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Journal of Veterinary

Featured Article

Problem Based Learning: An Introduction and

Overview of the Key Features of the Approach
Mark J. Newman
ABSTRACT
Problem Based Learning (PBL) has been adopted in educational programs in a variety of disciplines, including veterinary
medicine. There is a voluminous literature on the subject, but it often remains unclear just what is being done in the name of
PBL, and different accounts highlight different, often contradictory, positions on the key features of the approach. Similarly,
despite the many claims made for the advantages of PBL, the evidentiary basis of such claims is often questionable. This
article provides an introductory overview of what appear to be the key features of the approach and a brief summary of
empirical evidence on its effectiveness.

INTRODUCTION
Problem Based Learning (PBL) has been introduced into
education in many professional fields and appears to be of
growing interest to veterinary medical educators.
Cambridge Veterinary School in the United Kingdom,1
Cornell Universitys College of Veterinary Medicine,2 and
the newly created Western University of Health Sciences
College of Veterinary Medicine in the United States3 all
report using a form of PBL in their pre-clinical veterinary
medical curriculum. In its modern guise, PBL started to
become a feature of educational programs during the 1960s.
Since then there has been steady growth in the number of
programs and institutions that have adopted PBL around
the world. This transformation has been encouraged by an
almost evangelical PBL movement that has published a
wealth of anecdotal material extolling the virtues of the
approach.4 PBL has been endorsed by a wide variety of
national and international organizations,5 and, in recent
years, the advantages claimed for PBL have become part of
the generally articulated outcomes for education at all
levels.6
However, it is not always clear what exactly is being done in
the name of PBL.7, 8 There are a growing number of
references in the literature to adapted or hybrid PBL
approaches and approaches labeled Inquiry-based learning, which are apparently based on but not the same as
PBL.911 For example, a recent article in this journal
described Inquiry-based learning and contrasted it with
Problem Based Learning,12 but the description given of
Inquiry-based learning would match many definitions of
Problem Based Learning. There is no single unanimous
position about the theoretical basis for, or practice of, PBL.
There is not even agreement about whether there is, or
should be, one type of PBL or many variants.11, 13 The
wide dissemination of PBL has de facto spawned many
variations.14
A distinction that does appear useful is made by Bereiter
and Scardamalia15 between PBL and problem-solving
learning. They distinguish between PBL (upper-case) and
pbl (lower-case). Lower-case pbl refers to an indefinite range
of educational approaches that give problems a central place
in the learning activity. Practitioners of upper-case PBL, on
the other hand, tend to adhere to the structures and
12

procedures first systematized by Howard Barrows.16

Central to this system is a conception of learning as an
integrated process of cognitive, metacognitive, and personal
development. Barrows argues that a more accurate title
for the model he and his collaborators developed might
be student-centered, problem based, inquiry-based,
integrated, collaborative, reiterative, learning.17 However,
the label Problem Based Learning has stuck. And it is this
uppercase PBL that is the focus of this article.
It is not my intention to describe the many different theories
of learning and teaching that appear to provide the
principles that underpin PBL. The relationship between
some of the concepts (grey boxes), theories from which they
derive (clear boxes), and key features of PBL (black boxes)
are illustrated in Figure 1. It is worth noting that when
Barrows and his colleagues designed the original ProblemBased Learning Curriculum at McMaster Universitys
medical school in the late 1960s, they did so with a view
to overcoming what they perceived as the practical
problems of student boredom, students inability to apply
what they learned in medical school to clinical practice, and
the lack of professional skills of new graduates.18 The
explicit links with various theories of learning and education came after this as various disciplines analyzed and
developed their own versions of PBL.

WHAT TYPE OF LEARNING IS PBL INTENDED

TO PROMOTE?
Dolmans and Schmidt19 state that the aim of PBL is to help
students develop rich cognitive models of the problems
presented to them. Similarly, Savin-Baden20 argues that the
often unarticulated aim of teachers who use PBL approaches
is to develop in their students criticality, that is,
emotional, intellectual, and practical independence. Bailey
et al.21 emphasize enhancing enculturation into a community of practice as an aim of PBL. A summary of the ways in
which these aims have been operationalized, derived from
the work of Engel13 and Woods,22 is given in Box 1.

WHAT IS PROBLEM BASED LEARNING?

Engel13 describes the essential characteristics of a problembased curriculum as follows: it is cumulative (repeatedly
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Theories of self
regulation and
meta cognition

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Journal of Veterinary

Social constructivist theory

Knowledge is
socially constructed
in communities of
practice

Succsssful
learning
requires
adoption of
particular
attitudes and
strategies

Schema
theory

Activation of prior
learning and
subsequent knowledge
use facilitated by
learning in context

Learning in
small groups

Use of Problems
to stimulate,
contextulize and
integrate learning

Teacher as
facilitator of
process of learning
for which students
themselves are
responsible

Appropriate
Assessment

Importance of
Internal/Episte
mic motivation
to learn

Motivational
theory

Curriculum
theories

Use of explicit tutorial process to stimulate

reflection, active participation and
application

Use of knowledge requires communicative action students must also learn

these skills

Learning is an
active process of
reflection and
investigation

Theories of professional practice and of

learning

Figure 1: Summary of the key features and conceptual basis of Problem Based Learning

BOX 1: CAPABILITIES THAT PBL DEVELOPS

.

Awareness (active listening)

Personal learning preference

Defining real problems

(goals, mission, vision)

Problem solving

Learning skills
(laws, theories, concepts, etc.)

Look back and extending experience

(recognizing fundamentals in a given
situation)

Strategy (planning)

Creativity

Decision making

Stress management

Time management

Group and chairperson skills

Managing change

Interpersonal skills

Coping creatively with conflict

Reasoning critically and creatively

Adopting a more universal

or holistic approach

Practicing empathy, appreciating

the other persons point of view

Collaborating productively in
groups or teams

Self-directed learning

Self-directed lifetime learning

Self-assessment

Obtaining criteria

reintroducing material at increasing depth), integrated

(de-emphasizing separate subjects), progressive (developing
as students adapt), and consistent (supporting curricular
aims through all its facets). Others describe a continuum of
PBL models. Savin-Baden11 proposes six dimensions of PBL
JVME 32(1) 2005 AAVMC

and argues that the important differentiation is the way in

which knowledge, learning, and the role of the student are
conceptualized and manifest in the curriculum. Based on
the argument that the key variables in PBL are the
problem and the information gained, Harden and
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BOX 2: GENERIC PBL ESSENTIALS

.

Students must have responsibility for their own learning.

The problem simulations used in Problem Based Learning must be ill structured and allow for free inquiry.

Learning should be integrated from a wide range of disciplines or subjects.

Collaboration is essential.

What students learn during their self-directed learning must be applied back to the problem with reanalysis and
resolution.

A closing analysis of what has been learned from work with the problem and a discussion of what concepts and
principles have been learned is essential.

Self- and peer assessment should be carried out at the completion of each problem and at the end of every curricular
unit.

The activities carried out in Problem Based Learning must be those valued in the real world.

Student examinations must measure student progress towards the goals of Problem Based Learning.

Problem Based Learning must be the pedagogical base in the curriculum and not part of a didactic curriculum.

Davis23 propose a continuum of 11 types of PBL,

depending on the way in which the key variables are
employed to facilitate learning. Charlin et al.24 developed a
10-dimension model of PBL which they used to compare
PBL programs in three Canadian medical schools.
Notwithstanding the considerable differences between
these schools on the 10 dimensions, the authors argue
that each program was true PBL. Perhaps a more
practical approach for teachers and curriculum development teams is that provided by Barrows,17 who proposes a
list of essentials or principles for the design of PBL (see
Box 2).

KEY FEATURES OF PBL CURRICULA

As noted above, there is little agreement about the key
features of PBL and little high-quality research evidence
upon which to distinguish the relative effectiveness of
different designs (see below for discussion). Arguably,
across the various PBL literatures, five key features of a
PBL curriculum can be distinguished.
1. Teacher as Facilitator
Different terms are used to indicate the role played by a
teacher in the context of a PBL program, including tutor24
and facilitator.20 However, the widespread use of such
terminology does not necessarily indicate agreement or a
great depth of understanding of the practices and dispositions required for successful facilitation.20 Different aspects
of the role are emphasized in different accounts and models
of PBL. A common thread in descriptions of this role is that
the tutor or facilitator is a more knowledgeable member of
the community. Sociocultural approaches emphasize the
teachers role in enculturating the learner into the specific
community of practice through, for example, internalization
of the language, attitudes, and values of the community.21
Cognitive approaches emphasize the teachers role as
facilitator of cognitive development in the knowledge and
skills of the community.25
In the classroom, the PBL teacher employs his or her
knowledge of the subject area to support the processes of
14

cognitive or metacognitive development and/or enculturation. The PBL literature suggests a number of techniques
that PBL teachers may adopt in their interactions with
students. These techniques include the adoption of
particular role personae and forms of communicative
action (see Box 3).27 Teachers require preparation and
support for both the change to and maintenance of these
role personae, in particular visible institutional support in
the form of recognition of the high level of skill required and
adequate time to prepare for and carry out their role.
2. The Use of an Explicit Process to Facilitate Learning
The tutorial process is used as a framework to assist in the
development and practice of affective, cognitive, and
metacognitive skills. There are different models of the PBL
tutorial process. The process referred to in many medical
school PBL programs is largely derived from the seven-step
model developed at Maastricht.26 This version is explicit in
its adherence to a classical hypothetico-deductive approach,
which can appear to overemphasize problem solving rather
than learning. An alternative description of the tutorial
process provided by Wolff27 appears to give greater
emphasis to identifying gaps in knowledge and selfdirected learning strategies to fill these gaps (see Box 4).
These models of the PBL process act as guides for the tutor
and students to help them through the learning process.
In the first meeting of a cycle with a new scenario,
the students work through steps 1 to 4. Between meetings
the students engage in self-directed learning. The second
and third meetings in a cycle are devoted to getting
feedback on what the students have learned from the
research they have undertaken between the meetings,
synthesizing this information, and applying it to the
scenario. At the end of each cycle, the group reviews its
performance as a learning group and learning goals are
identified for improvement.22
The stages may be worked through sequentially, but often
the students will move backward and forward between the
stages during each cycle as they spend more time thinking
and discussing the issues. There appears to be little
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BOX 3: TEACHING TECHNIQUES FOR THE PBL TEACHER

Communicative actions
Role personae

. Staying silent
. Learner
.

Probing questions: Why? What do you mean? What does that mean?

Creator

Reflecting questions: How does this idea help you?

Director

Involvement questions: Who else has ideas on this?

Challenger

Physical positioning in group

Evaluator

Educational diagnosis questions: How do you feel about the way you formulated your ideas?

Negotiator

Stimulating interest

Modeler

Decreasing challenge where there are signs of boredom or over challenge

Designer

. Facilitator
Helping students to address issues with interpersonal dynamics
. Supporter
(e.g., by asking questions about dysfunctional group behaviors)

BOX 4: THE EIGHT TASKS OF PBL

1. Explore the problem: clarify terms and concepts that are not understandable, create hypotheses, identify issues.
2. Identify what you know already that is pertinent.
3. Identify what you do not know.
4. As a group, prioritize the learning needs, set learning goals and objectives, allocate resources; members identify which
task they will do.
5. Engage in a self-directed search for knowledge.
6. Return to the group and share your new knowledge effectively so that all group members learn the information.
7. Apply the knowledge; try to integrate the knowledge acquired into a comprehensive explanation.
8. Reflect on what has been learned and the process of learning.

discussion in the PBL literature about the student feedback

stage. Personal experience of observation in a number of
different PBL programs suggests that feedback is often
limited to the mini-lecture type identified by Hadwin.28
While this is recognized as a kind of first stage in the
students development in the PBL literature,29 according
to Hadwin28 it is the least effective at promoting selfregulation and fostering critical thinking. The issue of
feedback is also linked to the way in which the learning
objectives are divided among the students. Barrows argues
that from all the possible learning objectives identified in
each problem, students should prioritize a small number
that they will investigate, as this will facilitate greater
recognition of the complexity of any issue and deeper
learning.17 The aim of feedback, therefore, should be for the
students to share all the information they have obtained in
order to make in-depth analysis and synthesis of ideas
possible. The importance of the stage of applying the
knowledge back to the scenario is emphasized in the
PBL literature. It is argued that this attempted application
of the knowledge facilitates the elaboration of new and
JVME 32(1) 2005 AAVMC

existing relevant knowledge into appropriate semantic

networks.30
3. Use of Problems to Stimulate, Contextualize and
Integrate Learning
In the literature on PBL the terms problem, trigger, and
scenario are used to refer to the material presented to
students in initiating a specific learning cycle. Often these
terms are used interchangeably, even when, in practice,
there appear to be significant differences in the material
presented. To avoid confusion, the term scenario will be
used here. In the PBL literature, scenarios play at least three
roles in the construction of the learning environment:
discussion of the scenarios serves to encourage students to
activate relevant prior knowledge, stimulates students
interest and thus their intrinsic motivation to learn, and
sets a context for the learning of knowledge similar to that
in which future use of the knowledge will be required.31
For example, from the scenario given in Box 5, students in a
nursing education program that uses PBL identified four
broad learning issues:
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Journal of Veterinary

BOX 5: EXAMPLE OF SCENARIO FROM A PBL CURRICULUM IN NURSING

Nurse Sue Downs
Joy Chen is the newly appointed F Grade in charge of Blue team. She has been in post two months. Sue Downs is a D
Grade nurse in Joys team and has worked on the ward part-time for 10 years. Sue is popular with other members of staff
and with the patients. Joy feels that the teams documentation of patient assessments, care plans, and evaluation could be
improved. She perceives that when Sue is the named nurse, documentation is particularly poor. She also notices that
when Sue has been looking after a group of patients on a shift she frequently leaves work incomplete. Sue is quite open
about this, often reporting that she has not had time to do such and such in the handover meeting. Although nobody
complains about this, Joy feels it may cause resentment among the other team members, who have to do her work
for her.
Resources
Adair J. Effective Team Building. London: Pan Books, 1986.
Douglass LM. The Effective Nurse: Leader and Manager, 4th ed. St. Louis, MO: MosbyYear Book, 1992.
Sullivan MP. Nursing Leadership and Management. Springhouse, PA: Springhouse Corp., 1990.
Tappen RM. Nursing Leadership and Management: Concepts and Practice, 3rd ed. Philadelphia: Davis, 1995.
Driscoll J. Practising Clinical Supervision: A Reflective Approach. Edinburgh: Bailliere Tindall, 2000.
Core Concepts: Nurse Sue Downs
. Nursing Role: Aesthetics: *Management of change, Leading and motivating a team, Role modeling
.

Ethics: Leading a team, Dealing with staff

Professional Role: *The nurse as a change agent, *Reflective practice, Risk management, Clinical supervision,
Leadership, Performance management

Sociology: Role theory, Management of change theories, Organizational and occupational culture

Education/Psychology: Motivation theory, Theories of reasoned action, Learning styles, Learning theory

1. What are effective styles of leadership?

2. How best to implement change?
3. What are current National Health Service Guidelines
on patient documentation?
4. What is clinical supervision and preceptorship?32
4. Learning in Small Groups
The small group is an integral part of the PBL approach,
used consciously and conscientiously to achieve the learning outcomes.29 It is argued that purposefully designed and
successful small group learning facilitates learning through
the development of a learning environment that supports
and promotes both cognitive and metacognitive development. The links between the structures of small group
learning emphasized in PBL, the processes these structures
facilitate, and the learning outcomes that are claimed to
result from these processes are illustrated in Figure 2.
Implicit in the design of the PBL small group is the idea that
many of these positive actions (e.g., cooperation) do not
just happen by themselves, whereas many of the negative
actions (e.g., conflict) are a routine and inevitable part of
working in a group. The structures in small group PBL,
along with the tutorial process and the use of scenarios, help
the students learn how to learn in groups and learn how to
anticipate, prevent, cope with, and deal with the difficulties
that they will experience working in this way. This is not to
say that these structures are present in the organization of
all PBL small group learning environments.
16

In some models of PBL, the small group process includes

the requirement that at each session a different student
facilitate or chair the session. It is argued that this
reinforces the message that students must take responsibility for the learning process and for the functioning
of the group. It is also argued that facilitation skills are
an important part of the professional repertoire. Taking on
the role of facilitator in a supportive environment helps
students to practice and develop these skills.29 Learning to
perform in this role, therefore, becomes part of the goal
and process of learning. There are differences of opinion
about the ideal size for a PBL small group, but it is argued
that the development of skills for communication, the
development of knowledge, and collaboration are best
fostered in groups with between five and 10 members.29, 33
5. Assessment and Problem Based Learning
There is a shared view among PBL advocates that assessment drives learning and that there should be alignment
between the goals of a PBL program and what is assessed.
However, the consequences of this view are interpreted
differently. Some writers suggest that both the response
format and the content of the test must be appropriate to
PBL.34 Others argue that response format is of less
consequence than content and test design.35 Multiplechoice questions have often been rejected for use in PBL
programs, for various reasons including the belief that they
are suitable for measuring only lower levels of taxonomic
cognitive functioning.36 Others argue, however, that there is
no reason why multiple-choice questions cannot be used in
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Structures in small
group PBL:
Small group is the only
scheduled learning
environment
Students have to control
the process of learning Tutor will only facilitate
Students have to take
turns to act as a Chair
or Scribe in a session
Follow tutorial process
Students identify
learning goals
Students required to
evaluate each others
performance

Processes facilitated
by small group
environment:
Sharing ideas

Products:
Valuing of different
perspectives

Working together

Development of group
process/teamwork/
interpersonal skills

Providing support

Individual reflection

Conflict

Enhanced enthusiasm
and motivation

Sharing knowledge

Competition
Challenging of views
Active participation
Monitoring
Elaboration
Critical feedback
Exclusion

Increased ability in self

directed learning
Learning becomes more
meaningful and is thus
retained
Increased ability in
self-evaluation
Developing knowledge
as part of community of
practice

Testing out of
ideas/theories
Modelling
Evaluation
Recognition of the
different learning
opportunities afforded
by the scenario

Figure 2: Structures, actions and products of small group learning

PBL assessment, as the key issue is the quality of the design
and administration of the test rather than the method
itself.37 The Progress test,38 used with slight variation in
the PBL programs in a number of medical schools, uses the
multiple-choice question format.
A number of assessment formats are claimed to provide a
more valid measure of the learning developed by PBL
programs. Modified essay questions (MEQs) have been
used to assess PBL in both clinical and pre-clinical courses.
It is argued that the properly designed evolving MEQ opens
up possibilities for exercising intelligent guessing that
mirror the realities of clinical work and can thus measure
abilities and attitudes that other assessment methods
cannot.39 Although the reliability of the MEQ method has
been established,40 caution has been expressed about its
misuse and overuse in PBL programs.41 Studies have also
suggested that the MEQ measures nothing different from
the multiple-choice question.42
The Triple Jump Exercise is a learning process measure
widely used as an assessment tool in PBL programs.43 This
exercise consists of three steps (jumps): a structured oral
examination based on one or more patient problems, a timelimited study assignment in relation to the patient problems
in the first oral examination, and a repeat oral examination
in which the quality of self-learning around the assigned
topic is assessed. The Triple Jump Exercise is currently used
in a number of PBL programs around the world, including
the problem-based BSc Nursing program at McMaster
University in Ontario. Critics have argued, however, that
JVME 32(1) 2005 AAVMC

the Triple Jump Exercise is a very time-consuming,

costly method of assessment with poor measurement
characteristics.44

EVIDENCE ABOUT THE EFFECTIVENESS OF

PROBLEM BASED LEARNING
Problem Based Learning is no exception to the debates and
arguments about appropriate methods of evaluation that
characterize the field of education research.45, 46 PBL has
arguably been one of the most scrutinized innovations in
professional education.7 However, as Woodward47 points
out, empirical evidence that supports the theories that
underpin PBL is not the same as empirical evidence to
support the claim that it produces practitioners who
maintain consistently high levels of performance throughout their professional careers. Block and Moore48 argue that
despite the fact that many useful studies of PBL exist,
selection bias and the absence of control groups limit the
conclusions that can be drawn from them. Colliver49 has
reignited the debate about the effectiveness of PBL by
claiming that studies have erroneously claimed effects for
PBL when it was more likely that these effects were due to
differences in selection and philosophy of care.
To obtain a clearer picture of what high-quality research
studies indicate about the effectiveness of PBL, a research
project involving secondary data analysis in the form of a
review of reviews was carried out as part of the Project on
the Effectiveness of Problem Based Learning (PEPBL).8
Readers are advised to refer to the study report for details of
17

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Journal of Veterinary

the methods and results of this study, as only a summary

is given here. Five previous reviews of PBL were used.5054
Ninety studies cited in these reviews were identified as
providing evidence of the effectiveness of PBL; only 15 of
these met the quality inclusion criteria for the review of
reviews. Three of these 15 studies did not include any data
in the reports seen, and not all of the outcomes reported met
the quality criteria. The results regarding cognitive development, as measured by assessment of one kind or another,
varied. Of the 39 outcomes reported, 16 favored PBL and 23
the control group. A pilot meta-analysis carried out as part
of the review found a mean effect size estimate of d
0.3
(i.e., in favor of the control, not PBL). However, this result
should be treated with caution, as the outcomes included
are not independent.55

5
Tompkins C. Nursing education for the 21st century. In
Rideout E, ed. Transforming Nursing Education through
Problem-Based Learning. Sudbury, MA: Jones & Bartlett,
2001:121.

Only three of the included studies reported data that could

be interpreted as measures of improvements in practice.
One study appeared to show that PBL students held
more desirable attitudes towards practice.56 Of the seven
outcomes reported in a study of PBL in a nursing program,
two favored the PBL group.57 In a study of the use of PBL to
improve general practice consultation skills, only one
outcome measure of nine favored PBL.58 Two of the
included studies assessed changes in student learning
styles and appeared to suggest that PBL had a favorable
impact on student learning styles.56, 59 While student
satisfaction was reported in many of the studies considered
in the review, in only one study did the measurement of this
outcome meet the inclusion criteria. In this study, students
in the PBL curriculum appeared to rate their program more
highly.56

8
Newman M. A pilot systematic review and metaanalysis on the effectiveness of problem based learning
<http://www.ltsn-01.ac.uk/resources/features/pbl>.
Accessed 01/20/05. Learning and Teaching Subject
Network for Medicine, Dentistry and Veterinary Medicine,
Newcastle, UK, 2003.

The review described here was systematic but not comprehensive. Furthermore, there were many questions about
the design of PBL that were unclear in the studies included.
It could be argued that the outcomes assessed and/or
the methods of assessment used were not appropriate.
The absence of evidence should not be interpreted as
evidence of absence of effect. It does suggest, however,
that teachers and curriculum development staff should
treat claims for the effectiveness of any one particular
model of PBL with caution. Perhaps more importantly,
it suggests that the development of PBL curricula in
veterinary medical education should be accompanied
by rigorous evaluation.60

6
Hmelo C, Evensen D. Introduction to problem based
learning: Gaining insights on learning interactions through
multiple methods of enquiry. In Evensen D, Hmelo C,
eds. Problem Based Learning: A Research Perspective on
Learning Interactions. Mahwah, NJ: Lawrence Erlbaum,
2000:118.
7
Maudsley G. Do we all mean the same thing by
problem-based learning? A review of the concepts
and formulation of the ground rules. Acad Med 74:178185,
1999.

9
Cleverley D. Implementing Inquiry-Based Learning in
Nursing. London: Routledge, 2003.
10
Margetson D. What counts as problem-based learning.
Educ Health 11:193201, 1998.
11
Savin-Baden M. Problem-Based Learning in Higher
Education: Untold Stories. Buckingham, UK: Society for
Research in Higher Education/Open University Press,
2000.
12
Powell V, Steel C. Search for the woolly mammoth:
A case study in inquiry-based learning. J Vet Med Educ
30:254257, 2003.
13
Engel CE. Not just a method but a way of learning.
In Boud D, Feletti GP, eds. The Challenge of Problem-Based
Learning. London: Kogan Page, 1991:2233.
14
Barrows HS. Problem-Based Learning Applied to Medical
Education. Springfield: Southern Illinois University School of
Medicine, 2000.
15
Bereiter C, Scardamalia M. Process and product in
problem based learning. In Evensen D, Hmelo C, eds.
Problem Based Learning: A Research Perspective on Learning
Interactions. Mahwah, NJ: Lawrence Erlbaum, 2000:185195.
16
Barrows HS. A taxonomy of problem-based learning
methods. Med Educ 20:481486, 1986.

REFERENCES
1
Jeffries A. Curriculum development at Cambridge
Veterinary School. J Vet Med Educ 30:211214, 2003.
2
Quinlan KM. PBL at Cornell Universitys College of
Veterinary Medicine: Implications for undergraduate
education. PBL Insight 3(1):45, 2000.
3
Western University of Health Sciences College of
Veterinary Medicine. Founding Principles <http://
www.westernu.edu/veterinary/principles.xml>. Accessed
02/11/04. Western University of Health Sciences College of
Veterinary Medicine, Pomona, CA, 2003.
4
Wilkie K. The nature of problem-based learning. In
Glen S, Wilkie K, eds. Problem Based Learning in Nursing.
Basingstoke, UK: Macmillan Press, 2000:1134.
18

17
Barrows H. Generic Problem-Based Learning
Essentials <http://www.pbli.org/pbl/generic_pbl.htm>.
Accessed 02/11/04. Problem Based Learning Initiative
at Southern Illinois University School of Medicine,
Springfield, IL.
18
Barrows HS. Foreword. In Evensen D, Hmelo C,
eds. Problem Based Learning: A Research Perspective on
Learning Interactions. Mahwah, NJ: Lawrence Erlbaum,
2000:viiix.
19
Dolmans D, Schmidt H. What directs self-directed
learning in a problem based curriculum. In Evensen D,
Hmelo C, eds. Problem Based Learning: A Research Perspective
on Learning Interactions. Mahwah, NJ: Lawrence Erlbaum,
2000:251262.
JVME 32(1) 2005 AAVMC

[23.3.200512:09am]
[1220]
L:/Inprocess/UTPress/JVME/JVME32(1)-Revises-2/JVME-003.3d

[Page No. 19]

Journal of Veterinary

20
Savin-Baden M. Facilitating Problem Based Learning:
Illuminating Perspectives. Buckingham, UK: Society for
Research in Higher Education/Open University Press,
2003.
21
Bailey J, Hoffman K, Donaldson J. Dimensions of a PBL
Curriculum that Enhance Enculturation into a Clinical
Community of Practice. Chicago: American Education
Research Association, 2003.
22
Woods DR. Problem-Based Learning: Helping Your
Students Gain the Most from PBL. Hamilton, CA: D.R. Woods,
1995.
23
Harden R, Davis M. The continuum of problem-based
learning. Med Teach 20:317322, 1998.
24
Charlin B, Mann K, Hansen P. The many faces
of problem-based learning: A framework for
understanding and comparison. Med Teach 20:323330,
1998.
25
Schmidt H, Moust J. What makes a tutor effective?
A structural equations modelling approach to learning
in problem-based curricula. Acad Med 70:708714,
1995.
26
Schmidt HG. Problem-based learning: Rationale and
description. Med Educ 17:1116, 1983.
27
Wolff A. Problem-Based Learning. The role of the tutor:
A resource guide for faculty. Vancouver: Wolff Consulting,
2000.
28
Hadwin A. Promoting Self Regulation: Examining the
Relationships between Problem Based Learning in Medicine and
the Strategic Content Learning Approach. New York: American
Educational Research Association, 1996.
29
Benson G, Noesgaard C, Drummond-Young M.
Facilitating small group learning. In Rideout E, ed.
Transforming Nursing Education through Problem-Based
Learning. Sudbury, MA: Jones & Bartlett, 2001:75102.
30
Gijselaers WH. Connecting problem-based
practices with educational theory. In Wilkerson L, Gijselaers
WH, eds. Bringing Problem-Based Learning to Higher
Education: Theory and Practice. San Francisco: Jossey-Bass,
1996:1322.
31
Schmidt H, Moust J. Factors affecting small-group
tutorial learning: A review of research. In Evensen D,
Hmelo C, eds. Problem Based Learning: A Research Perspective
on Learning Interactions. Mahwah, NJ: Lawrence Erlbaum,
2000:1951.
32
Newman M. Problem Based Learning: An Exploration
of the Method and an Evaluation of Its Effectiveness in a
Continuing Nursing Education Programme <http://
www.hebes.mdx.ac.uk/teaching/Research/PEPBL/>.
Accessed 02/11/04. Middlesex University School of Health
& Social Sciences, London, 2004.
33
Myers Kelson A, Distlehorst L. Groups in problembased learning: Essential elements in theory and practice. In
Evensen D, Hmelo C, eds. Problem-Based Learning: A Research
Perspective on Learning Interactions. Mahwah, NJ: Lawrence
Erlbaum, 2000:167184.
34
Marks-Maran D, Gail Thomas B. Assessment and
evaluation in problem based learning. In Glen S, Wilkie K,
JVME 32(1) 2005 AAVMC

eds. Problem-Based Learning in Nursing: A New Model

for a New Context. Basingstoke, UK: Macmillan Press,
2000:127150.
35
Norman G. What should be assessed. In Boud D,
Feletti G, eds. The Challenge of Problem-Based Learning.
London: Kogan Page, 1991:254259.
36
Van der Vleuten CPM. The assessment of professional
competence: Developments, research and practical
implications. Adv Health Sci Educ 1:4167, 1996.
37
Swanson D, Case S, Van der Vleuten CPM. Strategies
for student assessment. In Boud D, Feletti G, eds. The
Challenge of Problem-Based Learning. London: Kogan Page,
1991:260274.
38
Arnold L, Willoughby T. The quarterly profile test.
Acad Med 65:515516, 1990.
39
Knox JDE. How to use modified essay questions. Med
Teach 2:2024, 1980.
40
Feletti GP. Reliability and validity studies on modified
essay questions. J Med Educ 55:933941, 1980.
41
Feletti GP, Smith EKM. Modified essay questions: Are
they worth the effort? Med Educ 20:132, 1986.
42
Norman G. Reliability and validity of some cognitive
measures of clinical reasoning. Teach Learn Med 1:194199,
1989.
43
Painvin C, Neufeld VR, Norman G. The triple jump
exercise: A structured measure of problem-solving and
self-directed learning. In Proceedings of the 18th
Conference of Research in Medical Education. Washington,
DC: Association of American Medical Colleges,
1979:7377.
44
Blake J, Norman GR, Smith EKM. Report card from
McMaster: Student evaluation at a problem-based medical
school. Lancet 345:899902, 1995.
45
Dolmans D. The effectiveness of PBL. The debate
continues: Some concerns about the BEME movement.
Med Educ 37:11291130, 2003.
46
Norman GR. RCT results confounded and trivial:
The perils of grand educational experiments. Med Educ
37:582584, 2003.
47
Woodward C. What can we learn from programme
evaluation studies in medical education? In Boud D,
Feletti G, eds. The Challenge of Problem-Based Learning.
London: Kogan Page, 1997:294307.
48
Block S, Moore GT. Project evaluation. In Tosteson D,
Adelstein S, Carver S, eds. New Pathways to Medical
Education. Cambridge, MA: Harvard University Press,
1994:114122.
49
Colliver J. Effectiveness of problem-based
learning curricula: Research and theory. Acad Med
75:259266, 2000.
50
Albanese MA, Mitchell S. Problem-based learning: A
review of literature on its outcomes and implementation
issues. Acad Med 68:5281, 1993.
51
Berkson L. Problem-based learning: Have the
expectations been met? Acad Med 68:S79S88, 1993.
19

[23.3.200512:09am]
[1220]
L:/Inprocess/UTPress/JVME/JVME32(1)-Revises-2/JVME-003.3d

[Page No. 20]

Journal of Veterinary

52
Vernon D, Blake RL. Does problem-based learning
work? A meta-analysis of evaluative research. Acad Med
69:550563, 1993.
53
Van den Bossche P, Gijbels D, Dochy F. Does
problem based learning educate problem solvers?
A meta-analysis on the effects of problem based
learning. Paper presented at the 7th Annual EDINEB
International Conference, Newport Beach, CA, June 2123,
2000.
54
Smits P, Verbeek J, De Buisonje C. Problem based
learning in continuing medical education: A review
of controlled evaluation studies. Brit Med J 324:153156,
2002.
55
Hedges, L. The basics of meta-analysis. Stockholm: 3rd
Campbell Collaboration Colloquium, 2003.
56
Moore GT, Block SD, Style CB, Mitchell R. The
influence of the New Pathway curriculum on Harvard
medical students. Acad Med 69:983989, 1994.
57
Lewis KE, Tamblyn RM. The problem-based learning
approach in baccalaureate nursing education: How effective
is it? Nurs Papers 19:1726, 1987.
58
Grol R, Mokkink H, Helsper-Lucas A, Tielens V,
Bulte J. Effects of the vocational training of general practice

20

consultation skills and medical performance. Med Educ

23:512521, 1989.
59
Coles CR. Differences between conventional and
problem-based curricula in their students approaches to
studying. Med Educ 19:308309, 1985.
60
Smith B, Walsh D. Teaching the art of clinical practice:
The veterinary medical teaching hospital, private practice,
and other externships. J Vet Med Educ 30:203206, 2003.

AUTHOR INFORMATION
Mark Newman, PhD, is a Senior Research Officer in the
Evidence for Policy and Practice Coordinating Center (EPPICentre), Social Science Research Unit (SSRU) of the Institute
of Education, University of London, 18 Woburn Square,
London WC1H 0NR UK. E-mail: [email protected]. He is
one of a team coordinating a major UK-government-funded
research project to produce systematic reviews on
educational topics. His major interest is evidence-based
practice in health care and education, including the
development of effective student-centered learning environments. He was the Principal Investigator on the Economic &
Social Science Research Councilfunded Project on the
Effectiveness of Problem Based Learning (PEPBL).

JVME 32(1) 2005 AAVMC