Advances in Health Sciences Education

The development of competency frameworks in healthcare professions: a scoping review Abstract Competency frameworks serve various roles including outlining characteristics of a competent workforce, facilitating mobility, and analysing or assessing expertise. Given these roles and their relevance in the health professions, we sought to understand the methods and strategies used in the development of existing competency frameworks. We applied the Arksey and O’Malley framework to undertake this scoping review. We searched six electronic databases (MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, and ERIC) and three grey literature sources (greylit.org, Trove and Google Scholar) using keywords related to competency frameworks. We screened studies for inclusion by title and abstract, and we included studies of any type that described the development of a competency framework in a healthcare profession. Two reviewers independently extracted data including study characteristics. Data synthesis was both quantitative and qualitative. Among 5710 citations, we selected 190 for analysis. The majority of studies were conducted in medicine and nursing professions. Literature reviews and group techniques were conducted in 116 studies each (61%), and 85 (45%) outlined some form of stakeholder deliberation. We observed a significant degree of diversity in methodological strategies, inconsistent adherence to existing guidance on the selection of methods, who was involved, and based on the variation we observed in timeframes, combination, function, application and reporting of methods and strategies, there is no apparent gold standard or standardised approach to competency framework development. We observed significant variation within the conduct and reporting of the competency framework development process. While some variation can be expected given the differences across and within professions, our results suggest there is some difficulty in determining whether methods were fit-for-purpose, and therefore in making determinations regarding the appropriateness of the development process. This uncertainty may unwillingly create and legitimise uncertain or artificial outcomes. There is a need for improved guidance in the process for developing and reporting competency frameworks.

Celebrating 50 years of problem-based learning: progress, pitfalls and possibilities

McMaster at 50: lessons learned from five decades of PBL Abstract Although educators frequently act as if curricula are as standardized as drug doses (300 mg of PBL t.i.d.), such is not the case. As a case in point, at its inception, Problem Based Learning was hailed as a major curriculum innovation, with the promise of enormous gains in learning outcomes. Very quickly, ecclesiastical debates arose as what was true PBL and what was “modified PBL”. Ironically, systematic reviews conducted fairly early in its evolution showed that the gains in learning outcome from PBL were neither large nor uniform (Vernon and Blake in Acad Med 68:550–563, 1993), and the most consistent finding was greater student satisfaction. In this paper, we review five decades of experience with the first PBL curriculum at McMaster. We point out how the curriculum has evolved, both theoretically and practically, in response to external influences, based both on empirical evidence and practical demands. We describe these changes in four broad domains—theoretical rationale, the curriculum, assessment and admissions.

PBL and sustainable education: addressing the problem of isolation Abstract Problem-based learning (PBL) is an innovative educational approach that dates back to the 1960s. However, the twenty-first century goal of sustainable education poses a challenge to PBL, especially as it relates to isolation. Here we discuss the underlying issue of isolation in three respects. First, the information-processing model of PBL depends on generalized skills, whereas real life problem-solving skills involve context-bound cognitive processes. Second, in all models of PBL, the focus on knowledge acquisition for a specific problem improves performance but separates education from the world at large. Third, the existing culture of measurement strengthens the aforementioned isolating effects. In response, we introduce a conceptual approach based on Hannah Arendt’s technical notion of ‘world’. We make suggestions to meet the criteria of sustainable education by reconnecting PBL to our shared world, and emphasizing a responsibility for this shared world.

Assessment in the context of problem-based learning Abstract Arguably, constructive alignment has been the major challenge for assessment in the context of problem-based learning (PBL). PBL focuses on promoting abilities such as clinical reasoning, team skills and metacognition. PBL also aims to foster self-directed learning and deep learning as opposed to rote learning. This has incentivized researchers in assessment to find possible solutions. Originally, these solutions were sought in developing the right instruments to measure these PBL-related skills. The search for these instruments has been accelerated by the emergence of competency-based education. With competency-based education assessment moved away from purely standardized testing, relying more heavily on professional judgment of complex skills. Valuable lessons have been learned that are directly relevant for assessment in PBL. Later, solutions were sought in the development of new assessment strategies, initially again with individual instruments such as progress testing, but later through a more holistic approach to the assessment program as a whole. Programmatic assessment is such an integral approach to assessment. It focuses on optimizing learning through assessment, while at the same gathering rich information that can be used for rigorous decision-making about learner progression. Programmatic assessment comes very close to achieving the desired constructive alignment with PBL, but its wide adoption—just like PBL—will take many years ahead of us.

A thorny path: the developmental course of problem-based learning for health sciences education in Asia Abstract Problem-based learning (PBL), has been in existence for half a century as of 2019 and still remains the most innovative medical education innovation due to its revolutionary pedagogical approach characterized by student-centered learning (SCL) and self-directed learning (SDL) using simulated real-life scenarios as the learning platform. Here, learning becomes more self-driven, meaningful and relevant, pertaining to the social accountability principle of higher education. Being popular worldwide and driven by a strong demand for medical education reform during the past two decades, PBL has rapidly swept across the medical education communities in Asian countries. Many medical schools in Asia were drawn in by the innovative pedagogical methodology that PBL embraces, but tended to neglect with time, often unintentionally, the philosophy that PBL embodies. As a result, PBL in Asia, for various local academic, cultural, economic and administrative reasons started drifting away from its intended educational purposes. Consequently, the acceptance and practice of PBL in Asia has taken compromised forms as PBL-hybrids embedded within long existing and incorrigibly traditional curricula, or other less effective forms for easier implementation and management, at the expense of SCL and SDL. PBL in health sciences education, which has had a 50-year flourishment in the West, remains a continuous struggle in Asia. PBL for health science education in Asia is certainly no panacea, and is probably heading for a thorny path, despite the ultimate hope for a promising future.

Behind the times: a brief history of motivation discourse in problem-based learning Abstract That idea that problem-based learning (PBL) is more motivating that traditional education has been prevalent since the inception of PBL at McMaster University in the late 1960s. Evidencing this through empirical research, however, has proven to be a lot more problematic. This paper retraces how the discourse on motivation started from a laymen’s conception in the early days of PBL, and slowly evolved into a field of scientific inquiry in the 1980s and 1990s. However, looking at the evolution of motivation theory over the same period, we show that motivation discourse in the burgeoning literature on motivation and PBL remained largely wedded to the laymen’s approach, and failed to catch up with the new achievement-goal theory and self-determination theory approaches. This paper proceeds to analyse the explosion of studies on PBL and motivation after 2000, acknowledging efforts to move away from anecdotal accounts and provide theoretical grounding to the research. However, once again, we show that the majority of the research employed outdated motivational measures that do not fully grasp the complexity of contemporary motivation theory. The paper concludes on the observation that single-course and curriculum-wide research interventions have yielded no conclusive results on the effect of PBL on intrinsic motivation, and that future research should therefore seek to use up-to-date motivational constructs in more targeted interventions.

The case for plural PBL: an analysis of dominant and marginalized perspectives in the globalization of problem-based learning Abstract The globalization of problem-based learning (PBL) in health professions education has been both celebrated and criticized. Using a critical narrative review approach, underpinned by our archive of global PBL literature and a targeted literature search, we analyze these dominant global discourses of PBL in health professions education. More precisely, we explore what is missed when the globalization of PBL is theorized either as a positive consequence of standardization, or a problematic spread of Western educational ideals and values around the world. We make visible how two dominant global discourses, a universalist and culturalist discourse, have emerged in the global proliferation of PBL. We also discuss the limitations of the two discourses by demonstrating how they either ignore contextual and cultural diversity or see it as problematic. We then turn to a perspective that has been marginalized in the PBL literature that emphasizes the global origins of PBL, transcending the dichotomy between West and non-West. We make a case for relating to PBL as a plural construct in order to learn from the cultural and situational nuances of educational activities labeled PBL around the world. We argue that PBL as a singular and universal concept has no global future, yet versions of PBL may continue to thrive locally. Finally, we propose avenues for future research that may help elucidate the global and local values that underpin our curricula, as well as the socio-political factors that perpetuate neo-colonialist views and practices in the uptake and implementation of PBL approaches across the globe.

Evidence-based medicine and problem based learning a critical re-evaluation Abstract Evidence-based medicine (EBM) has been the subject of controversy since it was introduced in 1992. However, it has yet to be critically examined as an alternative paradigm for medical education, which is how it was proposed. This commentary examines EBM on the terms on which it was originally advanced and within the context that gave rise to it, the problem-based learning (PBL) environment at McMaster University in the 1970s and 80s. The EBM educational prescription is revealed to be aligned with the information processing psychology (IPP) model of learning through acquisition of general problem solving skills that characterized the early McMaster version of PBL. The IPP model has been identified in the literature as discordant with an alternative, constructivist, model that emerged at Maastricht University in the Netherlands over the subsequent period. Strengths and weaknesses of EBM are identified from the standpoint of the underlying cognitive theories. Principles are proposed with which to guide an educationally viable approach to learning and teaching the valuable skills included within the original EBM formula.

How theory and design-based research can mature PBL practice and research Abstract Many educational institutions in higher education switched to problem-based learning (PBL) in the last 5 decades. Despite its’ successful implementation worldwide, many institutions still encounter problems in their daily teaching practices that limit deep learning in students. This raises the question: How else can we look at PBL practice and research? The main argument of this reflective paper is to better align PBL practice with the theories or principles of contextual, constructive, self-directed and collaborative learning. This paper explains what these principles or theories are. In addition, it discusses a new way to bridge theory and practice: design-based research (DBR), which combines redesigning theory-based teaching practices with investigating these practices in close collaboration with various stakeholders. There is no one-size-fits-all solution to address the problems encountered in PBL. We should be very careful in drawing conclusions about which PBL approach works best. No single solution works optimally under all conditions. At most, DBR can help us gain better insight into why PBL with certain characteristics, preferably based on theory, might work in a specific context with particular goals in mind.