Answer to "Once PBL has been implemented, should there be ongoing monitoring?"
Constant monitoring of PBL is required as erosion happens over time. Moust and colleagues (2005), in reflecting on 30 years of PBL at Maastricht University, identified several areas of possible erosion or ‘watering down’:
Skipping the brainstorming and elaboration phases (Steps 3 and 4), i.e. the problems identified (Step 2) are immediately transformed into learning issues (Step 5) without discussion
Reducing the synthesis and integration phase (Step 7, i.e. the reporting phase after self-study), to a short report on the main issues studied rather than relating to the patient (i.e. application of what was learnt)
Learners using the same resources so thus fail to add value.
For Lim (2012), signs of a dysfunctional PBL curriculum include:
Presence of curriculum components that undermine the PBL philosophy (e.g. learning issues are met by lectures so learners do not engage in self-study)
No ongoing maintenance of PBL (e.g. problems are not reviewed, student numbers increase without a concomitant increase in PBL groups)
Faculty development programmes ignore PBL as the overall curriculum strategy
PBL cases thus require regular updating as clinical guidelines change as do the various treatment options (e.g. medications, chemotherapy). If cases are developmental in that they follow patients over several years, dates will need to be updated annually. Not often reported in the literature but which undoubtedly happens at most medical schools is the student ‘grapevine’. Senior students think that they are being helpful by providing junior students with the cases and the learning outcomes. This is counter-productive in terms of the PBL approach in which learners should not be familiar with the ‘problem’ so that when presented, it triggers brainstorming and critical thinking as well as the identification of gaps. Writing a second set of cases to swop at different times with the original set is advisable but is onerous.
AZER, S.A., MCLEAN, M. ONISHI, H., TAGAWA, M., and SCHERPIER, A. (2013). Cracks in problem-based learning: What is your action plan? (Med Teach. 35:806-814).
LIM, W.K. (2012). Dysfunctional problem-based learning curricula: resolving the problem. (BMC Med Educ. 12:89 https://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-12-89)
MOUST, J.H.C., VAN BERKEL, H.J.M., and SCHMIDT, H.G. (2005). Signs of erosion: Reflections on three decades of problem-based learning at Maastricht University. (Higher Educ. 50:655-683).
WOOD, S.J., Woywodt, A., Pugh, M., Sampson, I. and Madhavi, P. (2015). Twelve tips to revitalise problem-based learning. (Med Teach. 37(8):723-729).