What the doctor ordered

15th December 2006 at 00:00
Walter Humes Is Research Professor In Education At The University Of Paisley

While receiving treatment for gastro-enteritis, I had an interesting conversation with the doctor on problem-based learning.

The topic served as a useful distraction for both of us - in my case, from the prospect of a further bout of projectile vomiting, and in his from what was doubtless a tedious and routine visit.

Problem-based learning is now used widely in many medical faculties as the preferred method of training doctors. Instead of being given large doses of formal knowledge unrelated to actual clinical situations, students are presented, from a very early stage in their course, with real cases and required to find out about the patient's history, interpret the symptoms, draw on relevant research and consider possible treatments. They normally work in teams under the guidance of an experienced clinician.

My doctor had strong views on the subject, based on his work in hospitals.

He expressed concern about the lack of basic anatomical and physiological knowledge exhibited by some students. Even final year students, he said, could show appalling ignorance of elementary medical facts.

He had doubts about the competence of some graduates, particularly since members of the public were now better informed about health issues and had higher expectations of medical expertise. He was also sceptical about the current emphasis on inter-personal skills in medicine.

Forced to choose, most patients would prefer a knowledgeable doctor with a brusque manner to one who had bedside charm but was unsure how to treat them.

I am not qualified to pass judgment on the extent to which these criticisms are justified, but they raise interesting questions about how best to promote knowledge and understanding, not only in medicine but also in other fields.

Within education, there is now considerable emphasis on problem-solving, the argument being that well-designed problems are more likely to encourage interest and engagement than didactic methods which involve the assimilation of information from formal teaching or textbooks. It is also intended to encourage independent learning, critical thinking and teamwork.

To tackle a problem intelligently is likely to require some prior propositional knowledge. This is perhaps most evident in subjects such as science and mathematics, which have a linear, sequential structure.

A problem that fails to take account of this is unlikely to provide a good basis for effective learning.

Furthermore, although the role of the teacher changes in problem-based approaches, it remains critically important. The "debriefing" exercise, where students explain and analyse what they have done, calls for skilful supplementary questioning by the teacher, if the full benefits of the learning experience are to be gained.

I am not a methodological purist, and think most educational debates about whether method A or B is better owe more to professional rivalry than to pedagogical principle. I believe in a mixed diet of educational methods, by which I mean it is desirable for teachers to try different approaches and to challenge pupils to try a variety of learning styles, some of which may require them to think in new ways.

None of us has a monopoly of wisdom, when it comes to promoting knowledge and understanding. Each learner is unique, and the hard task is to find the triggers - whether traditional or experiential - that encourage pupils to want to go on learning.

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