisms related
to hypotheses.
􀂄 Debate evidence related to the case and avoid
personal attacks on others.
􀂄 Comply with ground rules with regard to how
the group will function and how its
members treat one another.
􀂄 Participate in end-of-session reflection and
assessment by giving and receiving
constructive criticism regarding self, tutor,
student, and group performance.

41. Between Tutorial Session
􀂄 Research key learning issues using a
variety of resources
􀂄 Critically evaluate the credibility of
sources and the validity of the
information they have obtained in their
research.
􀂄 Integrate what they have learned through
research, lectures, labs, clinical skills,
Perspectives in Medicine (PIM), etc. into
what is discussed in tutorials
􀂄 Synthesize what they have learned and be
prepared to discuss it without reading
directly from their materials, as much as
possible, and apply it to the case at the
next tutorial session.

42. Determine priorities for
learning
• Consider time, resources and objectives
and set priorities regarding the relative
importance of each learning issue
• Remember that the primary task of each
problem is to provide a springboard to
learning, not to make a quick diagnosis
and work out a management plan.
• The problem is a stimulus for discussion,
asking questions, and a framework for
organizing your knowledge.
• It will encourage the development of sound
concepts and lead to the establishment of
principles which will apply throughout your
medical career

43. PBL: Starting the
case
• After the introductions and discussion
are completed, the tutor distributes the
first page (only) to each student and the
process begins with one of the
students reading it.
• Reading the case aloud keeps the
group focused
• Before moving on to the second page of
the session, the group should have
formed a clear idea of the problem so
far, what is known, what is needed to
know and where to go from here.

44. Problem-based learning is
designed to develop
􀂄 Integrated, context-specific knowledge
base
􀂄 Decision-making/critical thinking
process and skills
􀂄 Self-directed, life-long learning skills
􀂄 Interpersonal, collaboration, and
communication skills
􀂄 Constructive self and peer
assessment skills
􀂄 Professional ethics and behavior

45. PBL Case
(contd.)
• By the end of the session: Before the
end of each session, the students in
the group need to clarify their plans
for their own learning between
sessions by:
– FIRST, identifying all of the
significant issues and settle on a
"do-able" list of learning tasks for
the next session.

46. What is problem based
learning?
• In PBL students use "triggers" from the
problem case or scenario to define their own
learning objectives.
• Subsequently they do independent, self
directed study before returning to the group
to discuss and refine their acquired
knowledge.
• Thus, PBL is not about problem solving per
se, but rather it uses appropriate problems to
increase knowledge and understanding.
• The process is clearly defined

47. PBL
• PBL uses clinical cases as the context for
students to study basic and clinical
sciences.
• Its possible advantages over traditional
approaches include its greater relevance
to the practice of medicine, its ability to
promote retention and application of
knowledge, and its encouragement of selfdirected life-long learning.
• Possible disadvantages include higher
costs, both in resources and staff time.

48. PBL
• An educational method characterized by the use of
patient problems as a context for students to learn
problem-solving skills and acquire knowledge about
the basic and clinical sciences
• Students usually meet in small groups two or three
times a week for PBL tutorials
• They are presented with a clinical problem (eg, a
patient with chest pain), and, in a series of steps,
they discuss possible mechanisms and causes,
develop hypotheses and strategies to test the
hypotheses, are presented with further information,
and use this new information to refine their
hypotheses, finally reaching a conclusion.
• A tutor usually acts as a facilitator, guiding students
in this group-learning process.

49. • In the course of this exercise,
students identify both their existing
levels and gaps in their knowledge.
These gaps form the basis for
independent learning outside the
PBL tutorials. The identification and
pursuit of these so-called "learning
goals" is a key element of the PBL
process.

50. Rationale for using PBL
•
•
•
•
•
The PBL approach is based on principles of adult
education20 and cognitive psychology.21 It differs
fundamentally from traditional curricula, in which students
acquire "background" knowledge of the basic sciences in
the early years of the course and in the later years apply
this knowledge to the diagnosis and management of clinical
problems. This traditional approach has been criticised for
a number of reasons:4,22,23
It creates an artificial divide between the basic and clinical
sciences;
Time is wasted in acquiring knowledge that is subsequently
forgotten or found to be irrelevant;
Application of the acquired knowledge can be difficult;
The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising
for students.

53. The group learning process: acquiring
desirable learning skills

54. Generic Skills & attitudes
•
•
•
•
Teamwork
Critical evaluation of literature
Chairing a group
Self directed learning and use of
resources
• Listening Presentation skills
Recording
• Cooperation
• Respect for colleagues' views

55. • Group learning facilitates not only the acquisition
of knowledge but also several other desirable
attributes, such as communication skills,
teamwork, problem solving, independent
responsibility for learning, sharing information,
and respect for others. PBL can therefore be
thought of as a small group teaching method that
combines the acquisition of knowledge with the
development of generic skills and attitudes.
Presentation of clinical material as the stimulus
for learning enables students to understand the
relevance of underlying scientific knowledge and
principles in clinical practice.

56. •
when PBL is introduced into a curriculum, several other
issues for curriculum design and implementation need to
be tackled. PBL is generally introduced in the context of a
defined core curriculum and integration of basic and clinical
sciences. It has implications for staffing and learning
resources and demands a different approach to
timetabling, workload, and assessment. PBL is often used
to deliver core material in non-clinical parts of the
curriculum. Paper based PBL scenarios form the basis of
the core curriculum and ensure that all students are
exposed to the same problems. Recently, modified PBL
techniques have been introduced into clinical education,
with "real" patients being used as the stimulus for learning.
Despite the essential ad hoc nature of learning clinical
medicine, a "key cases" approach can enable PBL to be
used to deliver the core clinical curriculum

57. No CRoles
of participants in a PBL tutorial
aption Found
Wood, D. F BMJ 2003;326:328-330
Copyright ©2003 BMJ Publishing Group Ltd.

58. What happens in a PBL
tutorial?
• PBL tutorials are conducted in several ways. In
this article, the examples are modelled on the
Maastricht "seven jump" process, but its format of
seven steps may be shortened.
• A typical PBL tutorial consists of a group of
students (usually eight to 10) and a tutor, who
facilitates the session. The length of time
(number of sessions) that a group stays together
with each other and with individual tutors varies
between institutions. A group needs to be
together long enough to allow good group
dynamics to develop but may need to be
changed occasionally if personality clashes or
other dysfunctional behaviour emerges.

59. •
Students elect a chair for each PBL scenario and a "scribe"
to record the discussion. The roles are rotated for each
scenario. Suitable flip charts or a whiteboard should be
used for recording the proceedings. At the start of the
session, depending on the trigger material, either the
student chair reads out the scenario or all students study
the material. If the trigger is a real patient in a ward, clinic,
or surgery then a student may be asked to take a clinical
history or identify an abnormal physical sign before the
group moves to a tutorial room. For each module, students
may be given a handbook containing the problem
scenarios, and suggested learning resources or learning
materials may be handed out at appropriate times as the
tutorials progress.

60. Examples of trigger
material for PBL
scenarios
•
•
•
•
•
•
•
•
Paper based clinical scenarios
Experimental or clinical laboratory data
Photographs
Video clips
Newspaper articles
All or part of an article from a scientific
journal
A real or simulated patient
A family tree showing an inherited
disorder

61. PBL tutorial process
– Step 1 Identify and clarify unfamiliar terms presented in the scenario;
scribe lists those that remain unexplained after discussion
– Step 2 Define the problem or problems to be discussed; students may
have different views on the issues, but all should be considered;
scribe records a list of agreed problems
– Step 3 "Brainstorming" session to discuss the problem(s), suggesting
possible explanations on basis of prior knowledge; students draw on
each other's knowledge and identify areas of incomplete knowledge;
scribe records all discussion
– Step 4 Review steps 2 and 3 and arrange explanations into tentative
solutions; scribe organises the explanations and restructures if
necessary
– Step 5 Formulate learning objectives; group reaches consensus on
the learning objectives; tutor ensures learning objectives are focused,
achievable, comprehensive, and appropriate
– Step 6 Private study (all students gather information related to each
learning objective)
– Step 7 Group shares results of private study (students identify their
learning resources and share their results); tutor checks learning and
may assess the group

62. •
The role of the tutor is to facilitate the proceedings (helping
the chair to maintain group dynamics and moving the group
through the task) and to ensure that the group achieves
appropriate learning objectives in line with those set by the
curriculum design team. The tutor may need to take a more
active role in step 7 of the process to ensure that all the
students have done the appropriate work and to help the
chair to suggest a suitable format for group members to
use to present the results of their private study. The tutor
should encourage students to check their understanding of
the material. He or she can do this by encouraging the
students to ask open questions and ask each other to
explain topics in their own words or by the use of drawings
and diagrams.

63. PBL in curriculum design
•
•
PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses. In
practice, PBL is usually part of an integrated curriculum
using a systems based approach, with non-clinical material
delivered in the context of clinical practice. A module or
short course can be designed to include mixed teaching
methods (including PBL) to achieve the learning outcomes
in knowledge, skills, and attitudes. A small number of
lectures may be desirable to introduce topics or provide an
overview of difficult subject material in conjunction with the
PBL scenarios. Sufficient time should be allowed each
week for students to do the self directed learning required
for PBL.

64. No C Designing
and implementing a curriculum module using PBL supported by other
teaching methods aption Found
Wood, D. F BMJ 2003;326:328-330
Copyright ©2003 BMJ Publishing Group Ltd.

65. Writing PBL scenarios
• PBL is successful only if the
scenarios are of high quality. In most
undergraduate PBL curriculums the
faculty identifies learning objectives
in advance. The scenario should
lead students to a particular area of
study to achieve those learning
objectives

66. •
•
•
•
•
•
•
•
•
How to create effective PBL scenarios*
Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty
learning objectives
Problems should be appropriate to the stage of the curriculum and
the level of the students' understanding
Scenarios should have sufficient intrinsic interest for the students
or relevance to future practice
Basic science should be presented in the context of a clinical
scenario to encourage integration of knowledge
Scenarios should contain cues to stimulate discussion and
encourage students to seek explanations for the issues presented
The problem should be sufficiently open, so that discussion is not
curtailed too early in the process
Scenarios should promote participation by the students in seeking
information from various learning resources
*Adapted from Dolmans et al. Med Teacher 1997;19:185-9

67. Staff development
• Introducing PBL into a course makes new
demands on tutors, requiring them to
function as facilitators for small group
learning rather than acting as providers of
information. Staff development is essential
and should focus on enabling the PBL
tutors to acquire skills in facilitation and in
management of group dynamics
(including dysfunctional groups).

68. A dysfunctional group: a dominant character may
make it difficult for other students to be heard

69. A dysfunctional group: a dominant character may
make it difficult for other students to be heard
• Tutors should be also given information
about the institution's educational strategy
and curriculum programme so that they
can help students to understand the
learning objectives of individual modules
in the context of the curriculum as a
whole. Methods of assessment and
evaluation should be described, and time
should be available to discuss anxieties

71. Advantages of PBL
•
Student centred PBLIt fostersactive learning, improved
understanding, and retention and development of lifelong
learning skillsGeneric competenciesPBL allowsstudents to
develop generic skills and attitudes desirable in their future
practiceIntegrationPBL facilitates anintegrated core
curriculumMotivationPBL is fun for studentsand tutors, and
the process requires all students to be engaged in the
learning process"Deep" learningPBL fosters deeplearning
(students interact with learning materials, relate concepts to
everyday activities, and improve their
understanding)Constructivist approachStudentsactivate
prior knowledge and build on existing conceptual
knowledge frameworks

74. Disadvantages
• Tutors who can't "teach"Tutorsenjoy passing on
their own knowledge and understanding so may
find PBL facilitation difficult and frustratingHuman
resourcesMore staffhave to take part in the
tutoring processOther resourcesLarge numbersof
students need access to the same library and
computer resources simultaneouslyRole
modelsStudents may bedeprived access to a
particular inspirational teacher who in a traditional
curriculum would deliver lectures to a large
groupInformation overloadStudentsmay be
unsure how much self directed study to do and
what information is relevant and useful

75. Assessment of PBL
• Student learning is influenced greatly by
the assessment methods used. If
assessment methods rely solely on factual
recall then PBL is unlikely to succeed in
the curriculum. All assessment schedules
should follow the basic principles of
testing the student in relation to the
curriculum outcomes and should use an
appropriate range of assessment
methods.

76. •
Assessment of students' activities in their PBL groups is
advisable. Tutors should give feedback or use formative or
summative assessment procedures as dictated by the
faculty assessment schedule. It is also helpful to consider
assessment of the group as a whole. The group should be
encouraged to reflect on its PBL performance including its
adherence to the process, communication skills, respect for
others, and individual contributions. Peer pressure in the
group reduces the likelihood of students failing to keep up
with workload, and the award of a group mark added to
each individual's assessment schedule encourages
students to achieve the generic goals associated with PBL.

77. Conclusion
• PBL is an effective way of delivering
medical education in a coherent,
integrated programme and offers several
advantages over traditional teaching
methods. It is based on principles of adult
learning theory, including motivating the
students, encouraging them to set their
own learning goals, and giving them a role
in decisions that affect their own learning.

78. • PBL does not offer a universal panacea for
teaching and learning in medicine, and it has
several well recognised disadvantages.
Traditional knowledge based assessments of
curriculum outcomes have shown little or no
difference in students graduating from PBL or
traditional curriculums. Importantly, though,
students from PBL curriculums seem to have
better knowledge retention. PBL also generates a
more stimulating and challenging educational
environment, and the beneficial effects from the
generic attributes acquired through PBL

79. PBL: 5 Easy Steps
• Read the problem
Mrs. Paula Embledon
Mrs. Paula Embledon is a 78 year old woman who has
come to the emergency room complaining of shortness
of breath and pain in her chest. She had been in
relatively good health until three weeks previously,
when she sprained.....

80. 2. Brain storm
• Brainstorm
•
– hypotheses
• - what do we know in support of
the hypothesis?
• - what do we need to know to test
the hypothesis?
– learning issues

81. Brainstorm

82. • 3. Identify/Discuss/Assign
– essential issues (for everyone to look up)
– specific issues (for individuals to look up)
– overlapping issues

83. • 4. Individual Reading - Research Preparation

84. • 5. Return
•
– review case so far
– report and discuss
– assess progress - continue page/next
page/complete
– self-evaluation - How did things go? Any
suggestions for next time?
– next problem

85. • 5. Return

86. THE FIRST GROUP SESSION
•
•
•
<>Be sure you have the necessary information: Bring
your handbook to the session, especially at first. The tutors
will ensure that you have the information relevant to the
case to be discussed that day.
Seating arrangements: Be sure that conversation can flow
easily, and be sure that everyone can establish eye contact
with everyone else in the group. If this is not the case,
suggest seating changes during this first session.
Tutor introductions: Tutors will introduce themselves by
telling the group something about their field and personal
interests. Tutors may want to identify how they wish to be
addressed (e.g., "Please call me Barry in these group
sessions and Dr. Smith in the clinical setting"). Some
students will be more comfortable addressing the tutor as
Dr.

87. •
•
•
<>Student introductions: Students will be asked to introduce
themselves to the group. Let the tutor and the others know about
you, your interests, your background etc. Tell the group something
about yourself that they do not already know. Include areas of
special interest or experience outside of medicine.
Review the objectives of PBL and the evaluation process:
Briefly go over the process and the objectives of PBL and review
the evaluation process. It may help to discuss your understanding
of the objectives. It is especially useful if the members of the
group discuss their own experience in previous PBL groups - what
worked, what didn't. This should lead to a consensus as to how to
proceed in the current sessions. It also serves to prevent some
problems before they arise.
Choose a "secretary": The secretary is the email link between
the group and the PBL coordinator. He or she is also responsible
for i) ensuring tutor evaluation is carried out and the results
transmitted to the tutor and the PBL coordinator, and ii) giving
feedback on the process and problems to the PBL coordinator.

88. • <> Starting the case: After the
introductions and discussions are
completed, the tutor distributes the first
page (only) to each student and the
process begins with one of the students
reading it. Based on their current level of
knowledge the students then discuss the
key information presented, formulate
hypotheses as to the nature of the
problem, discuss what information may be
needed to test their hypotheses, and,
finally, generate a list of learning issues.

89. •
•
<>By the end of the session: Before the end of each session, the
students in the group need to clarify their plans for their own learning
between sessions by:
FIRST, identifying all of the significant issues arising from the hypothesis what is known in support of the hypothesis, what do they need to know?
•
SECOND, settling on a "do-able" list of learning tasks for the next
session.deciding which issues everyone will tackle and which will be
divided up (some issues are so fundamental to the whole area that all
students should read about them themselves).
•
THIRD, deciding what SPECIFIC questions individuals will try to answer
(even minor issues should be looked up by at least two individuals, to
promote discussion).
•
FOURTH, deciding on the "enquiry strategy" - how they will address these
learning issues (e.g. by looking up notes from a course, reading a section
of a textbook, doing a literature search, searching the internet, consulting
an expert, accessing community resources, and so on).