1969

McMaster University introduces problem-based learning in medical education

This year, McMaster University (located in Hamilton, Ontario, Canada), introduces problem-based learning in medical education, an approach that would prove to be more than a temporary fad and would eventually influence university teaching and learning dynamics in many universities throughout the world.

Problem-based learning (PBL)  is an educational approach that is based on andragogy, philosophy, psychology, educational research, teaching and learning, curriculum design and various other important areas.  According to Barrows, (1980), PBL can be explained as  “the learning that results from the process of working toward the understanding or resolution of a problem.”  This approach is usually case based, small group (of no more than eight), self-directed learning, in which a group is given a problem to solve.  The group has a tutorial leader or facilitator who shares information, rather than an expert, imparting knowledge. In sum, PBL learning is a process of building on prior knowledge, problem solving, using critical thinking approaches and reflecting (Maudsley 1989).  This self-directed, collective approach is a very different way to teaching and learning than lecture-based designs.

Before the introduction of PBL, the standard practice in medical schools has been to create lecture-based curricula in which to impart knowledge to our up and coming physicians.  This began to change in the late 1960’s with the introduction of McMaster University’s new approach to medical education.  This moment in history has changed the way many medical schools all over the world design and implement their curricula. Howard Barrows is usually credited for being the first person in Canada to apply problem-based learning to medical education.  Barrow’s work in PBL during the mid-1960s developed from the concepts around adult learning. PBL was thought to provide a method for students to integrate knowledge across subject boundaries and to develop problem-solving skills. Barrows grouped the objectives of PBL into four areas: structuring of knowledge in clinical contexts, clinical reasoning, self-directed learning skills and intrinsic motivation (Barrows, 1980). McMaster University was the first Canadian Medical School to adopt this model. 

The first class to experience McMaster’s PBL approach to medical education began in 1969.  This, of course, was preceded by many years of questioning, critiquing and final planning. Dr. John Evans, the Dean that had the courage to break with tradition and launch this new approach, perceived this model as a significant change in the standard approach to teaching students in medicine.  Pioneered in Canada, PBL curriculum was predominantly found at McMaster University for many years. However, in recent decades it has been adopted elsewhere in different forms and to various degrees. 

Up until the development of PBL curriculum, there seemed to be less of a holistic approach around the management of patient’s, disease, treatment and cure, (particularly in medicine versus some of the other health professions).  Undergraduate training was based on an ‘organ-based’ curriculum, primarily made up of didactic lectures on anatomy, physiology, pathology, and treatment. Since 1969, McMaster continued to cover this material, but  within the cased-based problems they present to students.  During the 1970’s and 1980s PBL has been a growing trend.  This author’s recent literature search resulted in 178 references on PBL in the health professions that were published in the last two years alone. Many of these references specifically focussed on medical undergraduate curriculum.  It seems to some that PBL may in fact be a ‘fad’, but more than a temporary fad, it seems to be a long-term trend, as this approach is being adopted internationally by many undergraduate and graduate medical education programs and by other fields and disciplines. Indeed, problem-based learning has been used in several European, South American and Asian medical schools, some of which include the U.K., Sweden, Switzerland, Brazil, Chile, and Hong Kong. The Canadian approach has influenced the planning in Australian medical schools, which have historically been known for their advanced knowledge, research and practice within adult education.  In 1983, McMaster experienced a slight change in their curriculum. This was thought to be a positive readjustment in their efforts to adapt to the needs of the learner and the proposed learning outcomes.  When reviewed in the 1990’s, PBL had been incorporated into 19 disciplines around the world, including the Harvard School of Business  (Kaufman, 1995)

In closing, the introduction of a problem-based curriculum by McMaster University in the late 1960’s has set a foundation for experiential learning and has led the way for other schools and disciplines in many other parts of the world.  With this learner-centred approach arise various questions as to the advantages and disadvantages regarding the learners and the learning outcomes. Indeed, there are continued debates over the use of problem-based learning (PBL) as a standard means in which to teach medical school students. These questions remain in the minds of many, as McMaster University successfully moves forward with their PBL approach, influencing the world of medical education along the way.  For those of us in medicine, it is invariably important to root into the realm of PBL, define its parameters, measure its success, compare it with other learning methods in a search for the most optimal mix of teaching and learning for our undergraduate learners. The way in which we learn, as well as the content that we learn, inevitably has an impact on the physician as a life long learner and most importantly, the populations health outcomes.  That is, morbidity and mortality of today and tomorrow. 

Bibliography

Barrows, H., Tamblyn, R., 1980.  Problem-based learning: an approach to medical education.  Medical Education.   Volume 1. New York: Springer Publishing Company.

Colliver, J., A.  2000.  Effectiveness of problem-based learning curricula: research and theory.  Academic Medicine. 75(3):  259-266.

Kassebaum, D., G.  1989.  Change in medical education: the courage and will to be different. Editorial. Academic Medicine.   64:446-447.

Kaufman, D., M.  1995.  Preparing faculty as tutors in problem-based learning.  Teaching Improvement Practices: Successful Strategies for Higher Education. Bolton, MA. Anker Publishing. 

Kaufman, D., M.  2000. Problem-based learning – time to step back?  Medical Education. 34: 509-511.

Lee, R., W., Kwan, C., Y.  Nov 23, 2001. Overview: PBL, What is it?

www.fhs.mcmaster.ca/mdprog/overview_pbl.htm

Maudsley, G. 2000. Promoting professional knowledge, experiential learning and critical thinking for medical students.  Medical Education. 34: 535-544.

Maudsley, G, 1999.  Do we all mean the same thing by “problem –based learning” a review of the concepts and a formulation of the ground rules.  Academic Medicine. 74(2): 178-185.

Muller, S.  1989.  Physicians for the twenty-first century. Report of the project panel on the general professional education of the physician and college preparation for medicine. J Med Educ.  59(2): 1-31.

Neufeld, V., R., Woodward, C., A., MacLeod, S., M.  1989.  The McMaster M.D. program: a case study of renewal in medical education. J Med Educ. 64:423-432.

Ryan, G., Little, P.  1991. Innovation in a nursing curriculum: a process of change. In: Boud, D., Feletti G.  The challenge of problem based learning. London, UK: Kogan Prage, 111-121. 

Schmidt, H. 2000.  Assumptions underlying self-directed learning may be false.  Medical Education.  34: 243-245

William, B.,  Spaulding.  1991.  Revitalizing medical education. McMaster Medical School. The early years 1965-1974. Hamilton: B.C. Decker Inc.

Prepared by Lynn Haslett (OISE/University of Toronto)

December 2001

Citation: Haslett, Lynn (2001). 1969: McMaster University introduces problem-based learning in medical education. In Daniel Schugurensky (Ed.), History of Education: Selected Moments of the 20th Century [online]. Available:  http://fcis.oise.utoronto.ca/~daniel_schugurensky/assignment1/1969mcmaster.html  (date accessed).

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