Skills to Enhance Problem-based Learning *
Michael Peterson, Ed.D.
University of Delaware, College of Health and Nursing Sciences
Abstract: Problem-based Learning
(PBL) has become a popular method of instruction among educators
in the health professions. Central to the effectiveness of PBL is
the ability of students to work together to solve problems. When
these abilities are lacking, PBL outcomes can be compromised. Since
these skills have not been emphasized in public school or higher
education, students are often forced to muddle through group processes
in the effort to learn. The purpose of this paper is to discuss
the interpersonal skills necessary to enhance PBL, and suggest how
these skills can be improved and incorporated into the curriculum.
learning (PBL) has gained acceptance and has been found effective
within a variety of disciplines in higher education.1,2 PBL
satisfies three important criteria that promote optimal learning.3 First, it provides an environment where the student is immersed in a
practical, on-going activity in which he/she receives feedback from
other students and the instructor. Second, the student receives guidance
and support from his/her friends and peers. Learning is not unidirectional
(teacher to student), but multi-directional, including other students,
tutors, and professors.4 As Savery and Duffy state, learning
occurs through the multiple interactions within the learning environment.5 Third, the learning is functional based on solving a real problem.
According to Camp, PBL is based on a foundation of collaboration and
integration within a small group context.6 Simply stated,
PBL depends upon the ability of students to work together to identify
and analyze problems, and/or generate solutions.
PBLs dependence upon group
effectiveness may lay at the heart of the difficulty for researchers
to definitively say that PBL improves learning.7,8 Kalaian
and Mullen reported that although tutor effectiveness was the crucial
item in learning at the start of the curriculum, by the end, learning
was more a function of the effectiveness of the small group process.9 The assumption that students can work together effectively is a misguided
one. Few employed health professionals, much less students, have the
skills needed to work in groups competently or effectively.10,11 This should come as no surprise since traditional lecture or textbook
generated learning is at the core of education from elementary school
through many graduate level programs. Subsequently, students are forced
to learn by trial and error how they personally work best in a group
setting. Their communication and group interaction habits are developed
over two decades of formal education. These habits, however, differ
from student to student. Some may try to take control of the group,
others will become passive, still others will become overly verbose,
while others will shy away from commenting.12 Observers of
student group interaction often find that students dont work productively,
waste time, repeat old information, or become confrontational.7 Regardless of the problem posed to a group of students, learning is
proportional to the ability of that group to work effectively together.12-14 Faculty, too, may lack the ability to utilize problem-based learning
effectively because of a lack of training in small-group management.15 In some instances they may find themselves in small groups that actually
harm individuals and the learning climate.15
Medical and health professionals
who have used PBL in the classroom have reported symptoms of weak group
process and interaction skills among the students.7,9,15 These problems compromise the learning process. Hitchcock and Anderson
identified five different small group dysfunctions:15
Apathy, or lack of meaningful interaction.
Limited or focused discussion that ignores other aspects
of an issue.
Dysfunctional group member who does not participate
or perform work equally with others in the group.
Scapegoated student, who becomes ignored by other
Domineering student who disrupts, or prevents others
to learn through the process.
For faculty, poor interpersonal skills (as determined
through informal interviews) can lead to:
Peter Senge stated that "a
group of talented individual learners will not necessarily produce a
learning team, any more than a group of talented athletes will produce
a great sports team."16 [As a point of clarification
and for the purposes of this article, group and team will be used synonymously]
To be a learning team, the learners need to have the interpersonal skills
that will help them become an effective team. For example, in a course
designed to teach students how to work together as a group to solve
problems, lack of interpersonal skills and over-reliance on previously
formed bad habits of group process created a decline in learning.17 In this course, students were randomly divided into two groups of six
students each. However, randomness created one group comprised of all
the "leaders" in the class, and one group with "no leaders."
All students had been instructed in the skills of team dynamics, and
were required to utilize these skills to solve a problem posed to them
by the instructor. Based on instructor observations, and qualitative
data obtained from students in the course, the "no leader"
group utilized the skills, followed the process, and worked effectively
and efficiently during the class. Their level of interaction and the
depth of analysis was good. The "leader" group started out
fine, but over the course of time began to break apart as individuals
began to try to gain dominance of the group and to formulate a process
to their individual preferences. Eventually, the group was pulled in
six different directions, communication broke down, and motivation declined.
Individually, the students were good, but together they were not successful.
Frustrating the situation even more for the "leaders" was
the fact that the other group was functioning effectively, having fun,
and learning. It became abundantly apparent to the "leaders"
that they needed to follow a process, and practice the skills taught
to them in order to learn and function effectively. This experience
impressed upon the students that interpersonal skills relating to group
process were essential for effective problem solving and learning, and
that sheer force of will does not breed success. Katzenbach and Smith
have expounded on the need for teams to have problem solving and interpersonal
skills.13 Without these skills being adequately developed,
student learning can be frustrated.
What Interpersonal Skills are Necessary?
The skills necessary for successful
teaming include: consensual decision making skills, dialogue and discussion
skills, team maintenance skills, conflict management skills, and team
leadership skills. Students who have these skills have a better opportunity
to learn more than students who do not have these skills.12,17-19
Consensual Decision Making Skills
The first skill team members need
before they join a team is consensus decision making.19 Consensus
is based on the term "to consent" as in "to grant permission."
When a team arrives at consensus, each team member permits the decision
to occur and agrees to support the decision. Consensus means that every
member of the team participates in the decision, and everyone agrees
with the decision. The decision, however, may not be the decision everyone
prefers, but it is one that everyone can live with. In PBL, reaching
consensus requires that every student participates, has equal opportunity
to be heard, and for their ideas to become part of the teams database.20,21 Consensual decision making, by definition, involves the contributions
of all members, not only a select few. In this environment, the likelihood
of an outcome acceptable to all is high.20
Consensus occurs at various levels.
Sheive and Metivier have outlined five levels of consensus.21 The first level is where all team members agree that no more information
is needed. The second level is where everyone understands what each
team member means. It involves clarifying the information. The third
level of consensus occurs when all members agree on the relationship
between a set of items (differentiating between main and supporting
ideas). The fourth level of consensus occurs when all agree on the hierarchy
within a set of ideas. Lastly, the fifth level of consensus is achieved
when all agree on the activities needed to solve a problem. Adopting
consensus as an operating style requires patience, the ability to listen
and learn from others, and a willingness to adjust ones own needs
with those of the teams. While consensus is time consuming, it
inevitably leads to well thought out and implementable solutions.20 Consensus is predicated on the need for individuals to understand
each other. Therefore to reach consensus students need to have the ability
to effectively engage in dialogue and discussion.
Dialogue and Discussion Skills
Dialogue is a process by which students
seek to understand one another. Dialogue is not just a technique, but
a principle that is founded on the belief that problem identification
and resolution are intimately linked with a core of common meaning.16 Before a solution can be determined, common definitions of the problem
must be identified.14
Dialogue is a process that builds
shared meanings and definitions of the problem between students within
a group. When the meanings are shared and understood the ability of
the students to resolve the problem is enhanced.
For dialogue to be effective it
must be nurtured not forced. It requires true facilitation, not manipulation,
where value judgements are not allowed. At most, students in a dialogue
ask questions to clarify meaning for the purpose of accurately understanding
anothers viewpoint and passion about an issue or problem.20 The issue is not whether you agree or disagree with another,
the issue is whether you understand the other persons view. Consequently,
effective listening and critical thinking skills are crucial.22
Dialogue is not used for the purpose
of making a decision. According to Senge et al., it will backfire if
channeled toward closure.14 This can be a problem with student
learning and is often exemplified when students go directly to solutions
rather than developing a shared meaning of the problem. Through dialogue
students learn how to think together. Students learn when individual
contributions lead to greater understanding of the problem and how to
Two effective procedures that enhance
dialogue are brainstreaming, and clarification.17,18,21 Brainstreaming,
as opposed to brainstorming, is a procedure that sequentially solicits
ideas pertaining to a problem from group members. Whereas brainstorming
involves a random solicitation of information that tends to favor the
more verbose and quick thinking individuals, brainstreaming allows all
group members equal opportunity to participate in idea generation. The
ability for each student to participate equally provides a potential
solution to problems with domineering, shy, or less cerebrally agile
students. By providing equal opportunity, all students develop a sense
of ownership and reduce the tendency to think unidirectionally. Following
brainstreaming, clarification is utilized to provide depth of meaning
of the brainstreamed items, and to promote understanding between students
about each item. Essential to dialogue is asking questions that clarify,
not challenge or place a value judgement on the item. Value-laden questions
breed interpersonal conflict which compromises the teams effectiveness.
For example, a student who feels
threatened by another students questioning may be less likely
to provide information in the future. The net result is a group with
fewer actively participating members, and less "brain power"
to engage the problem. Therefore, clarification is a skill that utilizes
effective questioning to promote understanding not agreement.
Questions are posed in a manner such as "Help me understand what
you mean by this statement?" "Please explain to me how your
item relates to the problem we are addressing?" Clarification also
requires that the student, whose brainstreamed item it is, clearly articulate
what they mean. This promotes critical thinking, for to be clear a student
must present information that is not ambiguous. All students in a group
must be allowed to ask for clarification of an item. When all students
understand, essentially they have consented to the meaning of that item.
In contrast, discussion is used
for the purpose of making a decision or reaching closure on an issue
or problem. For discussion to be effective it should follow dialogue.
When there is no common understanding of the problems and concerns,
or shared vision of what needs to be done, effective decision making
is compromised.23 Discussion is not a debate, and it is not
for the purpose of winning. Discussion is a skill that makes thought
processes visible, allows assumptions to surface and be challenged,
and exposes the sources of disagreement. Effective discussion focuses
on issues, not personalities.22 Discussion, mindfully done,
allows ideas to be challenged in a meaningful way, and focuses on making
a decision so a problem can be addressed and remediated. The role of
the facilitator is essential in effective discussion, for discussion
can become unfocused and purposeless if not done properly. The facilitator
must focus predominantly on the process, not the content of discussion.
The facilitator must monitor discussion so that it allows students to
reach a decision, challenge assumptions and involve all group members.
Facilitators should provide opportunity for all to participate in the
discussion. Discussion is useful in clustering items together into categories,
prioritizing items as to their relevance to the problem, or selecting
a solution to the problem. Facilitators must be careful not to interject
their ideas, but rather, focus on promoting student interaction and
discussion toward a decision. Tutors, for example, must be careful not
to practice facilitation by manipulation. That is, move the team to
their view or solution. If this occurs, students may learn to be dependent
upon the tutor, rather than becoming independent learners and decision
makers. Although, tutors may help teams where they lack information,
during discussion, they should take caution in moving the team to their
All teams have two fundamental tasks:
to accomplish a task, and to develop and maintain the team. Tipping,
Freeman and Rachlis reported that faculty and students had a low awareness
of effective group dynamics and the absence of mechanism for reflection
that could help groups analyze and learn from their behaviors.7 For teams to improve, and therefore learn, all members must contribute
to the on-going evaluation of the teams process and development.
This requires group members to provide feedback and evaluation on: 1)
each members commitment to the project, task, and team; 2) the
level of affective development including feelings of trust, belonging,
and work relationships; 3) the teams efficacy ability to
get the job done; and, 4) their ability to resolve conflict. Therefore,
team members must have and follow methods and procedures that allow
feedback.21 Feedback from others is essential for both personal
and team growth, and students should learn to self manage their own
groups by conducting on-going process evaluations.19 When
students do not receive on-going feedback about their own performance,
problems fester, resentments rise, and frustrations increase. Feedback
should not only occur from the instructor, via a grade, but should also
be on-going from both the instructor and other group members so that
students have opportunity to improve throughout the PBL process. Another
technique that serves to promote team maintenance is debriefing. Debriefing
is a technique of discussing how the team and/or the work of the team
is progressing. It serves to engage the group in self-assessment, and
enables the group to determine how it needs to change and to be self
correcting. For example, during debriefing students may address what
went well, what has been accomplished, what were some difficult moments,
what they need to work on, and what has been learned. Debriefing should
be done at the end of every other class period, as a minimum, to be
Conflict Resolution Skills
Conflict is healthy, common, and
necessary for team growth.15 However, conflict can become
destructive to student learning when it is personal or becomes an obstacle
to task completion. Conflict can occur when students lack the skills
necessary for team function. For example, a lack of dialogue skills
will result in misunderstandings, a lack of shared meaning, and confusion.
This can result in conflict and create resentment.13
Another source of conflict is the
difference in thinking styles between students. Teams are usually composed
of 5 to 10 students, each with a different background, a unique view
of the world, and a variety of thinking styles. This diversity provides
rich resources for problem solving.20 Thinking styles determine
how a student gathers information and how the student utilizes information
to solve problems. Not understanding or appreciating the value of other
students thinking styles creates conflict. For example, a more
intuitive student is more likely to consider several options simultaneously
when analyzing information, or jump from one step of analysis to another.
In contrast, a systematic thinker is more likely to make a plan for
problem solving, and complete one analysis before jumping to the next
step. If these students dont understand the value of each others
style and their respective manner for analyzing data, the systematic
thinker may view the intuitive thinker as flighty and impulsive, while
the intuitive thinker may view the systematic thinker as slow and ignorant.
Many potential conflicts are minimized when students are aware of the
various cognitive styles represented by individuals within the group.20
According to leaders in team process
conflict can be managed and minimized by:10,13,14,19
Focusing on the process and not the people as the
source of conflict.
Providing a safe, non-threatening environment that
allows conflict to surface and be resolved.
Developing common team purposes and goals.
Building shared meanings and perspectives.
Instituting a common approach to solving problems
and accomplishing team tasks.
Understanding differences in how individuals gather
and analyze data (i.e. thinking styles).
Hitchcock and Anderson also recommend
that ground rules be established to govern student interaction, and
to promote the above objectives.15 Ground rules serve to
prevent crises from occuring by establishing clear expectations, and
serve to establish norms of behavior which act as references for process
diagnosis when problems do occur.24 Ground rules should be
elicited from the group members,25 with certain ground rules
deemed mandatory.15 For example, students should be punctual
and attend class, no value judgements during brainstreaming/storming
and clarification, come to each group session prepared. Peterson utilized
a structured team problem solving approach that provided a systematic
method for problem solving and group interaction.17,18 The
structured system prevented behaviors and communication patterns that
create conflict. Student qualitative responses, and outside observations
from the Center for Teaching Effectiveness indicated that conflict was
significantly reduced, and students stayed on task during the team interaction.
By defining roles, space, and behaviors through a structured process,
conflict was minimized because students learned how to act and function
together to solve a problem.
Team Leadership Skills
In early teaming, every individual
should be given the opportunity to be assertive and to learn the value
of his/her thoughts and actions.19 This necessitates that
traditional views of a leaders role be modified.26 Teams need and seek participation and input from all members. Traditionally,
the leader of a group is seen as the authority, the one who makes the
final decision, generates member interaction, sets the agenda, and provides
direction.7 As a consequence, team members may become reliant
upon the group leader, and may not function well without his/her presence.
A student team which operates this way usually can not be productive
when a "student leader" (or tutor) is absent. This approach
is very much like traditional education modalities which have been reported
to contribute to a "learned helplessness" among students.27,28 Therefore, it becomes necessary for all team members to be able to lead
the team. This can occur when responsibility for the operation of the
team is shared. The technique is called role-sharing. Shared leadership
leads to shared accountability and competencies. The leader of a team
should focus on the process rather than the content of the problem solving
process. The leader performs more of a facilitory role, working to encourage
and manage communication, participation, and consensus.26 The leader functions to manage and implement dialogue and discussion
appropriately, as well as resolve conflict judiciously as it arises.
Most importantly, the leader keeps the team functioning within a problem
solving process. When students overtly share the leadership or facilitator
role, they are more attentive to team maintenance issues when they reassume
a team member status because they can empathize with the team leaders
responsibilities.20 In addition, effective leadership skills
allow students to become more self managed, which may allow for fewer
tutors, thereby reducing the cost of a PBL curriculum a common
obstacle to PBL implementation.4
The Importance of Structure
Teams need a common approach to
problem solving, and members need a safe, secure environment in which
to function, share ideas without being judged, interact, and to keep
them on task.12,16 Team process breaks down when there is
a lack of direction, purpose, and open communication between team members.
Although students have developed individual strategies for problem solving,
these strategies often do not mesh with the strategies of others, or
work well in a team setting. According to Shieve and Metivier, to promote
effective team interaction the team must have structure to:21
Provide an overall process for problem solving.
Provide procedures to govern the problem solving
Govern and regulate team member behaviors, roles,
When people feel that their ideas
do not matter, or feel vulnerable to ridicule, learning is hampered,
and a feeling of helplessness can develop.28 Student frustration
also results when team members pull the group in different directions,
or follow a process of problem solving that has not been agreed upon
by the entire team. Conflict occurs when student interaction is not
regulated such that unequal participation, workload, and learning occurs.15 Students may regress into conflict when there is an absence of rules
and thereby compromise learning.
Student groups that learn and follow
a structured problem solving process, utilizing a common set of procedures,
governed by techniques which regulate team behavior, have shown through
self-reported and outside observer data improvements in critical thinking,
interpersonal skills, problem solving, and learning.17,18 Czikszentmihalyi has long advocated the need for rules and structure
for obtaining an optimal psychological experience.29 Structure
in terms of behaviors, roles, and space may help students function more
competently and obtain a positive educational experience in PBL.
When Should Interpersonal Skills Be Learned?
Ideally, it would be advantageous
if all students had these skills prior to the implementation of PBL.
The reality is that not all students have adequately developed these
skills. There are three possible mechanisms for teaching students these
skills. The first is to create a skills course as a prerequisite to
PBL based courses or curriculums. The advantage to this approach is
that subsequent instructors do not have to concern themselves as intensely
with the process of learning, thereby freeing them to deal more directly
with the content to be learned. A second strategy is to train students
in interpersonal skills while they work on a problem in a specific course
already existing within a curriculum. This option has the advantage
of not having to create a new course, but it will compromise the learning
of content because the instructor will have to divide his/her attention
between the learning of teaming skills and the course content. This
strategy, however has been limited to smaller class sizes of 30 or less.18 Finally, tutors and faculty members could be trained to be team trainers,
and teach students teaming skills while they work on problems. This
spreads out the training and frees the instructor from having to spend
time on interpersonal skill development.
It is also important for faculty
to be competent in interpersonal skills before they can be expected
to train students. For PBL to be improved, the development of interpersonal
skills is a necessity. Continual reliance on the belief that students
will somehow be able to work out a problem will continue to compromise
PBL and student learning outcomes. PBLs effectiveness is impacted
by how well students work together. Therefore, enhancing Problem-based
Learning will require the development of the interpersonal skills upon
which PBL is built. Since PBL has not been the educational method of
choice in the majority of pre-medical education systems, suffice it
to say that many students will lack these skills upon entering the medical
school curriculum. By training students (as well as faculty) in these
skills prior to, or within existing medical courses which utilize PBL,
learning can be enhanced.
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The author may be contacted at:
Michael Peterson, Ed.D.
University of Delaware
College of Health and Nursing Sciences
113 Carpenter Sports Building
University of Delaware
Newark, DE 19716
Skills to Enhance Problem-based Learning Med
Educ Online [serial online] 1997;2,3. Available from: URL http://www.Med-Ed-Online.