Notes on Related Concepts: Problem-Based Learning

The way adults learn has been studied and described in detail. The traditional and adult learning model data presented below is representative of the theory in general and derived from the Tutor workshops in McMaster University Medical School and an excellent, concise Royal Society of Medicine publication on PBL [1]

The Traditional (Child-Centred) Learning Model

The way children are taught is the only style of education many people know, for it has dominated school, and even adult, education until recently. A superior authority decides what the children do for each lesson, which books they read, corrects any mistakes they make, sets their homework and provides and marks any tests. The following key concepts apply:

• The learner is a dependent person who submissively carries out the teacher’s directions.
• Learners are assumed to enter with little experience of value as a resource in learning. It is the experience of the teacher or textbook writer that counts.
• Learners become ready to learn what they are told they should learn to advance to the next grade level. For children, readiness to learn is largely a function of age. The principle is, however, continued on into third level and postgraduate education.
• Learning is based on transmission techniques – lectures, assigned reading and audio-visual presentations. It may be difficult to understand or store this information for use in a different situation.
• Learners are subject-oriented. They see learning as a process of being taught carefully prescribed content matter. The curriculum is organised according to subjects.
• Learner motivation is primarily external pressures from parents, teachers, competition for grades / progress and the consequences of failure.

The traditional learning model has become the basis of most radiology postgraduate and CME programmes. Conditioned at school or college to assume a role of dependency, adults demand to be taught [1].

The Problem-Based (Adult) Learning Model

In contrast to the traditional model, the following key points apply.

• The learner is self-directed. In learning, as in other areas of life, adults can make the transition from being dependent to being self-directed.
• Adults have a strong sense of self-identity and differing volumes and quality of experience. They have prior knowledge, onto which new facts can be ‘grafted.’ Adults become ready to learn when they experience a need to know or do something. Learning is based on techniques for information retrieval and analysis.
• Learners are problem-centred, task-centred. For adults, effective learning experiences need to be oriented towards life rather than towards subject matter. Acquiring information in the context of solving a problem improves understanding and retention.
• Learner motivation is primarily internal. Energy comes from interest in the problem at hand. Achieving effective problem-solving skills gives rise to increased self-esteem, recognition and self-confidence. These stimulate the adult to use the same approach again the next time a similar problem arises.

The adult learning model has become the basis of some Problem-Based Learning medical school curricula and has been incorporated into some CME programmes.
Some caveats:

• Adults entering a completely new situation / course may benefit greatly from didactic instruction before they can take their own initiatives (that’s why we wrote these notes!).
• Adults often have habitual ways of thinking and acting that may not be very open to new concepts (like PBL and EBR).
• The scope and veracity of adult’s prior knowledge is variable.
• The ‘child-centred’ model is valid for early stages of education.

How can this help you with practice and Continuous Professional Development?

Briefly, the ‘Traditional’ or ‘Technical / Rational’ approach has taught most of us that knowledge is permanent, change is from outside, efficiency and quality are demanded and measured through exams and learned routines and protocols are expected to work consistently over time. As we move from the certainties of postgraduate courses to the uncertainties of professional practice, a different approach is required. This is both because of natural decay in the relevance of our existing data over time and because of the need to acquire new knowledge to cope with new and old problems. In the ‘Adult Learning’ approach, this leads to a requirement for ‘professional artistry.’ This approach assumes that knowledge is problematic. All professionals can expect to have knowledge decay and knowledge gaps - there is room to be wrong. This is not a source of complacency but provokes a change from within. Quality comes from insights. Imagination and creativity continually reform the database of knowledge.

Problem-Based Learning courses are based on clinical cases / health scenarios. They require self-direction, motivation and a framework for critical reasoning (such as the EBM approach). The problems incorporate ‘trigger’ material and are carefully designed.

CPD: Some CME programmes recognise self-directed learning. For example, the Maintenance of Certification Program of the Royal College of Physicians & Surgeons of Canada awards CPD credits for Personal Learning Projects (provided the activities are planned and outcomes are recorded and evaluated), Information Searches, Learning Portfolios and Audits. These are all examples of self-directed, adult learning exercises. A program is in place to supply online educational material via the Canadian Association of Radiologists Journal [2-6]. The resources on this website can be used to support such activities.

…and how does this apply to EBR.net?

First, it is not our intent to be a didactic resource for passive adult learners. Although there is a short didactic introduction to each section, and references and links are supplied for further reading, the site won’t satisfy adults who demand to be taught!

Second, we do not intend to set up a ‘problem-based’ curriculum that will take adult learners through either ‘evidence-based practice’ or Radiology.

This website is a ‘BYOP’ (Bring Your Own Problem) resource for adult learners who have trained, or are training in, Radiology and who wish to find the best current answers for questions derived from their own practice. It can be used to support activities in teaching, learning, research and administration. As much as possible, we will point out limitations and developments in EBR as we go. Good luck and have fun!

References

1. How Adults Learn: How this Applies to Problem-Based Learning, in Problem-Based Learning in Medicine, David T, Patel L, Burdett K, Rangachari P., Editors. 1999, The Royal Society of Medicine Press Ltd.: London. p. 23-28. [ link ]

2. Shannon S, Self-directed learning and continuing professional development. Can Assoc Radiol J 2000; 51 (6):326-327. [ link ]

3. Shannon S, Writing a structured abstract. Can Assoc Radiol J 2000; 51 (6):328-329. [ link ]

4. Shannon S, Critically appraised topics (CATs). Can Assoc Radiol J 2001; 52 (5):286-287. [ link ]

5. Shannon S, Critically appraised topic sample: accuracy of ultrasonography in the diagnosis of rotator cuff tears. Can Assoc Radiol J 2001; 52 (5):288-289. [ link ]

6. Shannon S, Critical appraisal personal learning projects. Can Assoc Radiol J 2001; 52 (6):357-359; quiz 360. [ link ]