Problem-Based Learning in the Communication Sciences and Disorders Curriculum

Ronald Champoux, Ph.D.

Bloomsburg University

The concepts of active learning and cooperative learning are not new to educators (Pratton and Hales, 1986; Johnson, Johnson, and Smith, 1991; Mowrer, 1994; McKeachie, 1994). McKeachie states that a number of studies suggest that passive learning is usually less efficient than active learning. Johnson et al. indicate that in the past 90 years over 600 studies have been reported attesting to the positive results of cooperative learning. One approach to learning that incorporates both active participation and group cooperation is problem-based learning (PBL).

Problem-based learning was pioneered over 25 years ago and has largely been identified with the McMaster University Medical School in Hamilton, Ontario, which designed their entire curriculum around this approach. At present most medical schools in this country and many in other countries (Camp, 1997) have adopted this form of learning. Problem-based learning has also been adopted by many other fields of study.

Problem-based learning involves giving students a problem to solve. In the process of researching, reading and discussing among members of a group, the students learn the information required for a particular course or curriculum requirement. Assigned to a group of students (usually 5 or 6) is a tutor or facilitator who helps guide the students in their solution of problems and understanding of information. The students have a number of resources at their disposal, such as texts, experts, audio and visual media, the Internet, etc., to assist them in their task.

Unlike traditional methods of teaching and learning (e.g., lecturing), problem-based learning is student-centered and not instructor-centered. The student becomes motivated to learn because of the need to answer questions, which he/she may pose in his/her quest to solve a particular problem. Among the goals of problem-based learning is independent and life-long learning, and, in our field, the enhancement of clinical reasoning skills.

Problem-based learning is based on fundamental learning principles (Albanese and Mitchell, 1993). Among these are that current knowledge is affected by prior knowledge, that transfer of learning is more likely the closer the situation in which something to be learned resembles the situation in which it will be applied, and that elaboration of knowledge through discussion, questioning and critiquing results in better understanding of information.

Neufeld, Woodward, & MacLeod (1989) in a summary of studies on the "McMaster approach" indicate that "the evidence and experience to date support the assertion that satisfactory physicians – and in some ways special – physicians can be prepared..." (p.230). Norman and Schmidt (1992) in a review of studies of the psychological basis for problem-based learning conclude that there exists substantial differences between PBL and traditional approaches related to retention of knowledge and learning, favoring PBL.

Due to the growth of problem-based learning curricula in medical schools in this country and abroad, Albanese and Mitchell (1993) conducted a meta-analysis of PBL studies from 1972 to 1992, in order to study the outcomes of PBL and implementation issues. Among some of their findings was that, compared to conventional graduates, PBL graduates performed as well or better on clinical examinations and faculty evaluations. In addition, PBL appeared to be more nurturing and enjoyable for the students and the faculty tended to enjoy teaching with PBL. Some other findings, however, showed that in a few instances, PBL students were less well prepared in the basic sciences, tended to engage in backwards rather than forward reasoning, and appeared to have gaps in their cognitive knowledge. Albanese and Mitchell suggest that the latter issues be addressed before making comprehensive conversions to PBL.

In another meta-analysis of 35 studies comparing PBL with more traditional methods of medical education, Vernon and Blake (1993) found that PBL was significantly superior with respect to students’ program evaluations and measures of students’ clinical performance. There were no differences between methods on miscellaneous tests of factual knowledge. The authors conclude that the results favor the superiority of PBL over more traditional methods.

My interest in problem-based learning began with a desire to more actively involve students in my lecture courses. Although lecturing is enjoyable and has its place in education, it is a passive approach to learning. In my quest for more active approaches, I was led to PBL in 1992. After two days of orientation at McMaster University and one day at Tufts Medical School, I attempted PBL for the first time during my graduate Aphasia course in the fall of 1992. I randomly chose five students to participate in the PBL group, which met separately from the rest of the class, to whom I lectured. During the spring, 1993 semester I reflected on my experience with PBL while teaching a graduate course on Speech Disorders using the lecture approach. Beginning fall of 1993, I used PBL in all three of my graduate courses and began using more group interaction approaches in my undergraduate courses.

The mechanics of applying PBL involves grouping students (4-6 is ideal), finding a meeting place to meet the groups, and determining a meeting time for each group. Instead of my meeting a three-credit class three hours per week, I meet with each group two hours per week for a total of six hours (three groups). Six hours may seem like a lot for a three-credit course, but the lecture preparation time is decreased. Each session is videotaped and a different student acts as a secretary each week, typing the notes for dissemination the following week. The first session involves having the students determine the academic goals for the semester in behavioral terms and at the end of the session a problem (referral case) is handed out and learning objectives for the following week suggested. At the end of each session the students, as well as myself, fill out a peer evaluation form of each student’s quantity and quality of participation. During the week, the students must find resources, read, and be prepared to answer questions regarding the learning objectives of the previous week. Resources may include textbooks, library, Internet, faculty members, and professionals in the field, among others.

The grade for the course is determined by the performance of the student on a midterm and final essay examination, peer evaluation of sessions, facilitator evaluation of sessions, and essay probes given at the beginning of each session. I have experimented with not grading any exams but giving students feedback on their written responses and meeting with each student at the end of the semester to discuss his/her performance and arriving at a mutual agreement as to grade.

The implementation of problem-based learning does not come without risks or problems. College students are primarily exposed to the lecture method during their academic careers. Problem-based learning may present something very different to what they are used to. In PBL, students must become involved in discussions and interact with the other group members. They cannot hide. Some students enjoy this approach, while others do not. Some students do not like the fact that the structure afforded by the lecture method is lacking. I have definitely seen a decline in my student evaluations from the lecture format to the PBL format. On the whole, however, the majority of the students do rate PBL with positive rather than negative ratings. This is especially seen in the evaluation rating after the students’ externship experience. Therefore, a word of caution to those who are not yet tenured or who are applying for promotion. However, if one is committed to having students learn, PBL need not result in drastic evaluation changes.

Among some of the other problems to consider when implementing PBL are the number of students per group, meeting place, scheduling, support from administration, and support from colleagues. All of the above can add or detract from the enjoyment of PBL.

I must admit that I am not sure if what I am doing can even be called problem-based learning. It may well be a variant of the approach. What is similar between what I do and the McMaster approach is the giving of clinical problems to students to solve, but beyond that I do not know how much we resemble each other.

True problem-based learning should not be time or content constrained. That is, the giving of a clinical problem may raise questions and issues, which may not be found in a conventional outline for a course. These questions and issues, however, because they were originated from the students, should be addressed as soon as possible, unless they will be addressed at some future time with another problem. I find that, because of time constraints (the semester) and content constraints, some of my sessions sometimes become Socratic in nature.

During the first few semesters, I have noted that there were a lot more sessions than now where the students were much more actively engaged in discussing and solving the problem. My role then was clearly as facilitator. Those were moments of an academic high for me, watching students discussing and teaching each other and learning. I have let the paranoia of the above academic constraints creep in over the past few years.

Will I continue to conduct my courses using a PBL approach? The answer is yes. Will I change some things? The answer is yes. Below are changes or considerations for change.

First, as I reflect on what I have been doing, I observe that I seem to be following an

internal outline that closely resembles an outline I used in the lecture approach to my courses. I will now attempt to let the students move on a problem using their own strategies and style as a group. I will attempt not to impose my outline on them but let them discover what they feel they should learn to solve a problem. This, together with my facilitation, should not veer us too much off course. In other words, I will become more concerned not by how much content the students have been exposed to but by how well the students have learned what they and I feel is necessary to know to solve problems.

Second, I will review the functionality of my courses. As a clinical field, the fruit of our labor will be when the students apply what they learn. I will attempt to make my courses more practical regarding the diagnosis and treatment of disorders by providing the students with more examples of procedures, more exposure to the various disorders I present to them as problems, and more hands-on experiences. I will not neglect basic information, but will only present what students can apply clinically.

Third, I will review student assessment. I believe that graduate level students should not receive traditional grades but, rather, more feedback about their performances in the form of positive comments or as constructive criticism for change. Grades tend to take the focus away from learning and sometimes put students in competition with each other rather than as helpmates to learning. I will petition the Graduate School to offer Pass/Fail grades together with performance reviews on each student. If the Graduate School does not agree, another approach is to have the students take some responsibility in determining their own grades. I have attempted to do this during the spring, 1997 term in Disorders of Speech. The students only received feedback and constructive comments on their probes and exams, as well as their performance during PBL sessions. In some cases, the student was asked to elaborate or rewrite an answer to a question or to review some resources further and report back to me. At the end of the semester, the students met with me individually to discuss what they felt they deserved as a grade. After discussion, we arrived at a grade mutually acceptable to the both of us. I will pursue this approach more.

Fourth, I will review resources available to students for solving problems. At present we use texts, some videotapes, tests, manuals, faculty members, the telephone, the library, and the computer. However, we lack more representative samples of disorders and more functional resources. I will attempt to gather more video samples of disorders. I will also attempt to develop interactive video programs and/or actors to mimic disorders to give students more

hands-on experiences before they see actual clients.

Fifth, I will attempt to become more familiar with facilitation procedures in PBL sessions. I believe that I can become a more effective facilitator.

Summary

Inasmuch as I like and still enjoy lecturing, I find that, as a learning paradigm, it leaves something to be desired. Problem-based learning, I believe, is an approach, which appears to bridge the gap between academia and real-life. To be sure, lecture has its place but lectures should be used to enhance the basic information students should be getting through a more functional approach, such as PBL.

Problem-based learning is not the panacea to learning, but only one approach. However, its focus on active participation, problem solving and clinical reasoning lends itself nicely to the goals of the Communication Sciences and Disorders curriculum. The fact that data tend to support the efficacy of its use and that medical academia has adopted it suggests that it may have benefits within our academic programs.

References

Albanese, M. A. & Mitchell, S. (1993). Problem-based learning: A review of literature on its outcomes and implementation issues. Academic Medicine. 68, 52-81.

Camp, G. (1997). Problem-based learning: A paradigm shift of a passing fad. [WWW document]. URL http://www.utmb.edu/meo/f000003.htm

Johnson, D. W., Johnson, R. T., & Smith, K. A. (1991). Cooperative Learning: Increasing College Faculty Instructional Productivity. ASHE-ERIC Higher Education Report No. 4. Washington, DC: The George Washington University, School of Education and Human Development.

McKeachie, W. J. (1994). Teaching Tips. (9th ed.). Lexington, MA: D.C. Health and Company.

Mowrer, D. E. (1994). Cooperative Learning: New roles for students and professors. National Student Speech Language Hearing Association Journal. 21, 82-86.

Neufeld, V. R., Woodward, C. A., & MacLeod, S. M. (1989). The McMaster M.D. program: A case study of renewal in medical education. Academic Medicine. 64, 423-432.

Norman, G. R. & Schmidt, H. G. (1992). The psychological basis for problem-based learning: A review of the evidence. Academic Medicine. 67, 557-565.

Pratton, J. & Hales, L. E. (1986). The effects of active participation on student learning. Journal of Educational Research. 79, 210-215.

Vernon, D. T. & Blake, R. L. (1993). Does problem-based learning work? A meta-analysis of evaluative research. Academic Medicine, 68, 550-563.