8 Problem-Based Learning and Student-Centred Learning—a Perfect Match! – by David C.Y. Kwan

David C.Y. Kwan

Fifty years ago, in 1969, the American astronaut Neil Armstrong likened his first steps on the moon to one giant leap for mankind. In the same year, the newly established medical school of McMaster University in Canada made a small step towards student-centred learning, adopting an innovative learning philosophy termed “problem-based learning” (PBL). This marked a big leap in higher education worldwide. I was quite lucky to have had first-hand experience with PBL at McMaster during my 30-year career as a faculty member there (1978–2008). I also spent two decades (including two separate leaves of absence in Hong Kong and Taiwan) in Asia promoting PBL education. This year, marking the 50th anniversary of the official establishment of PBL, an international health science education journal invited me to contribute a manuscript about PBL development in Asia (probably because of my “notorious reputation” as the “Godfather of PBL in Asia”). The article that I wrote took on a somewhat disappointing tone, A Thorny Path: The Developmental Course of Problem-Based Learning for Health Sciences Education in Asia. In 2016, I also wrote a wake-up call paper for a regional journal, Five decades of skepticism about PBL in medical education: a reflection and outlook in the Asia Pacific context. Yes, I have been quite concerned, because PBL represents a revolutionary pedagogical approach characterized primarily by student-centred learning, using simulated real-life scenarios as the socially accountable learning platform. Perhaps student-centred learning is too vague a concept, making it difficult to pinpoint its true significance. Its role is certainly not as crystal clear as teacher-centred learning, especially for people who grow up and are educated in the comfort zone of the teacher-centred learning culture. To many, student-centred learning loosely refers to a fuzzy assortment of teaching strategies. I have heard people say that structured teaching by expert teachers is really “for the good of students” and thus qualifies as a form of student-centred learning. I have also heard people say that student-centred learning gives students full license to do what they want and “fulfil their satisfaction”.

Based on what I know and have read about student-centred learning, I feel that student-centred learning can be defined by the following principles:

1. Instruction in student-centred learning addresses the distinct learning needs, interests, aspirations, or cultural backgrounds of individual students, i.e., student-centred learning is personalized learning.
2. Students apply actions and take initiative to search for learning strategies to handle problems, i.e., student-centred learning is a form of active learning.
3. Students are given opportunities to make choices about their own learning strategies and they contribute to the design of learning experiences, i.e., student-centred learning is definitely self-directed learning.
4. Students advance in their education when they demonstrate that they have acquired the knowledge and skills they are expected to learn, i.e., student-centred learning is outcome-based learning.
5. Students are expected to take responsibility for their learning progress and should be able to reflect on and evaluate their own learning, i.e., student-centred learning is a type of reflective learning.
6. Students must realize that education in the classroom is best utilized by flipping from teaching to learning, i.e., student-centred learning is a flipped classroom education.

The above six principles are in good alignment with what is expected of students in PBL (and by this I mean authentic PBL, not the hybridized and distorted PBL that arises when teacher-centred learning characteristics begin to overtake student-centred learning). Like student-centred learning, PBL has also been criticized for being vague. To provide clarity, I helped to define PBL, once again using six principles that I call the 6-S principles: student-centred learning and self-directed learning are the learning attitudes; small group learning is the format; scenario-based learning is the learning platform; and support-oriented learning and self-reflective learning are the forms of learning facilitation. Effective integration in the application of these operating principles holds the key to the ultimate learning outcome for the learner (i.e., life-long learning).

PBL has remained the most innovative and effective educational concept in the health professions (not just medical education) for nearly half a century, since its official inception at McMaster University in Canada in 1969. The originally proposed philosophy of PBL, commonly referred to by the PBL forefathers as the “McMaster Philosophy”, has stood firm amidst many contemporary medical educational theories over the last half-a-century, attesting to its time-proven, humanistic, and inherently multi-strand solid foundation. In fact, PBL gave rise to the theoretical basis and the working framework for the subsequent emergence of project-based learning, case-based learning, team-based learning, outcome-based learning, flipped classroom learning, and interprofessional learning, all of which have inherited the characteristics of PBL and student-centred learning to varying degrees. None of these learning strategies, however, encompass all six of the guiding principles of student-centred learning mentioned above. Thus, PBL is the only true student-centred learning strategy.

That said, how do I justify “The thorny path…” and “…the skepticism…” in the papers I referred to earlier? Let me share the following e-mail discussions to make my point. Robert Chen of the Universiti Tunku Abdul Rahman (UTAR) at Kuala Lumpur wrote an e-mail message to the e-mail discussion group formed by the Asia Pacific Association of PBL in Health Sciences, in which he suggested that case-based learning be used to describe one type of student-centred learning (especially in medical education). He questioned, “Is there not any reason and movement to start shifting our focus from PBL to case-based learning? Particularly since there are some significant disadvantages of PBL, such as: 1) students encounter the case with ‘blank’ information, and (more importantly) 2) during the ‘follow-up discussion’ where students are to share their ‘home work’, that in most cases, this second session ends up being a ‘presentation’ rather than a discussion.” He rationalized his view by pointing out that ‘presentation’ means that students take turns giving a ‘mini-lecture’ using PowerPoint, with the lights out. As a result, group members, including the tutor, get bored and begin to dread this part of the second session. This type of “lights-out” presentation occurs in lieu of an active session in which students actively discuss or debate with each other the merits of the ‘presenting’ student’s information. Robert soon took the fire from Nemuel Fajutagana, who served as the Dean of the Medical School at the National University of Philippines and is currently the Chair responsible for organizing the upcoming Asia Pacific PBL conference to be held in Cebu in 2020. Nemuel responded to Robert’s first issue, “I do not believe that students will ever be in a situation where they will encounter a case with ‘blank’ information … The first issue can easily be addressed by constructing triggers appropriate to the level and requirement of the course.” To the second issue, Nemuel responded, “This can happen to any method. This is not generic to PBL. This is not a failure of PBL but rather a failure in facilitating PBL sessions.” I concurred with Nemuel and wondered why Robert considered cased-based learning to be student-centred learning, and why he felt that PBL was essentially teacher-centred learning. In fact, what Robert observed in the PBL process represents a typical case of compromised PBL conducted in a deviated environment that is not aligned with student-centred learning because of poorly trained teachers. This misunderstanding further attests to the importance of understanding the concept of PBL and its relationship to student-centred learning. Qualified faculty development activities appear to be essential and mandatory in schools that wish to entertain a student-centred learning strategy. In my PBL workshop, I always emphasize that students should NOT divide amongst themselves the learning objectives that arise from group brainstorming discussions around the problem, and that, in the next session, they should NOT take turns presenting select information using PowerPoint (a teacher-centred behavior that emulates teachers’ teaching). However, I still see this approach—which takes PBL off-track at the expense of student-centred learning—in action in classrooms today. David Fairholm of the University of British Columbia commented in his e-mail message: “PBL, teacher-centred learning, and case-based learning are all small group learning/teaching methods—each with its strengths and weaknesses, supporters and detractors, benefits and hindrances … However, PBL distinguishes itself in that it is the learning method of life, it is truly student-centred—the students decide what they must learn, then learn it, then share it with colleagues, then apply it … As a result, it has become a world-wide educational movement because of these student-centred learning features. One often refers to PBL schools but does not read or refer to case-based learning schools even though these are common instructional methods with basis in sound educational science.”

I rest my case.