Experience Of Facilitating Cpbl Tutorials Education Essay

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I am asked to facilitate PBL and CPBL at St. George's (SGUL) on a regular basis. Consequently, I selected this teaching experience as the topic of this assignment, in order to allow an opportunity to consider the role of these tutorials within undergraduate medical education and how to maximise the learning experience for the students.

When I was a medical student, PBL was relatively new and only comprised a very small proportion of the curriculum. Since then, PBL has been increasingly used in the UK and some medical schools now offer courses which almost solely employ PBL as the learning method. This has stimulated me to think about the theory underlying PBL and how it compares to traditional undergraduate medical education.

SGUL runs three separate undergraduate courses. One of these is the traditional five-year course, which accepts both school leavers and graduates. In this assignment, I shall refer to this course as MBBS5. The other course that is relevant to this assignment is the four-year course, which is only open to graduates. I shall refer to this course as MBBS4.

The experience of facilitating CPBL tutorials

I shall be describing my most recent experience of facilitating a series of five weekly CPBL tutorials with a group of seven students in the penultimate year of the MBBS4 course.

I have chosen to focus on the second tutorial in the series, as I felt that this was a particularly successful learning experience.

As usual, the tutorial started with one of the students presenting a patient that they had seen. Once the case had been presented, the other students asked questions, facilitating a discussion about diagnosis, management plan and any other issues that the case generated. The students identified topics that they would like to read more about and set learning objectives accordingly. They then researched these learning objectives for discussion at the next tutorial.

Once the students felt they had exhausted the discussion about the case, we moved on to discussing the learning objectives set the previous week. In the first tutorial, the students had identified the mental state examination (MSE) as a topic that they would like to read more about.

In the tutorial, the students discussed each area of the MSE, with particular focus on what questions to ask to elicit symptoms from a patient. This stimulated an interesting conversation about the different ways each student had learnt to elicit the symptoms. I also shared the questions that I use to examine a patient's mental state. The students reached the conclusion that there was no single right way to ask the questions and that they needed to develop their own way that they felt comfortable with.

We then used role play, during which I acted as a patient and the students were given an opportunity to practice performing a MSE. The students reported that they found this extremely useful, as it helped them to start to develop their own method for MSE and improved their confidence for performing the examination on a real patient.

Critical reflection on the experience

I often feel anxious prior to teaching sessions. My specific anxieties around PBL tutorials include motivating the students, as I have found it difficult in previous tutorials to encourage MBBS5 students to initiate a discussion; remaining within the boundaries of my role as a facilitator, rather than providing a didactic teaching session; and a fear that the students will ask questions that I am unable to answer.

I thoroughly enjoyed facilitating this set of tutorials. This was my first experience of tutorials with the MBBS4 students. I found them to be much more engaged with the tutorials than their peers on the MBBS5 course. They were able to generate excellent discussions without prompting from me. I found it easier to remain within my role as a facilitator, rather than providing active teaching.

The students discussed complicated psychological concepts at a high level, which I found particularly stimulating. This highlighted the depth of knowledge that can be gained from others and reminded me how important it is for doctors to draw upon this knowledge as they progress through their careers, rather than discounting their juniors as educators.

The MBBS4 students come from a vast variety of backgrounds, so each was able to bring a different set of skills and knowledge to the tutorials. For example, one of the students had a background in catering and she was able to raise important issues about a patient's nutritional status that I would not have considered.

In the past, I have found myself teaching rather than facilitating in CPBL and PBL. However, during this set of tutorials, I found that I was better at asking questions to prompt the students to think about the correct answers, rather than telling them the answer. I felt that this was also what the students wanted, whereas in my previous experiences with MBBS5 student groups, the students often seem keen to be 'spoon-fed' the answers, rather than using discussion to obtain knowledge from their peers. This may be because the MBBS4 course uses PBL as its main learning method from the start of the course, so the MBBS4 students are more familiar with the format and expect to learn by self-directed learning and sharing of knowledge. On the contrary, the MBBS5 students have a lot more traditional lectures and are accustomed to being taught in this manner.

I did not experience in anxiety during this set of tutorials. We successfully created a safe, relaxed environment and the students seemed to feel comfortable asking questions and discussing difficult feelings that they had experienced. This may have been because all the students in the group knew each other and were used to working with each in PBL settings. Again this is different to facilitating tutorials with MBBS5 students, who often are not well-acquainted with the other members of the group because until now the MBBS5 course has had a much larger cohort than the MBBS4 course.

However, the numbers accepted onto the MBBS4 course are increasing and I wondered whether this will impact on the group dynamics in MBBS4 PBL tutorials.

In terms of areas for improvement, I think it would have been helpful if I had also researched the learning objectives each week. I was surprised by the depth and breadth of reading by the students. At times, they discussed very complex subjects and I was not always able to answer their questions. For me, this highlighted the attrition of my knowledge since completing my postgraduate examinations two years ago and encouraged me to undertake more professional reading and revision.

On a positive note, I think the students found it helpful to see that I was able to function competently as a senior doctor despite being unable to recall everything I have learnt. Students can feel overwhelmed by how much they have to learn and retain. I felt that I was able to reassure them that it is acceptable not to be able to recall everything you have learnt and that you can refer to text books.

I received positive feedback through verbal comments from the students and written feedback to the course organisers. The students seemed to enjoy the tutorials and found them of educational value. As well as discussing the cases and learning objectives, we discussed a career in psychiatry, as a number of the students expressed an interest in this field. I think I was able to give the students a realistic and enthusiastic insight into my profession. My hope is that, even if the students do not pursue a career in psychiatry, they will have a positive view of mental health professionals, helping to lessen stigmatisation of the profession.

Key points

What is the evidence behind the development of PBL curricula?

Does having an expert facilitating PBL impact on student learning?

Are graduates better suited to PBL?

Literature review

My literature search revealed very minimal literature on CPBL. Therefore, I have decided to focus my key points and literature review on the broader topic of PBL.

The theoretical basis of PBL

Originally, PBL was based on the theory of contextual learning. The basic principle is that when material is learnt in the context of how it will be used, it supports learning and capacity to use the information. PBL uses this principle by providing a case in the real-life context of a patient visiting a doctor.

Colliver (2000) undertook a review of the literature and concluded that the contextual learning argument was based on a weak research finding.

Albanese (2000) concurred with Colliver's criticism of contextual learning theory as an argument for PBL and proposed four new theories for understanding how and why PBL works, specifically information-processing theory, cooperative learning, self-determination theory and control theory.

Schmidt (1983) claimed that information-processing theory underpinned PBL. This theory involves three major elements, namely prior knowledge activation, encoding specificity and elaboration of knowledge. Prior knowledge activation is the process of students using previously-gained knowledge to understand and organise new information. Encoding specificity is similar to contextual learning theory, i.e. learning is promoted when the environment in which something is learned resembles the environment in which it will be applied. Elaboration of knowledge describes how information will be better understood and easier to recall when there is an opportunity for elaboration in the form of discussion and answering questions.

This theory incorporates contextual learning theory but provides a more comprehensive theory for understanding PBL.

I will now briefly discuss each of the other three learning theories of PBL proposed by Albanese (2000) and reflect on my experience of facilitating PBL with respect to these theories. Firstly, cooperative learning refers to an individual's perception that they can only fulfil their goals if the other group members also do so.

Qin et al (1995) conducted a meta-analysis of studies assessing the effect of cooperative versus competitive learning on problem solving. They defined cooperation as the presence of joint goals, mutual rewards, shared resources, and complementary roles among members of a group. In competitive learning situations, individuals perceived that they could only reach their goals if the other group members could not. They found that members of cooperative teams outperformed individuals competing with each other with respect to problem solving. These results held for individuals of all ages and for studies of high, medium, and low quality. The superiority of cooperation, however, was greater on non-linguistic than on linguistic problems.

I observed cooperative learning in action during the set of CPBL tutorials that I have described in this assignment. The students were keen to share the knowledge that they had reaped from self-directed learning and support all group members to attain the same level of understanding. I felt that the students were better able to identify the sources of misunderstanding if a fellow student was struggling to understand a concept than I was as an expert facilitator.

Self-determination theory may underlie matters of motivation and behaviour relevant to PBL. Williams et al (1999) argue that self-determination theory has the potential to significantly improve education. The theory differentiates between two types of motivating conditions, controlled and autonomous. Controlled motivators are thought to be maladaptive and include external demands as well as "introjected regulation", which are internalized beliefs about what one "should" do. These are all associated with either explicit or implicit rewards or punishments. Under controlled forms of motivation, individuals act with a sense of pressure and anxiety. In educational terms, this refers to short-lived, rote learning, which students do not integrate into their long-term values and skills. Albanese (2000) inferred that traditional curricula tended to involve controlled forms of motivation.

Albanese (2000) described autonomous motivators as "those which are personally endorsed by the learner and reflect what the individual finds interesting and important". In comparison to the external rewards and punishments associated with controlled motivating conditions, autonomous motivation allows the individual to behave with a sense of volition, agency, and choice.

PBL promotes autonomous motivators by considering the perspectives of the students and encouraging students to accept more responsibility for their own learning. I felt that I was able to support this by asking the students what they wanted to achieve from the tutorials, facilitating their discussions by asking prompting questions and seeking the opinions and feelings of students in a non-judgemental manner. As I discussed in my reflection, we were able to create a safe, relaxed environment, which minimised pressure and control and encouraged a high level of performance and collaborative learning.

The final theory of PBL proposed by Albanese (2000) was control theory. This theory was first introduced by Glasser (1986), who conjectured that all behaviour, including learning is intended to satisfy one or more of the following five internal needs:

1) To survive;

2) To belong and be loved by others;

3) To have power and importance;

4) To have freedom and independence; and

5) To have fun.

Albanese felt that PBL satisfies all five needs. It allows freedom because the students are able to structure their time and choose what to discuss. It satisfies the need for power, as students have the power to set their own learning objectives. PBL promotes love and belonging because it allows students and facilitators to become more personally involved with one another than in lectures. The literature (Albanese and Mitchell, 1993) highlights how both students and faculty enjoy PBL, thereby satisfying the need for fun. PBL promotes survival through students helping students. These claims by Albanese (2000) are in concordance with what I experienced as the facilitator of the CPBL tutorials.

To conclude, although Colliver (2000) found the theoretical development of PBL to have been weak, there is an array of theory that can be applied to PBL. I have described four theories but there may be others. Further research is required to investigate how theory can be transformed into effective PBL.

Comparison of PBL-based and traditional curricula

In the early 1990s, four separate systematic reviews comparing PBL to traditional curricula were published. I shall summarise these reviews before moving on to discuss the more recent literature.

The first review was published in 1992 by Norman and Schmidt, who examined the psychological basis for PBL. They found no evidence that PBL brought about improvement in "general, content-free problem-solving skills". However, they felt that there was some preliminary evidence to suggest that PBL may "enhance both transfer of concepts to new problems and integration of basic science concepts into clinical problems". Their other conclusions were, "learning in a PBL format may initially reduce levels of learning but may foster, over periods up to several years, increased retention of knowledge"; "PBL enhances intrinsic interest in the subject matter"; and "PBL appears to enhance self-directed learning skills, and this enhancement may be maintained".

Albanese and Mitchell (1993) conducted a systematic review and meta-analysis of literature on the outcomes and implementation issues of PBL. They concluded from their findings that, compared with conventional medical education, PBL is more nurturing and enjoyable; PBL graduates perform as well, and sometimes better, on clinical examinations; and they are more likely to enter family medicine. However, they also found that PBL graduates tended to engage in backward reasoning rather than the forward reasoning experts engage in, and there appeared to be gaps in their cognitive knowledge base that could affect practice outcomes.

Vernon and Blake (1993) published a very similar meta-analysis of the literature, which supported "the superiority of the PBL approach over more traditional methods". They found that student attitudes, class attendance and mood were all consistently more positive for PBL than for traditional courses. In terms of clinical functioning, PBL students performed better than traditional students. However, there was no significant difference between the two groups on measures of clinical knowledge.

The conclusions of a literature review by Berkson (1993) were much less positive, stating, "the graduate of PBL is not distinguishable from his or her traditional counterpart. The experience of PBL can be stressful for student and faculty. And implementation of PBL may be unrealistically costly."

In 2000, Colliver reviewed the medical education literature from 1992 to 1998, including the four main reviews of PBL from the early 1990s, and produced a critical overview of PBL, its effectiveness for knowledge acquisition and clinical performance, and the underlying educational theory.

Colliver concluded, "the review of the literature revealed no convincing evidence that PBL improves knowledge base and clinical performance, at least not of the magnitude that would be expected given the resources required for a PBL curriculum". Unlike previous reviews, Colliver's review challenged thinking about the educational effectiveness of PBL. Colliver suggested that further research was required to clarify both theory and practice.

Later in 2000, Norman and Schmidt responded to Colliver's paper with their own interpretation of the research evidence. They did not think its was sufficient to rely on randomised controlled trials and argued for the use of a broad range of research designs and variables.

Albanese (2000) also produced a paper as a retort to the review by Colliver. Albanese used results of students from differing curricula on the United States Medical Licensing Examination (USMLE) to suggest that PBL produced higher scores than traditional lectures. Albanese concluded that the positive effect that PBL has on the learning environment is "a worthwhile gain in, and of, itself", despite the absence of a thorough understanding of its effect on knowledge.

Since 2000, PBL has been used increasingly in undergraduate medical education in the UK. During this time the educational theory behind PBL has continued to develop and several new reviews and studies have been published.

A review was conducted by Newman (2003), which included only randomised controlled trials and quasi-experimental studies in which student performance or other outcomes were objectively measured. They concluded that outcomes for students in the PBL groups were less favourable than those in the "control group". However, there was no consensus in the studies that they reviewed on what constituted a control group.

Dochy et al (2003) were responsible for another recent meta-analysis of the effects of PBL, which showed that PBL had a positive effect on knowledge application of students. However, no effect on knowledge was found.

A number of studies including that by Prince et al (2005) (check ref) have used self-report questionnaires to compare the opinions and competencies of graduates from PBL and non-PBL schools. The results suggest that PBL graduates are better prepared with respect to several of the competencies.

Antepohl et al (2003) conducted a questionnaire study of all graduates of the new PBL medical curriculum at the Faculty of Health Sciences, Linköping University, Sweden. They found that "graduates of the new medical curriculum showed a high degree of satisfaction with their undergraduate education and how it prepared them for medical practice". However, this study had some limitations. The use of postal questionnaires introduces response bias. They had a good response rate of 77% but it is possible that the 23% who did not respond may not had a positive view of their medical education.

This study raised questions regarding the degree to which graduates' subjective retrospective evaluation of their own undergraduate education can provide relevant information concerning the quality of the course. Schmidt and van der Molen (2001) overcame this issue when comparing PBL graduates to traditional graduates. They identified and corrected self-overestimation among PBL graduates by referring to self-ratings results in areas in which a difference between PBL and traditional students was not expected. If differences did occur, they were used to quantify self-overestimation and to correct for it.

Tiwari et al (2006) conducted a randomised controlled trial aimed at comparing the effects of PBL and lecturing approaches on the development of students' critical thinking. Their results revealed that PBL students had "significantly higher critical thinking disposition scores on completion of PBL compared with lecture students". "They also continued to have higher scores, albeit to a lesser degree, than the lecture students for two years afterwards." This study involved small numbers of students and relied upon self-report by students, which can introduce recall bias. Despite these limitations, this study highlights the need for further research to determine whether the differences in critical thinking are maintained in subsequent years.

Also in 2006, Schmidt et al conducted a large, robust study comparing professional competencies of PBL graduates to traditional graduates in the Netherlands. Participants were asked to complete a questionnaire, rating themselves on eighteen professional competencies derived from the literature. They concluded, "PBL not only affects the typical PBL-related competencies in the interpersonal and cognitive domains, but also the more general work-related skills that are deemed important for success in professional practice".

More recently, Koh and colleagues (2008) performed a systematic review of how PBL during medical school affected the competence of doctors after graduation. The authors only included publications that incorporated a control group of graduates from a "traditional" curriculum. This high quality study employed a thorough methodology, whereby doctors' self assessments of their competencies and assessments by independent observers were considered separately. Little correlation was seen between self-assessed and observer-assessed competency. Self-assessment showed a strong level of evidence against PBL for possession of medical knowledge, but this was not confirmed by independent observation. The authors concluded that PBL has positive effects on graduate competencies in important social and cognitive domains. Again, one of the problems with this review was the absence of a definition of the control "traditional" curriculum.

In 2009, Macallan et al evaluated which components of CPBL contributed most to the success of the model using semi-structured questionnaires, focus groups and a consensus method. They showed that students found CPBL a "positive learning experience". They found that successful CPBL was supported by "the tutor's level of expertise and a non-threatening learning environment, conducive to student questioning". This study verified the idea that CPBL is "a parallel teaching approach that helps structure the teaching week, but does not replace traditional bedside teaching".


Upon reflection, I noted significant differences in the way in which the MBBS 4 students interacted in the CPBL tutorials and their ability to use these tutorials as a learning tool compared to students on the MBBS 5 course. I wondered whether this may reflect how learning styles change as we become adults and mature.

McCrorie (2002) described graduate-entry students as "highly motivated and committed" and "much more self-directed, challenging, demanding, questioning".

"Graduates have already learnt how to study and how to ration the other temptations of student life in order to keep up with their studies. This makes them better able to handle a self-directed learning approach" (Rushforth, 2004).

Taylor et al stated, "the major difference between adults and younger learners is the wealth of their experience" (Taylor, Marienau, & Fiddler, 2000, p.7). This is something that I reflected on following the CPBL tutorials, as the students in the group came from a variety of backgrounds. Each student was able to bring a different perspective and knowledge to the group, allowing for a richer learning environment.

On the other hand, students on the MBBS 5 course who have started their medical degree straight from school tend to have a similar educational background and experiences.

In the 1950s, Malcolm Knowles developed the theory of andragogical learning, contrasting the learning methods of adults with those of children, pedagogical learning. Knowles claimed that one of the main differences between these two forms of learning was that the role of the educator was minimised in adult learning.

Andragogy is based on the following five assumptions about how adults learn and their attitude towards and motivation for learning (Kaufman, 2003):

Adults are independent and self directing;

They have accumulated a great deal of experience, which is a rich resource for learning ;

They value learning that integrates with the demands of their everyday life;

They are more interested in immediate, problem centred approaches than in subject centred ones; and

They are more motivated to learn by internal drives than by external ones.

Learner-centeredness is described in the literature as a distinguishing characteristic of adult education. Traditional medical curricula reflect inform students as to what they should learn and what kinds of knowledge are considered important (Sheared & Sissel, 2001) (Titmus, 1999). In contrast, PBL places learners at the centre of their learning experience and promotes flexibility and individuation for self-directed, empowered adults (Manusco, 2000).

However, andragogy has been criticised, as adults do not automatically become self-directed upon achieving adulthood. They may not be psychologically equipped for it and may prefer or need direction from others (Beitler, 1997) (Titmus, 1999) (Courtney, Vasa, Luo, & Muggy, 1999). Kaufman (2003) suggested that graduates may have some limitations to their learning, including fixed learning approaches, greater financial concerns and a limited scientific background at enrolment.

Study of the literature reveals a lack of empirical evidence to support the differentiation between childhood and adult learning. Nonetheless, many education methods that are often used in higher education, including experiential learning, student autonomy and self-directed learning, stem from andragogy.

Analysis of literature and discussion

What is the evidence behind the development of PBL curricula?

In the early 1990s, four systematic reviews of undergraduate medical education cautiously supported the short-term and long-term outcomes of PBL compared with traditional learning (Albanese & Mitchell, 1993; Vernon & Blake, 1993; Berkson, 1993; Norman & Schmidt, 1992).

There were limitations to the reviews, as highlighted by Albanese and Mitchell (1993), including weaknesses in the criteria used to assess the outcomes of PBL; general weaknesses in study design; a limited research base, with studies of PBL curricula coming from only a handful of medical schools; and diversity in what different individuals call PBL.

Furthermore, these studies were conducted at a time when PBL was a relatively new and innovative style of medical education. Therefore, reports of negative experiences may not have been submitted or accepted for publication. There was also a risk of confounding, as it is very difficult to randomly assign students to different teaching methods for large segments of their training.

These limitations lessen the confidence one can give conclusions drawn from the literature regarding the outcomes of PBL at that time.

On the whole, recent research largely supports the findings of the earlier reviews, which suggested that graduates of PBL curricula are better able to apply knowledge and function clinically. However, the literature does not demonstrate differences in the knowledge base of graduates from the two different curricula.

Albanese (2000) argued that PBL improves clinical competence by making students more confident and self-aware as professional learners, thereby producing more efficient and enthusiastic doctors.

Nonetheless, not all the literature is consistent with this view. Rolfe et al (1995) demonstrated that graduates from a traditional curriculum were rated higher for teaching, diagnostic skills and understanding of basic mechanisms compared to those from a PBL curriculum.

There is a wealth of evidence to support the claim that PBL results in greater participant enjoyment and enthusiasm for learning than traditional medical education. For example, Colliver (2000) found that students value the interpersonal skills that PBL encourages and that are also key to effective clinical practice.

Research into this field continues to be problematic. A lot of the recent studies used questionnaires to compare the outcomes of different curricula, which introduce recall and response bias.

When appraising some PBL quantitative studies, I noticed that the studies were not based on any learning theory or were not testing predictions from a learning theory and, thus does not offer better understanding of why or why not PBL might work. A challenge for future research is to use learning theory to design quantitative PBL studies and use the data from studies to support theory.

Macallan et al (2009) considered CPBL from the students' viewpoint. They acknowledge that this is a common limitation of PBL research, as "students may not correctly perceive those factors that truly enhance their learning". However, I agree with their comment that more objective measures are difficult to apply in this context.

Another of the weaknesses of the studies that I have encountered is that comparisons are often made between students or graduates from different medical schools. Consequently, it is difficult to know whether any differences observed are the result of curriculum design or the overall context of the school.

Although randomised controlled trials have not been able to prove statistical effectiveness of PBL, there is considerable practical evidence from the 1993 reviews that students and faculty enjoy PBL more than traditional teaching methods.

There are a variety of arguments for believing that it is too early to accept the negative findings of the literature. It seems that more refined research methods and a wider range of research designs and variables are required to identify educational changes in a complex, learning environment. Bligh (2000, page) stated, "lack of hard `scientific' evidence for the effectiveness of PBL is not a reason for delaying implementation of PBL in curricula".

There is opportunity for more UK-based studies following the introduction of PBL-based curricula at many UK medical schools over the past ten years. The literature regarding CPBL is very sparse, so this could be a key focus of future research.

Does having an expert facilitating PBL impact on student learning?

There is much controversy in the literature as to whether an expert PBL facilitator promotes learning or not.

Barrows (1985) suggested that non-directive facilitation was more important than subject-matter expertise when he described the role of PBL tutor as follows:

"Instead of giving students the information and facts they need through lectures and readings, they must learn to facilitate and indirectly guide student learning. They must allow students to determine on their own what they need to know and to learn through the study of varied resources. Instead of telling students exactly that they should learn and in what sequence they should learn it, the tutor must help students determine this for themselves."

Hendry et al (2003) claimed that some PBL tutors are too dominant. They reported that "a dominant tutor causes tension and conflict in groups which leads to lack of commitment, cynicism or student absenteeism". However, it has also been shown that too little regulation by the facilitator also causes problems.

Silver and Wilkerson (1991) demonstrated that expert tutors impede student-to-student discussion by taking a more directive role in the tutorials, speaking more often, providing direct answers to students' questions and suggesting more items for discussion.

However, other studies have found the opposite effect. A study by Eagle et al (1992) found that in tutorials facilitated by an expert tutor, students generated twice as many learning issues and spent almost twice the amount of time on self-directed study than students attending tutorials facilitated by non-experts.

Macallan et al (2009) found that students "greatly appreciated it when expert clinicians demonstrated how clinical reasoning applied to the case".

As a result of these contradictory findings, some researchers began to investigate the relationship between tutor characteristics and differential contextual circumstances (Dolmanset al, 2002). These studies were based on the notion that "PBL is a complex learning environment in which different variables influence each other mutually" (Dolmans et al, 2005).

Schmidt examined the effect of tutor expertise on test scores under conditions of PBL courses with low or high structure and curricular materials that match poorly or well to students' level of prior knowledge (Schmidt, 1994). He found that when the structure of a course is low and/or students lack prior knowledge, the tutor's expertise has a greater impact on student performances.

Dolmans et al (1999) demonstrated that tutorial groups with relatively low levels of productivity require much more input from a tutor than highly productive groups. As discussed in my reflection, this is consistent with my experience. The MBBS4 students were highly productive and my role in the tutorials was minimal. On the other hand, my previous experience of PBL and CPBL with MBBS5 students has been that the students did not engage in the process or generate sufficient discussion or learning objectives. In these tutorials, I found myself taking a much more central role.

Bochner et al (2002) identified one contributory factor to the inconsistent findings is as the fact that there are no established standards by which to determine expertise.

Although there has been debate as to whether the facilitator needs to be an "expert", the consensus view seems to be that expertise in group dynamics together with supportive enthusiasm is more valuable than deep subject knowledge.

I found that, for the most part in this series of tutorials, my role was solely as a facilitator. However, the students occasionally discussed complex clinical issues, which were not easy to fully understand from reading a textbook. This was when I would step in to explain the concept in the clinical context.


Helped to understand how PBL should run to be effective - try to use prompting questions rather than give direct answers

Use ice breakers at first tutorial to help with group dynamics

The skill of PBL facilitation is that of knowing when to provide assistance to the group, be it suggesting useful resources they might like to consider or interjecting with thought provoking comments to guide the breadth and depth of learning, without necessarily imparting facts.4↵4Maudsley G . Roles and responsibilities of the problem-based learning tutor in the undergraduate medical curriculum. BMJ1999;318:657-61.