research on problem based learning

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• Published: 17 February 2022

Effectiveness of problem-based learning methodology in undergraduate medical education: a scoping review

• Joan Carles Trullàs   ORCID: orcid.org/0000-0002-7380-3475 1 , 2 , 3 ,
• Carles Blay   ORCID: orcid.org/0000-0003-3962-5887 1 , 4 ,
• Elisabet Sarri   ORCID: orcid.org/0000-0002-2435-399X 3 &
• Ramon Pujol   ORCID: orcid.org/0000-0003-2527-385X 1  

BMC Medical Education volume  22 , Article number:  104 ( 2022 ) Cite this article

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Problem-based learning (PBL) is a pedagogical approach that shifts the role of the teacher to the student (student-centered) and is based on self-directed learning. Although PBL has been adopted in undergraduate and postgraduate medical education, the effectiveness of the method is still under discussion. The author’s purpose was to appraise available international evidence concerning to the effectiveness and usefulness of PBL methodology in undergraduate medical teaching programs.

The authors applied the Arksey and O’Malley framework to undertake a scoping review. The search was carried out in February 2021 in PubMed and Web of Science including all publications in English and Spanish with no limits on publication date, study design or country of origin.

The literature search identified one hundred and twenty-four publications eligible for this review. Despite the fact that this review included many studies, their design was heterogeneous and only a few provided a high scientific evidence methodology (randomized design and/or systematic reviews with meta-analysis). Furthermore, most were single-center experiences with small sample size and there were no large multi-center studies. PBL methodology obtained a high level of satisfaction, especially among students. It was more effective than other more traditional (or lecture-based methods) at improving social and communication skills, problem-solving and self-learning skills. Knowledge retention and academic performance weren’t worse (and in many studies were better) than with traditional methods. PBL was not universally widespread, probably because requires greater human resources and continuous training for its implementation.

PBL is an effective and satisfactory methodology for medical education. It is likely that through PBL medical students will not only acquire knowledge but also other competencies that are needed in medical professionalism.

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There has always been enormous interest in identifying the best learning methods. In the mid-twentieth century, US educator Edgar Dale proposed which actions would lead to deeper learning than others and published the well-known (and at the same time controversial) “Cone of Experience or Cone of Dale”. At the apex of the cone are oral representations (verbal descriptions, written descriptions, etc.) and at the base is direct experience (based on a person carrying out the activity that they aim to learn), which represents the greatest depth of our learning. In other words, each level of the cone corresponds to various learning methods. At the base are the most effective, participative methods (what we do and what we say) and at the apex are the least effective, abstract methods (what we read and what we hear) [ 1 ]. In 1990, psychologist George Miller proposed a framework pyramid to assess clinical competence. At the lowest level of the pyramid is knowledge (knows), followed by the competence (knows how), execution (shows how) and finally the action (does) [ 2 ]. Both Miller’s pyramid and Dale’s cone propose a very efficient way of training and, at the same time, of evaluation. Miller suggested that the learning curve passes through various levels, from the acquisition of theoretical knowledge to knowing how to put this knowledge into practice and demonstrate it. Dale stated that to remember a high percentage of the acquired knowledge, a theatrical representation should be carried out or real experiences should be simulated. It is difficult to situate methodologies such as problem-based learning (PBL), case-based learning (CBL) and team-based learning (TBL) in the context of these learning frameworks.

In the last 50 years, various university education models have emerged and have attempted to reconcile teaching with learning, according to the principle that students should lead their own learning process. Perhaps one of the most successful models is PBL that came out of the English-speaking environment. There are many descriptions of PBL in the literature, but in practice there is great variability in what people understand by this methodology. The original conception of PBL as an educational strategy in medicine was initiated at McMaster University (Canada) in 1969, leaving aside the traditional methodology (which is often based on lectures) and introducing student-centered learning. The new formulation of medical education proposed by McMaster did not separate the basic sciences from the clinical sciences, and partially abandoned theoretical classes, which were taught after the presentation of the problem. In its original version, PBL is a methodology in which the starting point is a problem or a problematic situation. The situation enables students to develop a hypothesis and identify learning needs so that they can better understand the problem and meet the established learning objectives [ 3 , 4 ]. PBL is taught using small groups (usually around 8–10 students) with a tutor. The aim of the group sessions is to identify a problem or scenario, define the key concepts identified, brainstorm ideas and discuss key learning objectives, research these and share this information with each other at subsequent sessions. Tutors are used to guide students, so they stay on track with the learning objectives of the task. Contemporary medical education also employs other small group learning methods including CBL and TBL. Characteristics common to the pedagogy of both CBL and TBL include the use of an authentic clinical case, active small-group learning, activation of existing knowledge and application of newly acquired knowledge. In CBL students are encouraged to engage in peer learning and apply new knowledge to these authentic clinical problems under the guidance of a facilitator. CBL encourages a structured and critical approach to clinical problem-solving, and, in contrast to PBL, is designed to allow the facilitator to correct and redirect students [ 5 ]. On the other hand, TBL offers a student-centered, instructional approach for large classes of students who are divided into small teams of typically five to seven students to solve clinically relevant problems. The overall similarities between PBL and TBL relate to the use of professionally relevant problems and small group learning, while the main difference relates to one teacher facilitating interactions between multiple self-managed teams in TBL, whereas each small group in PBL is facilitated by one teacher. Further differences are related to mandatory pre-reading assignments in TBL, testing of prior knowledge in TBL and activating prior knowledge in PBL, teacher-initiated clarifying of concepts that students struggled with in TBL versus students-generated issues that need further study in PBL, inter-team discussions in TBL and structured feedback and problems with related questions in TBL [ 6 ].

In the present study we have focused on PBL methodology, and, as attractive as the method may seem, we should consider whether it is really useful and effective as a learning method. Although PBL has been adopted in undergraduate and postgraduate medical education, the effectiveness (in terms of academic performance and/or skill improvement) of the method is still under discussion. This is due partly to the methodological difficulty in comparing PBL with traditional curricula based on lectures. To our knowledge, there is no systematic scoping review in the literature that has analyzed these aspects.

The main motivation for carrying out this research and writing this article was scientific but also professional interest. We believe that reviewing the state of the art of this methodology once it was already underway in our young Faculty of Medicine, could allow us to know if we were on the right track and if we should implement changes in the training of future doctors.

The primary goal of this study was to appraise available international evidence concerning to the effectiveness and usefulness of PBL methodology in undergraduate medical teaching programs. As the intention was to synthesize the scattered evidence available, the option was to conduct a scoping review. A scoping study tends to address broader topics where many different study designs might be applicable. Scoping studies may be particularly relevant to disciplines, such as medical education, in which the paucity of randomized controlled trials makes it difficult for researchers to undertake systematic reviews [ 7 , 8 ]. Even though the scoping review methodology is not widely used in medical education, it is well established for synthesizing heterogeneous research evidence [ 9 ].

The specific aims were: 1) to determine the effectiveness of PBL in academic performance (learning and retention of knowledge) in medical education; 2) to determine the effectiveness of PBL in other skills (social and communication skills, problem solving or self-learning) in medical education; 3) to know the level of satisfaction perceived by the medical students (and/or tutors) when they are taught with the PBL methodology (or when they teach in case of tutors).

This review was guided by Arksey and O’Malley’s methodological framework for conducting scoping reviews. The five main stages of the framework are: (1) identifying the research question; (2) ascertaining relevant studies; (3) determining study selection; (4) charting the data; and (5) collating, summarizing and reporting the results [ 7 ]. We reported our process according to the PRISMA Extension for Scoping Reviews [ 10 ].

Stage 1: Identifying the research question

With the goals of the study established, the four members of the research team established the research questions. The primary research question was “What is the effectiveness of PBL methodology for learning in undergraduate medicine?” and the secondary question “What is the perception and satisfaction of medical students and tutors in relation to PBL methodology?”.

Stage 2: Identifying relevant studies

After the research questions and a search strategy were defined, the searches were conducted in PubMed and Web of Science using the MeSH terms “problem-based learning” and “Medicine” (the Boolean operator “AND” was applied to the search terms). No limits were set on language, publication date, study design or country of origin. The search was carried out on 14th February 2021. Citations were uploaded to the reference manager software Mendeley Desktop (version 1.19.8) for title and abstract screening, and data characterization.

Stage 3: Study selection

The searching strategy in our scoping study generated a total of 2399 references. The literature search and screening of title, abstract and full text for suitability was performed independently by one author (JCT) based on predetermined inclusion criteria. The inclusion criteria were: 1) PBL methodology was the major research topic; 2) participants were undergraduate medical students or tutors; 3) the main outcome was academic performance (learning and knowledge retention); 4) the secondary outcomes were one of the following: social and communication skills, problem solving or self-learning and/or student/tutor satisfaction; 5) all types of studies were included including descriptive papers, qualitative, quantitative and mixed studies methods, perspectives, opinion, commentary pieces and editorials. Exclusion criteria were studies including other types of participants such as postgraduate medical students, residents and other health non-medical specialties such as pharmacy, veterinary, dentistry or nursing. Studies published in languages other than Spanish and English were also excluded. Situations in which uncertainty arose, all authors (CB, ES, RP) discussed the publication together to reach a final consensus. The outcomes of the search results and screening are presented in Fig.  1 . One-hundred and twenty-four articles met the inclusion criteria and were included in the final analysis.

Study flow PRISMA diagram. Details the review process through the different stages of the review; includes the number of records identified, included and excluded

Stage 4: Charting the data

A data extraction table was developed by the research team. Data extracted from each of the 124 publications included general publication details (year, author, and country), sample size, study population, design/methodology, main and secondary outcomes and relevant results and/or conclusions. We compiled all data into a single spreadsheet in Microsoft Excel for coding and analysis. The characteristics and the study subject of the 124 articles included in this review are summarized in Tables 1 and 2 . The detailed results of the Microsoft Excel file is also available in Additional file 1 .

Stage 5: Collating, summarizing and reporting the results

As indicated in the search strategy (Fig.  1 ) this review resulted in the inclusion of 124 publications. Publication years of the final sample ranged from 1990 to 2020, the majority of the publications (51, 41%) were identified for the years 2010–2020 and the years in which there were more publications were 2001, 2009 and 2015. Countries from the six continents were represented in this review. Most of the publications were from Asia (especially China and Saudi Arabia) and North America followed by Europe, and few studies were from Africa, Oceania and South America. The country with more publications was the United States of America ( n  = 27). The most frequent designs of the selected studies were surveys or questionnaires ( n  = 45) and comparative studies ( n  = 48, only 16 were randomized) with traditional or lecture-based learning methodologies (in two studies the comparison was with simulation) and the most frequently measured outcomes were academic performance followed by student satisfaction (48 studies measured more than one outcome). The few studies with the highest level of scientific evidence (systematic review and meta-analysis and randomized studies) were conducted mostly in Asian countries (Tables  1 and 2 ). The study subject was specified in 81 publications finding a high variability but at the same time great representability of almost all disciplines of the medical studies.

The sample size was available in 99 publications and the median [range] of the participants was 132 [14–2061]. According to study population, there were more participants in the students’ focused studies (median 134 and range 16–2061) in comparison with the tutors’ studies (median 53 and range 14–494).

Finally, after reviewing in detail the measured outcomes (main and secondary) according to the study design (Table 2 and Additional file 1 ) we present a narrative overview and a synthesis of the main findings.

Main outcome: academic performance (learning and knowledge retention)

Seventy-one of the 124 publications had learning and/or knowledge retention as a measured outcome, most of them ( n  = 45) were comparative studies with traditional or lecture-based learning and 16 were randomized. These studies were varied in their methodology, were performed in different geographic zones, and normally analyzed the experience of just one education center. Most studies ( n  = 49) reported superiority of PBL in learning and knowledge acquisition [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ] but there was no difference between traditional and PBL curriculums in another 19 studies [ 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ]. Only three studies reported that PBL was less effective [ 79 , 80 , 81 ], two of them were randomized (in one case favoring simulation-based learning [ 80 ] and another favoring lectures [ 81 ]) and the remaining study was based on tutors’ opinion rather than real academic performance [ 79 ]. It is noteworthy that the four systematic reviews and meta-analysis included in this scoping review, all carried out in China, found that PBL was more effective than lecture-based learning in improving knowledge and other skills (clinical, problem-solving, self-learning and collaborative) [ 40 , 51 , 53 , 58 ]. Another relevant example of the superiority of the PBL method over the traditional method is the experience reported by Hoffman et al. from the University of Missouri-Columbia. The authors analyzed the impact of implementing the PBL methodology in its Faculty of Medicine and revealed an improvement in the academic results that lasted for over a decade [ 31 ].

Secondary outcomes

Social and communication skills.

We found five studies in this scoping review that focused on these outcomes and all of them described that a curriculum centered on PBL seems to instill more confidence in social and communication skills among students. Students perceived PBL positively for teamwork, communication skills and interpersonal relations [ 44 , 45 , 67 , 75 , 82 ].

Student satisfaction

Sixty publications analyzed student satisfaction with PBL methodology. The most frequent methodology were surveys or questionnaires (30 studies) followed by comparative studies with traditional or lecture-based methodology (19 studies, 7 of them were randomized). Almost all the studies (51) have shown that PBL is generally well-received [ 11 , 13 , 18 , 19 , 20 , 21 , 22 , 26 , 29 , 34 , 37 , 39 , 41 , 42 , 46 , 50 , 56 , 58 , 63 , 64 , 66 , 78 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 ] but in 9 studies the overall satisfaction scores for the PBL program were neutral [ 76 , 111 , 112 , 113 , 114 , 115 , 116 ] or negative [ 117 , 118 ]. Some factors that have been identified as key components for PBL to be successful include: a small group size, the use of scenarios of realistic cases and good management of group dynamics. Despite a mostly positive assessment of the PBL methodology by the students, there were some negative aspects that could be criticized or improved. These include unclear communication of the learning methodology, objectives and assessment method; bad management and organization of the sessions; tutors having little experience of the method; and a lack of standardization in the implementation of the method by the tutors.

Tutor satisfaction

There are only 15 publications that analyze the satisfaction of tutors, most of them surveys or questionnaires [ 85 , 88 , 92 , 98 , 108 , 110 , 119 ]. In comparison with the satisfaction of the students, here the results are more neutral [ 112 , 113 , 115 , 120 , 121 ] and even unfavorable to the PBL methodology in two publications [ 117 , 122 ]. PBL teaching was favored by tutors when the institutions train them in the subject, when there was administrative support and adequate infrastructure and coordination [ 123 ]. In some experiences, the PBL modules created an unacceptable toll of anxiety, unhappiness and strained relations.

Other skills (problem solving and self-learning)

The effectiveness of the PBL methodology has also been explored in other outcomes such as the ability to solve problems and to self-directed learning. All studies have shown that PBL is more effective than lecture-based learning in problem-solving and self-learning skills [ 18 , 24 , 40 , 48 , 67 , 75 , 93 , 104 , 124 ]. One single study found a poor accuracy of the students’ self-assessment when compared to their own performance [ 125 ]. In addition, there are studies that support PBL methodology for integration between basic and clinical sciences [ 126 ].

Finally, other publications have reported the experience of some faculties in the implementation of the PBL methodology. Different experiences have demonstrated that it is both possible and feasible to shift from a traditional curriculum to a PBL program, recognizing that PBL methodology is complex to plan and structure, needs a large number of human and material resources, requiring an immense teacher effort [ 28 , 31 , 94 , 127 , 128 , 129 , 130 , 131 , 132 , 133 ]. In addition, and despite its cost implication, a PBL curriculum can be successfully implemented in resource-constrained settings [ 134 , 135 ].

We conducted this scoping review to explore the effectiveness and satisfaction of PBL methodology for teaching in undergraduate medicine and, to our knowledge, it is the only study of its kind (systematic scoping review) that has been carried out in the last years. Similarly, Vernon et al. conducted a meta-analysis of articles published between 1970 and 1992 and their results generally supported the superiority of the PBL approach over more traditional methods of medical education [ 136 ]. PBL methodology is implemented in medical studies on the six continents but there is more experience (or at least more publications) from Asian countries and North America. Despite its apparent difficulties on implementation, a PBL curriculum can be successfully implemented in resource-constrained settings [ 134 , 135 ]. Although it is true that the few studies with the highest level of scientific evidence (randomized studies and meta-analysis) were carried out mainly in Asian countries (and some in North America and Europe), there were no significant differences in the main results according to geographical origin.

In this scoping review we have included a large number of publications that, despite their heterogeneity, tend to show favorable results for the usefulness of the PBL methodology in teaching and learning medicine. The results tend to be especially favorable to PBL methodology when it is compared with traditional or lecture-based teaching methods, but when compared with simulation it is not so clear. There are two studies that show neutral [ 71 ] or superior [ 80 ] results to simulation for the acquisition of specific clinical skills. It seems important to highlight that the four meta-analysis included in this review, which included a high number of participants, show results that are clearly favorable to the PBL methodology in terms of knowledge, clinical skills, problem-solving, self-learning and satisfaction [ 40 , 51 , 53 , 58 ].

Regarding the level of satisfaction described in the surveys or questionnaires, the overall satisfaction rate was higher in the PBL students when compared with traditional learning students. Students work in small groups, allowing and promoting teamwork and facilitating social and communication skills. As sessions are more attractive and dynamic than traditional classes, this could lead to a greater degree of motivation for learning.

These satisfaction results are not so favorable when tutors are asked and this may be due to different reasons; first, some studies are from the 90s, when the methodology was not yet fully implemented; second, the number of tutors included in these studies is low; and third, and perhaps most importantly, the complaints are not usually due to the methodology itself, but rather due to lack of administrative support, and/or work overload. PBL methodology implies more human and material resources. The lack of experience in guided self-learning by lecturers requires more training. Some teachers may not feel comfortable with the method and therefore do not apply it correctly.

Despite how effective and/or attractive the PBL methodology may seem, some (not many) authors are clearly detractors and have published opinion articles with fierce criticism to this methodology. Some of the arguments against are as follows: clinical problem solving is the wrong task for preclinical medical students, self-directed learning interpreted as self-teaching is not appropriate in undergraduate medical education, relegation to the role of facilitators is a misuse of the faculty, small-group experience is inherently variable and sometimes dysfunctional, etc. [ 137 ].

In light of the results found in our study, we believe that PBL is an adequate methodology for the training of future doctors and reinforces the idea that the PBL should have an important weight in the curriculum of our medical school. It is likely that training through PBL, the doctors of the future will not only have great knowledge but may also acquire greater capacity for communication, problem solving and self-learning, all of which are characteristics that are required in medical professionalism. For this purpose, Koh et al. analyzed the effect that PBL during medical school had on physician competencies after graduation, finding a positive effect mainly in social and cognitive dimensions [ 138 ].

Despite its defects and limitations, we must not abandon this methodology and, in any case, perhaps PBL should evolve, adapt, and improve to enhance its strengths and improve its weaknesses. It is likely that the new generations, trained in schools using new technologies and methodologies far from lectures, will feel more comfortable (either as students or as tutors) with methodologies more like PBL (small groups and work focused on problems or projects). It would be interesting to examine the implementation of technologies and even social media into PBL sessions, an issue that has been poorly explorer [ 139 ].

Limitations

Scoping reviews are not without limitations. Our review includes 124 articles from the 2399 initially identified and despite our efforts to be as comprehensive as possible, we may have missed some (probably few) articles. Even though this review includes many studies, their design is very heterogeneous, only a few include a large sample size and high scientific evidence methodology. Furthermore, most are single-center experiences and there are no large multi-center studies. Finally, the frequency of the PBL sessions (from once or twice a year to the whole curriculum) was not considered, in part, because most of the revised studies did not specify this information. This factor could affect the efficiency of PBL and the perceptions of students and tutors about PBL. However, the adoption of a scoping review methodology was effective in terms of summarizing the research findings, identifying limitations in studies’ methodologies and findings and provided a more rigorous vision of the international state of the art.

Conclusions

This systematic scoping review provides a broad overview of the efficacy of PBL methodology in undergraduate medicine teaching from different countries and institutions. PBL is not a new teaching method given that it has already been 50 years since it was implemented in medicine courses. It is a method that shifts the leading role from teachers to students and is based on guided self-learning. If it is applied properly, the degree of satisfaction is high, especially for students. PBL is more effective than traditional methods (based mainly on lectures) at improving social and communication skills, problem-solving and self-learning skills, and has no worse results (and in many studies better results) in relation to academic performance. Despite that, its use is not universally widespread, probably because it requires greater human resources and continuous training for its implementation. In any case, more comparative and randomized studies and/or other systematic reviews and meta-analysis are required to determine which educational strategies could be most suitable for the training of future doctors.

Abbreviations

• Problem-based learning

Case-based learning

Team-based learning

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Characteristics ofthe 124 included studies.

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Trullàs, J.C., Blay, C., Sarri, E. et al. Effectiveness of problem-based learning methodology in undergraduate medical education: a scoping review. BMC Med Educ 22 , 104 (2022). https://doi.org/10.1186/s12909-022-03154-8

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Problem-Based Learning

Problem-based learning  (PBL) is a student-centered approach in which students learn about a subject by working in groups to solve an open-ended problem. This problem is what drives the motivation and the learning. 

Why Use Problem-Based Learning?

Nilson (2010) lists the following learning outcomes that are associated with PBL. A well-designed PBL project provides students with the opportunity to develop skills related to:

• Working in teams.
• Managing projects and holding leadership roles.
• Oral and written communication.
• Self-awareness and evaluation of group processes.
• Working independently.
• Critical thinking and analysis.
• Explaining concepts.
• Self-directed learning.
• Applying course content to real-world examples.
• Researching and information literacy.
• Problem solving across disciplines.

Considerations for Using Problem-Based Learning

Rather than teaching relevant material and subsequently having students apply the knowledge to solve problems, the problem is presented first. PBL assignments can be short, or they can be more involved and take a whole semester. PBL is often group-oriented, so it is beneficial to set aside classroom time to prepare students to   work in groups  and to allow them to engage in their PBL project.

Students generally must:

• Examine and define the problem.
• Explore what they already know about underlying issues related to it.
• Determine what they need to learn and where they can acquire the information and tools necessary to solve the problem.
• Evaluate possible ways to solve the problem.
• Solve the problem.
• Report on their findings.

Getting Started with Problem-Based Learning

• Articulate the learning outcomes of the project. What do you want students to know or be able to do as a result of participating in the assignment?
• Create the problem. Ideally, this will be a real-world situation that resembles something students may encounter in their future careers or lives. Cases are often the basis of PBL activities. Previously developed PBL activities can be found online through the University of Delaware’s PBL Clearinghouse of Activities .
• Establish ground rules at the beginning to prepare students to work effectively in groups.
• Introduce students to group processes and do some warm up exercises to allow them to practice assessing both their own work and that of their peers.
• Consider having students take on different roles or divide up the work up amongst themselves. Alternatively, the project might require students to assume various perspectives, such as those of government officials, local business owners, etc.
• Establish how you will evaluate and assess the assignment. Consider making the self and peer assessments a part of the assignment grade.

Nilson, L. B. (2010).  Teaching at its best: A research-based resource for college instructors  (2nd ed.).  San Francisco, CA: Jossey-Bass. 

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• v.29(1); 2019 Mar

Advancing Critical Thinking Through Learning Issues in Problem-Based Learning

Carol c. thompson.

Rowan University, Glassboro, NJ USA

Health professions educators are increasingly urged to use learning designs that promote critical thinking and the development of interpersonal competencies. Problem-based learning (PBL) has a long, albeit contested, history as a collaborative and deep think-aloud process that participants use to reach conclusions about medical cases. In order to make progress, participants must assess what they do not know and what they must learn in order to continue. Answering these learning issues (LI) requires self-direction and cognitive presence. This study analyzes the discussions that participants used in the reporting phase of the LI process in an 8-week PBL module on cardiac-renal systems. Data were drawn from 10 class sessions and analyzed for critical thinking using a model based on Garrison and Newman et al. Participants at first presented LI reports didactically but over time initiated active learning strategies. The findings indicate large increases in the numbers of LI reports in which participants engaged in collaborative thinking. There were also large increases in the amount of time devoted to critical thinking as participants aligned the LI process more closely with the intent of PBL. Participants’ identity development as experts also underwent changes and the fluidity of the expert roles increased. Thoughtful design of the LI process can help learners develop the habitus of self-direction and collaborative critical thinking that they need in order to develop clinical reasoning.

Introduction

Medical educators are increasingly urged to use learning designs that promote both critical thinking (CT) and the development of interpersonal competencies [ 1 – 3 ]. Problem-based learning (PBL), which requires participants to construct their learning collaboratively, addresses both directives. A crucial activity in PBL is the development of learning issues (LIs) in which participants determine what the group does not know and must know in order to move forward in diagnosing cases. These LIs become crucial opportunities for participants to develop interactional competencies, self-direction, and CT.

CT includes, first, the cognitive skills of analysis, synthesis, and evaluation (Bloom’s taxonomy), second, argumentation and judgment/evaluation [ 4 ], and third, the interpretation and use of evidence to justify hypotheses [ 5 , 6 ]. CT is promoted when learners have opportunities and requirements for making their thinking visible to their peers [ 7 – 9 ] and for reflection [ 10 ]. As Jeong [ 11 ] suggests, reflection is increased when participants must examine assertions, and the need to argue points can be a useful spur to depth [ 11 , 12 ]. How frequently participants analyze what is said, critically assess it, and justify their assessments indicates the extent to which they are engaging in CT.

LIs, which Mpofu and colleagues [ 13 ] argue, “guide the students’ studying” (p. 330), are a particularly valuable opportunity for the development of both CT and self-direction. However, identifying LIs can be difficult for beginners who must metacognitively assess [ 14 ] what they already know and what will be salient in the case. Following Vygotsky’s [ 15 ] sociocultural constructivism, PBL frameworks are structured so that participants use the help of more expert others to do what they cannot do on their own. Facilitators act as guides in these zones of proximal development (ZPD), offering help (scaffolding) that encourages further inquiry and reflection; their prompts and questions can be particularly useful to participants learning to identify and discuss LIs. Eventually, self-directed students may even find relevant issues that instructors themselves had not identified [ 13 , 16 ]. Self-direction also appears to have some payoff beyond preclinical coursework. As van den Hurk and colleagues [ 17 ] note, LIs appear to encourage the development of self-direction during subsequent training. Some studies indicate that PBL students tend to function better in clinical situations than those in traditional lecture-based curricula [ 18 – 20 ], and that collaborative thinking can model the collegiality and teamwork that they will later need as practicing physicians [ 21 ].

To date, many studies of the LI process in medical education use self-report, and relatively few focus on what participants are actually saying as they analyze case problems and the knowledge needed to solve them. In their analysis of a single hour of discussion, Visschers-Pleijers [ 22 ] and colleagues used a discourse approach in their focus on the LI process. This kind of attention to the discussion in LI sessions is important because it is an indicator of the extent to which participants actually use the PBL and LI tenets of collaborative knowledge construction, distributed expertise [ 7 ], and self-direction [ 23 , 24 ] to engage in CT. The research by Kamin and colleagues [ 6 ] focused primarily on the larger PBL activity and included LIs in the process of integration. Other studies, for example, one by Hmelo-Silver and Barrows [ 7 ], looked at participant structures and the facilitator’s role in knowledge building, but not directly at CT. These studies point toward a potentially rich area for further inquiry.

Therefore, the study described in this article sought to use participant speech to investigate the use of CT over an extended time period in a PBL class of first-year medical students. The study was conducted at Rowan University, a midsized public university in New Jersey, USA, at its School of Osteopathic Medicine. The school has a longstanding practice of offering students the choice of applying to either the PBL or traditional curriculum upon acceptance to the school, and not all who apply to the PBL program are accepted. Students remain on their chosen track for both preclinical years. There are no didactic systems-based courses in the PBL track, and its explicit goal is the development of clinical reasoning. Facilitators are faculty trained in PBL processes.

This study focused on how LIs became an opportunity for collaborative work and development of students’ CT. The study gathered data from ten LI sessions over an 8-week module on cardio-renal processes. By concentrating on the LI portion of the PBL process, I wanted to understand its value for participants in helping them assess their knowledge and what they needed to know to work on the cases. It was also important to understand how the LI process might be valuable in its own right as a contribution to the CT that is a cornerstone of PBL. The focus was on how the desired characteristics of PBL were realized within the LI process, the extent to which the LI process itself promoted CT, and how students’ identities as experts [ 25 ] developed over the course of the 8 weeks.

Materials and Methods

The medical school is one of two attached to Rowan University, and it has a long history of educating osteopathic students in southern New Jersey. Just prior to this study, the school had expanded its PBL curriculum from one PBL section to four. The section discussed here was comprised of seven students and a faculty facilitator. During each week, three classes, each three hours long, were devoted to each case. Students were expected to prepare prior to class, and roles were distributed and rotated weekly (for example, “driver” in charge of the computer case progress, scribe). The curriculum materials had been developed at Southern Illinois University; case information was presented by computer program on a screen visible to all participants. The information with which the patient presented was revealed by the computer “driver,” and the participant acting as scribe recorded the case notes on the walls. Answers to the questions the group formulated for the computerized patient were gradually transformed into differentials.

New cases were presented each week, and the LIs were developed at the end of the first and second class meetings devoted to each case. Usually the participants collaboratively made lists of terms and concepts they wanted to know more about as they discussed the cases. They ranked them, selected the most urgent ones, and then volunteered to address them. During the first 5 weeks, they occasionally developed their own topics that they personally wanted to know more about. At other times, the facilitator helped participants construct LIs that would be particularly germane to the case, suggested modifications, or noted important areas of uncertainty in the case discussions. Following a comment by the facilitator mid-module students began to rotate topic choices. The reporting phase was conducted at the beginning of the following class session.

Prior to beginning the study, IRB approval was sought and granted; subsequently, I sought permission from both the facilitator and the students to be present in the room over the following weeks and record the classroom dialogue. All students were assigned pseudonyms.

Participants

The participants included one section of seven first-year medical students in the second 8-week module of their first semester. They had varying levels of experience in the health field including a bachelor’s degree in pharmacy, experience as an emergency medical technician, and experience at a social needs-oriented nonprofit. The facilitator was an emergency room physician and long-time faculty member trained in PBL.

Data Collection

Classes met for a total of 9 hours a week. I took extensive field notes and observed and recorded classes (including breaks) over the 8-week module on cardio-renal issues. Ten sessions had LI reports. I also conducted member checking to make sure my understanding of what participants were saying was accurate.

Data Analysis

The recordings were transcribed and discourse analysis conducted. To assess critical thinking, a framework based on the models developed by Garrison [ 25 ] and Newman and his colleagues [ 26 ] was employed. Garrison’s model was used to identify aspects of problem solving, including problem clarification and framing the problem in context (p-clar) and making judgments about potential solutions (eval). In addition, Newman and his colleagues were helpful in identifying critical assessment (C-assess; making judgments about potential solutions and the remarks of others) and justification for assertions (ju). The transcripts and field notes were further analyzed for participants’ role take-up as experts.

The LI process was challenging, as might be expected for new medical students. At the beginning of the module, participants chose manageable topics such as cardiomyopathy and arrhythmia. By mid-module, they were beginning to consider both which issues they should develop and how. They began to consider scope, with one participant asking whether they “should go narrower or wider,” and they began to choose more processes more challenging for them such as baroreceptor reflex blood pressure regulation.

The LI reports in the beginning were simple PowerPoint lectures; most also contained quick checks for understanding framed as multiple choice or yes/no questions at the end. As Table ​ Table1 1 indicates, the participants were increasingly able to sustain interactions with CT as the weeks progressed. For example, although there was a single interaction of approximately 1 min in the late September class session, by October 10 (4 sessions later), there were 6 interactions for a total of 9 min, and 2 weeks later, the discussions totaled 20 min. At this point, participants were increasingly extending the LIs as discussion opportunities, indicating a move from passive responses to much more active ones. As there were no further cases the entirety of the final session was devoted to LIs. The participants made the most of their time, engaging in lengthy interactions with substantial CT (see Table ​ Table2 2 ).

Discussions within LIs (minutes)

Levels of CT in LI discussions (P-clar; ps; C-assess/eval; ju)

Next, the extent to which participants used those interactions as opportunities for CT was analyzed. Because participants structured the initial LIs as lectures with brief questions meant to check for understanding, the early discussions tended to be at the level of problem clarification (see Table ​ Table2). 2 ). As the participants began to interact for longer periods, they also used more CT attributes. By October 10, three discussions used all of them, and 2 weeks later, four discussions used all CT attributes and the other discussions used most of the CT attributes.

By mid-October, there was a growing interactivity that grew out of a friendly rivalry between 2 students, Adam and Andrew. As they began to challenge each other during the LIs, they opened the door for others to join the discussion and to structure the LIs differently. Three students presented their LIs by drawing on the wall and without notes or PowerPoints. They began to encourage actual discussions, moving entirely from lecture format to interactional positions. The two women, Maria and Jennifer, had spoken very little during the first weeks of class; they began to participate more visibly by mid-module. This interactivity coincided with the increased use of critical thinking noted above, particularly as students assessed each other’s statements. Participants also began to assess their own learning needs (“I need to work more on EKG”; “Can you actually distinguish all these things from 1 EKG? I don’t think I’m going to be able to do that.”) The substantial restructuring of the LI, abandoning the lecture format for one that was much more interactive, had the effect of aligning the LIs with the purposes of the PBL process: to use CT in a collaborative and self-directed manner. The complexity of the responses in the reconfigured reporting phase coincided with their ability to make more substantial justifications for their positions, to better build on the thinking of others, and to evaluate and reevaluate their own positions with respect to the cases.

Table ​ Table3 3 contains a discussion excerpt from mid-module with increasing use of gently worded critical assessment to correct misunderstandings (see Adam’s comment in line 5: “I would say”) and also of justifications, a pattern that continued through the end of the 8 weeks. Maria was now willing to speak up; although she confined her comments to assessments of what others were saying, she was known to be accurate in her understanding of processes. As this excerpt indicates by mid-module, the participants were comfortable using the LI process to learn from each other. At the same time, they were also beginning to teach each other during breaks on multiple occasions.

Mid-module CT examples (P-clar; ps; C-assess/eval; ju; brackets indicate overlapping speech)

By the end of the module, participants used the LI process even more extensively to arrive at answers. In the final class meeting, there was no case discussion, so the LI report phase and discussions had no time constraints. Participants used the increased time available for discussion around the report phase, sustaining their discussions with the nearly continuous use of CT for 55 min.

Table ​ Table4 4 contains a brief excerpt of dialogue from the final class meeting. At that point in the discussion, participants were analyzing the implications of a comment raised by Jason at the end of his LI report on cardiac pressure equalization: (“… here’s I think on the exam or on the future if you see like this dip, you know, its characteristic of um a stenotic valve.”). The participants were able to use problem solving (ps), critical assessment (C-assess), and justifications (ju) in their thinking, and this brief excerpt of the 55-min discussion consists almost entirely of CT. Only 2 words (stemi and um) in this excerpt were not codable as CT, and the critical assessments often incorporated justifications as in line 18 (“But wouldn’t it be more proper to say that the left hypertrophies so you have that equalization or close to equalization of pressure?”). The brackets indicate the considerable overlaps in speech, where participants eagerly replied to the statements of others; these indicate the intensity of the discussion and the participants’ engagement in it (ll. 13–23). The vehement “No!” by Maria and Jennifer in line 30 reflects their engagement and close tracking of the discussion as it evolved. Adam then adds a justification to their one-word assessment and Andrew then agrees as well.

Final class session examples (brackets indicate overlapping speech)

There were also significant role changes over the 8 weeks. First were the notable ways in which the two women initially performed in a markedly gendered fashion. One apologized at the beginning of her first 2 LI presentations:

• 9-30: Jennifer: I apologize ahead of time. I don’t know how useful this is going to be [said twice].
• 10-5-16 Jennifer: Is that, is that, sorry. My memory is really bad today.

Maria, the other woman, initially spoke so softly that Jason frequently took on the role of acting as her mouthpiece. However, several of the men referred positively to the women’s thinking in discussions, and both Maria’s and Jennifer’s self-effacing postures toward the group in the LIs began to diminish by the middle of the module and disappeared by the end.

The data in this study indicate that the LI process can have significant value when participants reflect on how they are using it. Over the 8 weeks, there were two significant changes in how participants used the LIs. First, with the implicit approval of the facilitator, the initially passive LI learning space became an active one, engaging participants in critical thinking, collaboration, and self-direction. Second, the growing interactions encouraged the participants to use each other’s expertise.

The first change occurred as students replaced the didactic formats with which they might have been more familiar with more active ones, reconceptualizing the purpose and structure of the LIs. As participants mentioned to the facilitator in late October, they had sometimes been thinking of their own individual interests, choosing LIs for themselves that they thought they would learn the most from. However, the facilitator often guided them in choosing LIs that would be useful; his comments helped them develop questions that targeted essential case information. This was crucial to participants’ understanding of the LI process, because it directed efforts away from personal interest to group needs. Although they began to think more carefully about forming their questions, they continued to choose them in what one participant called a “free-for-all.” When they were encouraged to rotate the LIs and link them more carefully to the case, their understanding of the value in the LI process encouraged them to develop more complex questions. Participants were eventually able to identify learning issues that had substantial worth not only as they helped move case resolutions forward but also as they answered the larger effort to understand the cardiac/renal systems in the module.

The reporting phase then became an opportunity for extended discussion. As the group’s need to understand, the case became primary, interaction, engagement, and CT all increased. The deeper engagement with the material and each other visible in Tables  3 and ​ and4 4 created a space in which participants could elaborate on their ideas and use CT. Their growing comfort as a group encouraged them to ask presenters for justifications that deepened the discussions, both for the presenters and for the others. The participants began to try out new reporting formats, drawing on the walls, speaking without notes or PowerPoint slides, and then providing time for the group to respond with questions of their own.

That improvisation restructured the LIs as a more interactional process with considerable fluidity in roles as experts [ 27 ], important because there were considerable differences in prior job and educational experiences. The participants presented themselves variously as novices and as experts. Jason, a younger student, often used rather professorial language toward the group interwoven with requests for help. For example, in October, he began his LI report advising the others, “I won’t be going into that because you can read that on your own….So just keep that in mind…” He then requested help with pronouncing some of the terms. On the other hand, Jennifer whose considerable experience was in adolescent development was initially hesitant to use her expertise in discussing physiological processes. However, she gradually began to contribute valuable insights that helped resolve issues in the cases. Adam’s experience as an emergency medical technician conferred standing to play the role of expert most frequently in cardiac cases. By the middle of the module, though, the increased fluidity of expert/novice relations encouraged everyone to take on the role of expert at different times.

The participants used the facilitator in a variety of ways. In the beginning, he offered occasional suggestions for developing LIs; as discussions became more complex, detailed, and intense, participants sometimes called on him to provide information of both cardiac and renal processes that seemed opaque to them. His long experience as a practicing physician gave him multiple real-life examples that he used to explain physiological processes or correct misunderstandings. As Patel and colleagues [ 28 ] indicate, PBL programs need to have clear strategies for ensuring that the reasoning in self-directed learning is productive rather than incorrect. Where discussions headed off in incorrect directions the facilitator stepped in if others did not, and his awareness that he needed to be a fading presence allowed him to stand back when he was not needed. However, facilitator presence must be carefully modulated so that opportunities for critical thinking are not shut down. As can be seen in the LI trajectory in this case, moves by participants toward more active learning can initially be tentative and need to be encouraged.

For beginning medical students cases are examples of ill-structured problems without obvious correct answers. As Jonassen [ 29 ] argues, ill-structured problems are best addressed through constructivist frameworks; in these frameworks, “designers assume responsibility for constructing the problem space for the learners” [ 30 ] (p. 69). However, the LI part of the PBL process offers a space for learners to claim the problem-solving space as their own, to develop their CT skills, and to understand the advantages offered in PBL.

Conclusions

This study sought to understand how critical thinking and interpersonal competencies could be realized within the LI part of the PBL process in a class of beginning medical students. It focuses particularly on the growth of critical thinking that was encouraged when students began to conceptualize the LI as a problem space for discussion rather than as a simple report. The participants in this study learned to use their varied backgrounds and their willingness to teach and learn from each other thoughtfully. It provides an example of the importance of the LI in participants’ engagement and development.

Limitations

The study has two limitations. First, although there are copious data over time the sample size of 7 is small. Second, participants were able to self-select into either the traditional or PBL curricula; those who saw PBL as a labor intensive way to pass exams rather than as an avenue for cognitive development could opt into the traditional program.

Future Directions

This study adds to the limited literature that addresses LI processes through participant speech. There is a need for more research that examines the extent to which LI discussions can be used as hinges into understanding cases; further work on participant talk in both the developing and reporting phases could also be helpful in targeting LIs to student needs earlier in the PBL process. This focus in this study was on the reporting phase, but understanding how participants can best develop LIs could also be significant and useful to course designers.

It would also be helpful to understand the extent to which facilitators introduce the LI process as both individual and interactional. As is the case with other active learning strategies such as Team-based Learning, individual preparation is critical not only to the success of the learning process but also to subsequent performance on exams and clinical clerkships [ 31 ]. As this study demonstrates, however, the collaborative practices provide a crucial space for the development of both the disposition of self-direction and collaborative critical thinking that they need in order to develop clinical reasoning.

Acknowledgments

The author is indebted to Dean Linda Boyd and Victor Scali, D.O., of the Rowan University School of Osteopathic medicine for their assistance in making this research possible, and to the students in the PBL class and to Matthew Tribble.

Compliance with Ethical Standards

Prior to beginning the study, IRB approval was sought and granted.

The author declares that there is conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Problem-Based Learning (PBL)

What is Problem-Based Learning (PBL)? PBL is a student-centered approach to learning that involves groups of students working to solve a real-world problem, quite different from the direct teaching method of a teacher presenting facts and concepts about a specific subject to a classroom of students. Through PBL, students not only strengthen their teamwork, communication, and research skills, but they also sharpen their critical thinking and problem-solving abilities essential for life-long learning.

See also: Just-in-Time Teaching

In implementing PBL, the teaching role shifts from that of the more traditional model that follows a linear, sequential pattern where the teacher presents relevant material, informs the class what needs to be done, and provides details and information for students to apply their knowledge to a given problem. With PBL, the teacher acts as a facilitator; the learning is student-driven with the aim of solving the given problem (note: the problem is established at the onset of learning opposed to being presented last in the traditional model). Also, the assignments vary in length from relatively short to an entire semester with daily instructional time structured for group work.

By working with PBL, students will:

• Become engaged with open-ended situations that assimilate the world of work
• Participate in groups to pinpoint what is known/ not known and the methods of finding information to help solve the given problem.
• Investigate a problem; through critical thinking and problem solving, brainstorm a list of unique solutions.
• Analyze the situation to see if the real problem is framed or if there are other problems that need to be solved.

How to Begin PBL

• Establish the learning outcomes (i.e., what is it that you want your students to really learn and to be able to do after completing the learning project).
• Find a real-world problem that is relevant to the students; often the problems are ones that students may encounter in their own life or future career.
• Discuss pertinent rules for working in groups to maximize learning success.
• Practice group processes: listening, involving others, assessing their work/peers.
• Explore different roles for students to accomplish the work that needs to be done and/or to see the problem from various perspectives depending on the problem (e.g., for a problem about pollution, different roles may be a mayor, business owner, parent, child, neighboring city government officials, etc.).
• Determine how the project will be evaluated and assessed. Most likely, both self-assessment and peer-assessment will factor into the assignment grade.

Designing Classroom Instruction

See also: Inclusive Teaching Strategies

• Take the curriculum and divide it into various units. Decide on the types of problems that your students will solve. These will be your objectives.
• Determine the specific problems that most likely have several answers; consider student interest.
• Arrange appropriate resources available to students; utilize other teaching personnel to support students where needed (e.g., media specialists to orientate students to electronic references).
• Decide on presentation formats to communicate learning (e.g., individual paper, group PowerPoint, an online blog, etc.) and appropriate grading mechanisms (e.g., rubric).
• Decide how to incorporate group participation (e.g., what percent, possible peer evaluation, etc.).

How to Orchestrate a PBL Activity

• Explain Problem-Based Learning to students: its rationale, daily instruction, class expectations, grading.
• Serve as a model and resource to the PBL process; work in-tandem through the first problem
• Help students secure various resources when needed.
• Supply ample class time for collaborative group work.
• Give feedback to each group after they share via the established format; critique the solution in quality and thoroughness. Reinforce to the students that the prior thinking and reasoning process in addition to the solution are important as well.

Teacher’s Role in PBL

See also: Flipped teaching

As previously mentioned, the teacher determines a problem that is interesting, relevant, and novel for the students. It also must be multi-faceted enough to engage students in doing research and finding several solutions. The problems stem from the unit curriculum and reflect possible use in future work situations.

• Determine a problem aligned with the course and your students. The problem needs to be demanding enough that the students most likely cannot solve it on their own. It also needs to teach them new skills. When sharing the problem with students, state it in a narrative complete with pertinent background information without excessive information. Allow the students to find out more details as they work on the problem.
• Place students in groups, well-mixed in diversity and skill levels, to strengthen the groups. Help students work successfully. One way is to have the students take on various roles in the group process after they self-assess their strengths and weaknesses.
• Support the students with understanding the content on a deeper level and in ways to best orchestrate the various stages of the problem-solving process.

The Role of the Students

See also: ADDIE model

The students work collaboratively on all facets of the problem to determine the best possible solution.

• Analyze the problem and the issues it presents. Break the problem down into various parts. Continue to read, discuss, and think about the problem.
• Construct a list of what is known about the problem. What do your fellow students know about the problem? Do they have any experiences related to the problem? Discuss the contributions expected from the team members. What are their strengths and weaknesses? Follow the rules of brainstorming (i.e., accept all answers without passing judgment) to generate possible solutions for the problem.
• Get agreement from the team members regarding the problem statement.
• Put the problem statement in written form.
• Solicit feedback from the teacher.
• Be open to changing the written statement based on any new learning that is found or feedback provided.
• Generate a list of possible solutions. Include relevant thoughts, ideas, and educated guesses as well as causes and possible ways to solve it. Then rank the solutions and select the solution that your group is most likely to perceive as the best in terms of meeting success.
• Include what needs to be known and done to solve the identified problems.
• Prioritize the various action steps.
• Consider how the steps impact the possible solutions.
• See if the group is in agreement with the timeline; if not, decide how to reach agreement.
• What resources are available to help (e.g., textbooks, primary/secondary sources, Internet).
• Determine research assignments per team members.
• Establish due dates.
• Determine how your group will present the problem solution and also identify the audience. Usually, in PBL, each group presents their solutions via a team presentation either to the class of other students or to those who are related to the problem.
• Both the process and the results of the learning activity need to be covered. Include the following: problem statement, questions, data gathered, data analysis, reasons for the solution(s) and/or any recommendations reflective of the data analysis.
• A well-stated problem and conclusion.
• The process undertaken by the group in solving the problem, the various options discussed, and the resources used.
• Your solution’s supporting documents, guests, interviews and their purpose to be convincing to your audience.
• In addition, be prepared for any audience comments and questions. Determine who will respond and if your team doesn’t know the answer, admit this and be open to looking into the question at a later date.
• Reflective thinking and transfer of knowledge are important components of PBL. This helps the students be more cognizant of their own learning and teaches them how to ask appropriate questions to address problems that need to be solved. It is important to look at both the individual student and the group effort/delivery throughout the entire process. From here, you can better determine what was learned and how to improve. The students should be asked how they can apply what was learned to a different situation, to their own lives, and to other course projects.

See also: Kirkpatrick Model: Four Levels of Learning Evaluation

I am a professor of Educational Technology. I have worked at several elite universities. I hold a PhD degree from the University of Illinois and a master's degree from Purdue University.

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CPM’s 2023 Research Base Executive Summary Problem-Based Learning

This is a summary of CPM’s 2023 research base on Problem-Based Learning. For more information and for references, please see the full report, available from https://cpm.org/research-base ( PDF copy ).

What is Problem-Based Learning?

Mathematics education researchers have largely accepted that problem-solving is an essential part of doing mathematics. They now focus on how the distribution and delegation of power in mathematics classrooms influence students’ opportunities to learn (Agarwal & Sengupta-Irving, 2019; Schoenfeld, 2016). While there are many types of authority at play in classrooms, the most relevant type of authority for mathematics learning is mathematical authority, or “who possesses mathematical knowledge that is taken as true” (Langer-Osuna, 2017, p. 238). This research base article focuses on the influence of mathematical authority on mathematics sensemaking in problem-based tasks.

CPM’s Pillar of Problem-Based Learning refers to:

     A. using tasks that cannot be solved by a simple algorithm and that are often embedded in complex real-world contexts;

     B. supporting students in collaboratively constructing knowledge through productive discourse practices (i.e., active, student-centered learning); and

     C. sharing mathematical authority with students. In problem-based learning, students construct knowledge by making connections to form big mathematical ideas.

Problem-based learning develops students’ problem-solving skills, content knowledge, and eventually, the ability to be self-directed, independent learners (Duch et al., 2001; Hmelo-Silver & Barrows, 2015; Hammond, 2014). For example, empirical research has demonstrated that problem-based tasks are better than traditional tasks for supporting students in applying their knowledge to novel problems (i.e., transfer) and being self-directed in their learning (Hmelo, 1998; Hmelo & Lin, 2000; Schmidt et al., 1996). According to Langer-Osuna (2017), a leading scholar on mathematical authority, agency, and identity, fostering shared authority between teachers and students supports increased student ownership of mathematical ideas (Bianchini, 1999; Ehrlich & Zack, 1997; Lotan, 1997), conceptual understanding (Hiebert et al., 1997), and positive identification with mathematics (Hand, 2012; Lotan, 2003).

CPM infers from this research that…

Problem-based learning supports students in learning mathematics in ways that will be useful to them in their future mathematics classes, in their careers, and in their lives outside of school and work. When students understand how to solve problems rather than how to correctly select and implement procedures, they develop mathematical authority and thus are more likely to enjoy and see the value in mathematics.

Why are problem-based tasks important for learning mathematics?

Over half a century of cognitive and sociocultural research on learners’ mathematical thinking indicates that it is more effective (i.e., it better supports understanding and problem solving), although perhaps less efficient (i.e., it may not allow for “covering content” as quickly), to let students work with their peers to struggle through making sense of a problem and invent ways to solve it, rather than showing students how to solve problems (Choppin, 2022; Schoenfeld, 2016). In fact, to do mathematics, the problem has to actually be a problem for the problem-solver (Schoenfeld, 2016). In sum, if we wish for students to develop productive mathematics problem-solving dispositions that follow them into adulthood, it is essential that students’ own ideas become more central in instructional activities (Boaler & Greeno, 2000, Boaler & Selling, 2017).

Problem-based learning supports students in authentically engaging in mathematics. Doing mathematics inherently requires struggle since problem-solving only happens when the path to the solution is unclear. Problem-based learning is thus riskier for teachers than other forms of instruction because it requires putting students’ ideas at the center of instruction—including their uncertainties and misconceptions—rather than the de facto correct ideas of the teacher and the textbook. Using heterogeneous grouping by randomly assigning students to teams can expose students to many different ideas, which then supports them in making decisions about which ideas to pursue. Though problem-based learning may take more time than other ways of teaching, it pays off as students develop productive mathematics problem-solving dispositions that stick with them for life.

If Problem-Based Learning is important for mathematics learning, why is it not more widespread?

Unfortunately, many commercially available mathematics curricula today do not support problem-solving (Larson, 2014). A 2022 study by Choppin et al. characterized the curricula of six mathematics textbook publishers—Math in Focus, Holt, Prentice Hall, Glencoe, CMP, and CPM—and found that all but CPM and CMP were substantially composed of tasks that served as delivery mechanisms for content rather than tasks that functioned as thinking devices that support student sensemaking.

Problem-based learning is essential for supporting mathematical sensemaking, and CPM is one of the few secondary mathematics curricula that function as a “thinking device” for students rather than as a “delivery mechanism.” Because students do not come into the classroom as blank slates who will integrate everything they encounter exactly as the teacher and textbook intend, it is essential for curricula to support students in developing problem-solving skills as they persevere in making sense of mathematical tasks. Engaging in productive struggle during problem-solving is much more aligned with the mathematical practices of mathematicians than consuming a curriculum of discrete facts and skills derived from experts’ knowledge. In CPM materials, tasks are designed to engage students in mathematical practices that make learning the knowledge and skills found in traditional curricula much more sensible, enduring, and relevant.

Who is Problem-Based Learning good for?

Although it is common practice to argue that students with learning and intellectual disabilities need explicit instruction instead of problem-based learning, research has shown that these students can develop conceptual understandings through problem-solving by (a) using mathematics tasks that are connected to real-world applications; (b) collaborating with peers and using manipulatives; and (c) inventing their own strategies rather than using standard algorithms (e.g., Lambert & Sugita, 2016). For more information, see the NCSM publication, “Inclusion and Intervention: Understanding “Disability” in the Mathematics Classroom,” by Jasien and Hayes (2022).

Problem-based learning is appropriate for all students in inclusive classrooms.

What does it look like for students to engage in Problem-Based Learning?

Mathematical authority is not a binary (e.g., students do not either have or lack mathematical authority), but rather occurs along a spectrum, and is dynamic (rather than static), expanding (rather than finite), and situational (rather than stable across time) (Bishop et al., 2022). When students have a high degree of mathematical authority, they “are ‘authorized’ to solve mathematical problems for themselves, are publicly credited as the ‘authors’ of their ideas, and develop into local ‘authorities’ in the discipline” (Stein et al., 2008, p. 332).

Problem-based learning requires inviting students to make mathematical decisions and contribute substantive mathematical ideas. In other words, in a classroom where problem-based learning is flourishing, students exercise a high level of mathematical authority by making conjectures, explaining their work, justifying their reasoning to one another, and building on each other’s ideas. Of course, this is unlikely to happen at the beginning of the school year in any classroom because it requires building a classroom culture that supports students in taking on more and more mathematical authority over time. Mathematical authority can shift from moment to moment and day to day depending on student engagement and the mathematical ideas of the lesson, but over time, teaching for problem-based learning should support all students in exercising mathematical authority.

How is Problem-Based Learning different from more traditional mathematics learning?

In too many classrooms, the teacher and textbook are the primary sources of claims about what is right and how mathematical thinking should unfold (Engle & Conant, 2002; Herbel-Eisenmann & Wagner, 2007; Litke, 2015, 2020; Mehan, 1979; NCTM, 2014). In classrooms where the teacher and textbook are the primary sources of mathematical authority, students’ mathematical sensemaking is backgrounded in favor of behavioral compliance, with demands like giving the teacher complete attention and always being on task without socializing (Cazden, 2001; Hand, 2012). Teaching in ways that support students in becoming problem solvers who enjoy mathematics requires making space for students to be their full selves, including by attending to students’ relationships with each other (e.g., their social and academic status), attending to their emotional and physical needs, and allowing goofiness and social talk to occur with mathematical discourse (Joseph, 2021).

For many students, including high-achieving students, traditional classroom practices that do not make room for problem-solving activities like exploration and justification can lead students to disaffiliate with mathematics (e.g., the common phrase, “I’m not a math person;” Boaler & Greeno, 2000; Pope, 2001).

Problem-based learning may require teachers to significantly shift their pedagogy, moving from a teacher-centered approach toward a student-centered approach. While traditional teaching methods may work for some students in terms of performing well on assessments, they do not work well for most students. Even more, there are too many students earning good grades or taking advanced mathematics classes who achieve in mathematics not because they enjoy or see intrinsic value in it, but because they know how to “do school” and see its importance for their future (e.g., collegiate gatekeeping). Problem-based learning invites more students to see themselves as belonging in mathematics class and creates more meaningful mathematics learning for those who already see themselves as belonging.

Does facilitating Problem-Based Learning mean that I no longer take on the role of being a mathematical authority?

Sharing mathematical authority does not mean that teachers should withdraw or abdicate their own authority. The idea that authority is finite (i.e., there is only so much to go around) comes from the widespread misconception that mathematical authority is a zero-sum game (Bishop et al., 2022). When teaching problem-based learning, teachers act as expert learners by using open questions to scaffold students toward mathematical understandings, thus offering students a kind of apprenticeship in mathematical thinking (Hmelo-Silver & Barrows, 2015).

Problem-based learning expands the mathematical authority within a classroom as teachers share, rather than give away, their intellectual authority with students. In fact, when teachers abdicate their mathematical authority, students’ mathematical reasoning can suffer. By modeling the practices of expert learners rather than acting as a source of finished knowledge, teachers support students in reasoning mathematically.

How can I share my mathematical authority as a teacher without short-changing the value of Problem-Based Learning?

Teachers can support students in developing mathematical authority by eliciting and probing student thinking (Arnesen & Rø, 2022; Ellis et al., 2019; Hamm & Perry, 2002), building on students’ ideas (Arnesen & Rø, 2022; Drageset, 2014; Sherin, 2002), supporting students in engaging in evaluative work by making connections (Arnesen & Rø, 2022; Drageset, 2014; Kazemi & Hintz, 2014; Stein et al., 2008), assigning competence (Esmonde, 2009; Hand, 2012; Jilk, 2016), and facilitating peer-to-peer mathematical relationships (Langer-Osuna, 2015).

Problem-based learning requires teachers to exercise their mathematical authority while still sharing mathematical authority with students. Teachers can do this by questioning in ways that:

• probe process before probing content (e.g., encouraging the student(s) to explain their work and justify their reasoning to one another, or using study team and teaching strategies to help students learn from each other);
• model mathematical practices (e.g., asking for detailed explanations (how) and justification (why), or asking for connections between multiple students’ thinking and between multiple representations); and
• foster mathematical discourse amongst students (e.g., asking open-ended questions that make space for students to share and build on each other’s ideas, strategies, representations, and explanations).

What student moves influence mathematical authority in classrooms that feature Problem-Based Learning?

Langer-Osuna et al. identified a small set of student actions that frequently preceded shifts in who exercised mathematical authority in teams, with all of these actions involving students publicly naming aspects of their teamwork: asking for clarifications (e.g., “So what are we working on?”), stating the work to be done (e.g., “We are supposed to get a new card”), and making their own process the object of consideration (e.g., by counting manipulatives aloud).

Problem-based learning reflexively supports and requires students to develop a growth mindset, persistence with an expectation of difficulty during mathematical problem-solving, and willingness to take social and academic risks, all essential aspects of developing mathematical authority. For example, students engaging in problem-based learning will often need to ask for clarifications from their teammates, direct their team members, find resources for problem-solving, and expose their own uncertainties. CPM materials are designed to support students in engaging in these activities and more by incorporating team roles, which are used to their fullest potential when they support students in making their mathematical ideas (including their uncertainties) public.

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Algebra Tiles Session

Used throughout cpm middle and high school courses, concrete, geometric representation of algebraic concepts., two-hour virtual session,,  learn how students build their conceptual understanding of simplifying algebraic expressions, solving equations using these tools.  , determining perimeter,, combining like terms,, comparing expressions,, solving equations, use an area model to multiply polynomials,, factor quadratics and other polynomials, and, complete the square., support the transition from a concrete (manipulative) representation to an abstract model of mathematics.., foundations for implementation.

This professional learning is designed for teachers as they begin their implementation of CPM. This series contains multiple components and is grounded in multiple active experiences delivered over the first year. This learning experience will encourage teachers to adjust their instructional practices, expand their content knowledge, and challenge their beliefs about teaching and learning. Teachers and leaders will gain first-hand experience with CPM with emphasis on what they will be teaching. Throughout this series educators will experience the mathematics, consider instructional practices, and learn about the classroom environment necessary for a successful implementation of CPM curriculum resources.

Page 2 of the  Professional Learning Progression (PDF) describes all of the components of this learning event and the additional support available. Teachers new to a course, but have previously attended Foundations for Implementation, can choose to engage in the course Content Modules in the Professional Learning Portal rather than attending the entire series of learning events again.

Building on Instructional Practice Series

The Building on Instructional Practice Series consists of three different events – Building on Discourse, Building on Assessment, Building on Equity – that are designed for teachers with a minimum of one year of experience teaching with CPM instructional materials and who have completed the Foundations for Implementation Series.

Building on Equity

In  Building on Equity , participants will learn how to include equitable practices in their classroom and support traditionally underserved students in becoming leaders of their own learning. Essential questions include: How do I shift dependent learners into independent learners? How does my own math identity and cultural background impact my classroom? The focus of day one is equitable classroom culture. Participants will reflect on how their math identity and mindsets impact student learning. They will begin working on a plan for Chapter 1 that creates an equitable classroom culture. The focus of day two and three is implementing equitable tasks. Participants will develop their use of the 5 Practices for Orchestrating Meaningful Mathematical Discussions and curate strategies for supporting all students in becoming leaders of their own learning. Participants will use an equity lens to reflect on and revise their Chapter 1 lesson plans.

Building on Assessment

In  Building on Assessment , participants will apply assessment research and develop methods to provide feedback to students and inform equitable assessment decisions. On day one, participants will align assessment practices with learning progressions and the principle of mastery over time as well as write assessment items. During day two, participants will develop rubrics, explore alternate types of assessment, and plan for implementation that supports student ownership. On the third day, participants will develop strategies to monitor progress and provide evidence of proficiency with identified mathematics content and practices. Participants will develop assessment action plans that will encourage continued collaboration within their learning community.

Building on Discourse

In  Building on Discourse , participants will improve their ability to facilitate meaningful mathematical discourse. This learning experience will encourage participants to adjust their instructional practices in the areas of sharing math authority, developing independent learners, and the creation of equitable classroom environments. Participants will plan for student learning by using teaching practices such as posing purposeful questioning, supporting productive struggle, and facilitating meaningful mathematical discourse. In doing so, participants learn to support students collaboratively engaged with rich tasks with all elements of the Effective Mathematics Teaching Practices incorporated through intentional and reflective planning.

Core Connections Integrated III Correlations

Correlation of INT3 to CCSS Appendix A PDF

Correlation of INT3 to CCSS Math Practices PDF

INT3 Text to CCSS Standards PDF

Core Connections Integrated II

Correlation of INT2 to CCSS Appendix A PDF

Correlation INT2 to CCSS Math Practices PDF

INT2 Text to CCSS Standards PDF

Core Connections Integrated I Correlations

Correlation of INT1 to CCSS Appendix A PDF

Correlation INT1 to CCSS Math Practices PDF

INT1 Text to CCSS Standards PDF

Core Connections Algegra 2

CCSS Appendix A to Textbook CCA2 PDF

CCA2 Text to CCSS Standards Traditional PDF

Correlation CCA2 to CCSS Math Practices PDF

Core Connections Geometry Correlations

Correlation of CCG to CCSS Appendix A PDF

CCG Text to CCSS Standards Traditional PDF

Correlation CCG to CCSS Math Practices PDF

Correlation of CCG to PARCC Model Framework PDF

Core Connections Algebra Correlations

CCSS Appendix A to Textbook CCA PDF

CCA Text to CCSS Standards Traditional PDF

Correlation CCA to CCSS Math Practices PDF

Correlation of CCA to PARCC Model Framework PDF

Core Connections 3 Correlations

• Correlation CC3 to CCSS Grade 8 Standards PDF
• CC3 Text to CCSS Standards Grade 8 PDF
• Correlation CC3 to CCSS Math Practices PDF

Core Connections 2

• Correlation CC2 to CCSS Grade 7 Standards PDF
• CC2 Text to CCSS Standards Grade 7 PDF
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Core Connections 1

• Correlations CC1 to CCSS Grade 6 Standards PDF
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Problem-Based Learning: What and How Do Students Learn?

• Published: September 2004
• Volume 16 , pages 235–266, ( 2004 )

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• Cindy E. Hmelo-Silver 1  

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Problem-based approaches to learning have a long history of advocating experience-based education. Psychological research and theory suggests that by having students learn through the experience of solving problems, they can learn both content and thinking strategies. Problem-based learning (PBL) is an instructional method in which students learn through facilitated problem solving. In PBL, student learning centers on a complex problem that does not have a single correct answer. Students work in collaborative groups to identify what they need to learn in order to solve a problem. They engage in self-directed learning (SDL) and then apply their new knowledge to the problem and reflect on what they learned and the effectiveness of the strategies employed. The teacher acts to facilitate the learning process rather than to provide knowledge. The goals of PBL include helping students develop 1) flexible knowledge, 2) effective problem-solving skills, 3) SDL skills, 4) effective collaboration skills, and 5) intrinsic motivation. This article discusses the nature of learning in PBL and examines the empirical evidence supporting it. There is considerable research on the first 3 goals of PBL but little on the last 2. Moreover, minimal research has been conducted outside medical and gifted education. Understanding how these goals are achieved with less skilled learners is an important part of a research agenda for PBL. The evidence suggests that PBL is an instructional approach that offers the potential to help students develop flexible understanding and lifelong learning skills.

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Problem-Based Learning: Conception, Practice, and Future

Designing Problem-Solving for Meaningful Learning: A Discussion of Asia-Pacific Research

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Hmelo-Silver, C.E. Problem-Based Learning: What and How Do Students Learn?. Educational Psychology Review 16 , 235–266 (2004). https://doi.org/10.1023/B:EDPR.0000034022.16470.f3

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