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Sue Shaw, Julia Lacey, Briony Leighton and Bruce
Warner are teacher-practitioners working at the Pharmacy Academic
Practice Unit, University of Derby, Mickleover Campus, Chevin Avenue,
Derby DE3 9GX.
Correspondence to Sue Shaw
e-mail s.shaw@derby.ac.uk
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Problem-based learning (PBL) is an innovative learning method that forces
academic learning to engage with practice. The problems are taken from
practice, possible solutions are found from the learning process and
the learning is a transferable skill that prepares students to tackle
future practice issues. In addition, PBL enables pharmacy education to
link directly with continuing professional development (CPD), a mandatory
requirement for continued registration with the Royal Pharmaceutical
Society as a practising pharmacist. Who can facilitate this learning?
This article describes how the role of the teacher-practitioner offers
the best combination of skills to support this style of learning. PBL
has evolved as a learning solution because pharmacy practitioners and
academics have battled with the dilemma of teaching students knowledge
relating to continuously changing information on drugs and their application,
with the need to develop the skills of student-led lifelong learning.
Our understanding of the implications for adopting PBL is growing with
recent investigations in a postgraduate clinical programme1 and, in a
limited way, in undergraduate teaching and learning for pharmacists in
the UK.2
In the past two years we have gained extensive experience in postgraduate
PBL and confidence in delivery and assessment of expected outcomes of
learning. A hospital-based MSc in clinical pharmacy has been available
from the pharmacy academic practice unit of the University of Derby since
1993. Postgraduate teaching has historically been delivered by pharmacists
who work solely in academia, with specialist clinical pharmacists providing
input to content of learning material, since they are considered experts
in a particular field of practice. However, the academic pharmacist delivering
the material may not have this expertise,
or an understanding of current practice. Conversely, the specialist pharmacist
may not have an understanding of the design of learning materials to
engage student interest and improve learning outcomes. The optimum model,
we would argue, is a combination of the two.
Teacher-practitioners are pharmacists who work at the interface between
practice and academia so they are best placed to enable this model. In
Derby they are responsible for running and developing the programme which
supports 80 postgraduate students each year. The teacher-practitioners
of the programme have a key role to play as they are able to balance
their academic experience of learning design with the clinical “expert” knowledge
and skills relevant to practice. In order to appreciate this fully, an
understanding of current PBL issues is necessary.
What is PBL?
Boud3 described PBL as learning that is centred around “a problem,
a query or a puzzle that the learner wishes to solve”. Boud and
Feletti4 went on to describe PBL as a style of learning in which the
problems act as the context and driving force for learning. In other
words, with PBL, the learning starts when the problem arises — in
much the same way that learning in practice starts when a pharmacist
is faced with a new challenge. PBL has been described as “one of
the most important educational developments in the past 30 years”.5
PBL differs from “problem-solving” in that the problems are
encountered before all the relevant knowledge has been acquired. Problem-solving
comes after the acquisition of knowledge and problem-solving skills.
With PBL, students, not the teacher, make the immediate decisions about
what they will research and learn in relation to the scenario to allow
them to build upon their existing knowledge. They engage with the problem
presented to them, and decide what information they need to learn and
what skills they need to gain in order to manage the situation effectively. How does PBL work?
The “McMaster philosophy” for PBL was popularised in medical
education by the work of Neufeld and Barrows.6 The problem was presented
to a small group of students. They applied their previous experience
and expertise, asking questions and identifying issues that required
a further information search. The students collated this information
and used it to synthesise a solution to the problem. Importantly, they
recognised that few problems in health are totally “solved” and
that other issues may present which require further investigation. In
the small group setting, critical thinking was encouraged and arguments
developed. Many models for the PBL process have subsequently been developed,
the most widely recognised description being the Maastricht seven jump
model.7 The basic principles of PBL are shown in the Panel.
The basic principles of
problem-based learning
Presentation of a “problem”, often described as
a “trigger”, to stimulate student learning (problem
scenario)
Generation of ideas from the problem and discussion of general
principles and concepts which can be generalised to other situations
by a group of students, all under the guidance of a facilitator
to identify prior knowledge and understanding (facilitation)
Analysis of the problem to identify group and individual learning
issues relating to the problem and discussions held, under the
guidance of the facilitator (facilitation)
Time for individual study and learning outside the group (independent
learning)
Synthesis and testing of newly acquired information by the
group, under the guidance of a facilitator (facilitation)
Assessment of the skills promoted by PBL (assessment) |
Teacher-practitioners
are ideally placed to facilitate this learning by integrating academia
and practice developing the learning process,
through development of the trigger, facilitation of the group process
and assessment. Development of the trigger PBL is learning that stems from, and comes
after, exposure to a trigger (the problem) that is presented without
prior detailed teaching of all the material involved.
The primary point of each trigger is to encourage learning, not to make
a quick diagnosis and work out a management plan. It will be apparent
that PBL may be considered to be a formal description of daily learning
through practice. Since this is being used in a formal postgraduate education
setting, the learning that students gain must meet the needs of the agreed
MSc curriculum. Therefore, in order to maximise the learning opportunities
for the student group, the developed trigger must be real to practice
and also must support the intended learning outcomes for the curriculum.
The academic pharmacist is aware of the learning outcomes of the curriculum
that need to be met by the trigger but may not have the knowledge of
current practice that is needed to create it. The teacher-practitioner
is in a position to understand the principles of learning outcomes in
order to develop the trigger and is able to relate the realities of practice
to ensure learning is relevant to students and is attuned to the world
of work.
Facilitation — the group PBL process The facilitator in PBL, rather
than being a “content expert” who provides facts, is responsible
for guiding students to identify key issues in each case and to support
learning in those areas in appropriate breadth and depth. The facilitator’s
role is also one of management of group dynamics. There is much debate
in the literature as to whether the facilitator should be a non-subject
expert or a subject expert. For example, if the trigger considered is
cystic fibrosis, should the facilitator be a subject expert who is not
familiar with facilitation or a facilitation expert who is not familiar
with cystic fibrosis.
Academics are often trained in a traditional, didactic style. They may
feel uncertain about facilitating a PBL session for a subject in which
they have no specialist knowledge. There may be antagonism towards the
requirement for “reskilling” as PBL facilitators, seen as “deskilling” of
their current role as lecturers.8 However, subject specialists may be
poor facilitators because they have a tendency to interrupt the group
learning process and revert to lecturing. Nonetheless, students value
expertise. Davis and Harden5 suggested that “it could be argued
that the best facilitator is the subject-matter expert who understands
the course and the curriculum and who has the appropriate group facilitation
skills”. Teacher- practitioners balance their skills of facilitation
with their knowledge of practice but may not have the expert knowledge
that the students wish them to provide. The outcome of this approach
is that students are aware from the outset that they will have to learn
for themselves, because the facilitator is not able to provide them with
a simple, ready-made solution.
Assessment The academic is aware of the principles that govern assessment
and its influence on driving the learning process. Indeed, specific methods
for assessment designed for PBL have been described by Macdonald and
Savin-Baden and include such methods as “tripartite assessment”,
the “triple jump” and the “patchwork text”.9 These may include evaluation of the student and group learning experience,
for example, the nature of contribution, ability to work as a team and
quality of evidence provided.
The expert practitioner might concentrate on testing the knowledge of
a student, whereas PBL develops other skills such as the transferable
skills of reasoning, fostering of independent enquiry, problem-solving,
team or group working, critical analysis, evaluation of literature and
communication.
Assessment is a major factor in motivating students to learn. The teacher-practitioner
is ideally placed to balance assessment to reflect both knowledge attainment
and practical skills. Assessment is paramount for students, but the prevailing
ethos is the development of lifelong learning expectations. PBL has the
advantage of raising students’ awareness of how to learn and inspiring
them to do this.
How PBL fits with CPD
The model of CPD adopted by the Royal Pharmaceutical Society is supported
by the PBL process. Practitioners are faced with a problem, which may
be one that they have not encountered before and for which they need
to acquire knowledge or skills. Their first step is to reflect on the
nature of the problem then to consider the different options available
to resolve their individual learning needs. Depending on the immediacy
of the need to gain resolution and their own personal approach, the
practitioner will reject some of these options and select others. If
the practitioners is a member of a supportive PBL group, the learning
may be discussed and consolidated. When the learning has been undertaken,
practitioners then test their learning in practice and evaluate the
outcome.
PBL is based on the principles of adult learning theory encouraged
by academics. This includes motivating students, allowing them to set
their
own learning goals and giving them a role in decisions that affect their
own learning. Students acquire an extensive, integrated knowledge base
that is readily recalled and applied to the analysis and solution of
problems (“deep learning”), allowing problems to be dealt
with systematically.
The teacher-practitioner can assist in this approach by fostering active
learning, improved understanding and retention, and the development of
lifelong learning skills. Students need to “learn how to learn” in
a profession where CPD is mandatory. Teacher-practitioners can also help
students develop generic skills, such as literature retrieval, critical
appraisal of available information and the seeking of opinions of peers
and specialists. Summary
For PBL to be accepted as a model within postgraduate education, it
needs to deliver the learning outcomes stated within curricula. Academic
pharmacists are well placed to assist with this. For students to
gain
knowledge relevant to current practice, content and resources need
to be shaped by those who have expertise within particular clinical
areas. The subject expert provides this input.
As a learning approach, PBL combines the rigours of academia with
the relevance of daily practice. Teacher-practitioners, uniquely,
have the
learning foundation of an academic, combined with current practice.
This enables them to support student learning through design, facilitation
and appropriate assessment, leading to development of lifelong learning
skills.
We believe that teacher-practitioners are uniquely placed to investigate
and deliver problem-based learning in situ.
References
1. Shaw S, Gerrett D, Warner B. A preliminary study to evaluate the
impact of problem-based learning (PBL) to a postgraduate clinical pharmacy
programme
in the UK. Pharmacy Education 2006;6:33–39.
2. Silverthorne J, Mackellar A, Thomas S, Price G, Cantrill J. Problem-based
learning in the fourth year of the MPharm at Manchester. Pharmaceutical
Journal 2005;274:117–20.
3. Boud D. Problem-based learning in education for the professions. Sydney:
Higher Education Research and Development Society of Australia; 1985.
4. Boud D, Feletti G. The challenge of problem-based learning. 2nd edition.
London: Kogan Page; 1997.
5. Davis MH. Harden RM. AMEE Medical Education Guide No. 15: Problem-based
learning: a practical guide. Medical Teacher 1999;21:130–40.
6. Neufeld V, Barrows S. The McMaster philosophy: an approach to medical
education. Journal of Medical Education 1974;49:1040–50.
7. Schmidt, HG. Problem-based learning: rationale and description. Medical
Education 1983;17:11–16.
8. Wood, D. ABC of learning and teaching in medicine: problem-based learning.
BMJ 2003;326:328–30.
9. Macdonald R, Savin-Baden M. Learning and Teaching Support Network
Assessment Series No 13: A briefing on assessment in problem-based learning.
York: LTSN; 2004. |
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