Guest Perspective(4)

Problem-Based Learning: A Socratic Method of Teaching for This Century

Nadeem Karimbux, D.M.D., M.D., Assistant Dean, Dental Education, and Associate Professor, Harvard School of Dental Medicine; Associate Editor of MedEdPORTAL representing ADEA

A faculty member stops in his tracks and peers into a seminar room.He sees eight first-year dental students sitting around a table with a facilitator (another faculty member).One student reads aloud from pages of a clinical case.Another student illustrates and explains a point on the board.A third student jots down the student-generated ideas and items that will need to be researched later. The pace is relaxed, yet serious. The students are inquisitive and engaged.They feel comfortable raising their own ideas and theories.No question is considered unimportant or "stupid."The only time the facilitator interrupts the group dynamic is to ask an open-ended question that always starts with "Why?"The observer, accustomed to commanding his students' attention in lectures, wonders why the facilitator isn't "teaching" the students what is important to know.

This is problem-based learning (PBL) in its finest expression-a process that puts students at the center and engages them as active participants, communicators, and learners.PBL allows students to explore the basic, clinical, population, and social sciences intrinsic to clinical cases that are "revealed" during these group meetings, called tutorials.The clinical cases, written by faculty, unfold over several sessions, allowing the students to conduct research in between.

Students are intrigued by these cases. They want to learn and problem solve.Along the way they are challenged to hypothesize, explain, generate learning agendas, search out answers, and then reflect on the authenticity of the resources they have consulted.Over time, the PBL curriculum gives students the skills to be what we call "adult learners."That means they are comfortable communicators and critical thinkers, and they have the skills to be literate scientific and clinical scholars.

The ADEA CCI white paper, Educational Strategies Associated with Development of Problem-Solving, Critical Thinking, and Self-Directed Learning,examines the best teaching practices associated with dental education.In its conclusion, the authors assert that active learning strategies rooted in the teaching methods first developed by Socrates have a vital role to play.They write:

"In one of his dialogues known as 'Euthyphro,' Plato described Socrates' method of teaching in which questions were posed to students and the students were forced to use their insight and logical reasoning to reach a conclusion, a technique that Plato described as conversational interaction. Consistent with the perspectives of Socrates 2500 years ago, a review of the evidence indicates that several active learning strategies described in this article are associated with the development of the mental capacities needed for the expert practice of dentistry. These practices include:

  1. In-class activity such as writing notes, analyzing problems, or reviewing cases that provide opportunities to apply the information being communicated;
  2. Use of questions by instructors that require students to analyze problem etiology, compare alternative approaches, provide rationales for plans of action, and predict outcomes;
  3. Frequent in-class quizzing with immediate feedback on response correctness;
  4. Prospective simulations in which students perform decision making for structured and ill-structured problems;
  5. Retrospective critique of cases in which decisions are reviewed to identify errors as well as exemplary performance;
  6. Writing assignments that request students to analyze problems and discuss alternative theories about etiology, compare solutions, and defend decisions about proposed actions; and
  7. Analyzing work products to compare how outcomes correspond to the best practice standards, including comparing the results of students' reasoning about problems to those of experts."

PBL was first implemented in dental classes at the Harvard School of Dental Medicine (HSDM) in fall 1994. In the ensuing years, the HSDM predoctoral curriculum has transitioned from a traditional curriculum to a PBL-hybrid curriculum in both preclinical and clinical education, with the expectation that this pedagogy will enhance the students' critical and interdisciplinary thinking and communication skills as well as their general professional competencies.

My colleagues and I have written about the professional and personal ways that both students and faculty have benefited from the new curriculum.Nevertheless, implementing PBL poses some challenges that need to be overcome.PBL creates a different dynamic than the traditional lecture- and teacher-centered curriculum. In order to introduce PBL, a dental school and its administration need to commit to this major reconstruction of the curriculum with both physical and administrative resources. Traditionally walled-off departments and curriculum content need to be taught in a more multi-disciplinary fashion.The faculty needs to be trained in the new pedagogy. PBL cases need to be developed, and the physical structures within the school may require renovation to accommodate small group learning.

Despite these challenges, any school or faculty that values graduates with the skills championed by Socrates will greatly benefit from PBL. Several medical and dental schools in the United States and abroad have implemented PBL as a central part of their curriculum.Resources for the implementation and outcomes of PBL can be found in Academic Medicine and the Journal of Dental Education.For more specific resources, readers may also contact me at nadeem_karimbux@hms.harvard.edu.