Beyond Status Quo: Perspectives on Teaching & Learning
Part I: Can we use Problem-Based Learning (PBL) in health entrepreneurship education?
Sarrah Lal is an Assistant Professor at the Michael G. DeGroote School of Medicine in the Faculty of Health Sciences at McMaster University. She is interested in designing and commercializing new medical technologies, creating inspiring learning experiences in health entrepreneurship, and developing future leaders in this space. This bi-weekly series explores educator and learner perspectives. It chronicles the co-design of learning experiences.
Since the late 1960’s, the Michael G. DeGroote School of Medicine at McMaster University has used problem-based learning (PBL) to enhance medical education. Here, the PBL experience uses case studies to help learners identify their own learning needs as they are also challenged to understand (and “solve”) the clinical case at-hand. Independently, and within group settings, learners pull together information from disparate peer-reviewed sources and then work together to generate various approaches to “solving” the case. Through tutor-facilitated group discussions, learners work towards a shared understanding of content based on the stipulated learning objectives. Learning is enhanced through the independent and group-based process, the perspective-sharing, and a collaborative approach to addressing each clinical case.
In 2019, as a brand-new Assistant Professor in the brand-new Division of Education & Innovation in the Department of Medicine, I was intrigued by this PBL approach. It was regimented and structured, unlike many of my previous experiences with PBL in my own undergraduate education. Eager to experience it first-hand, I spent a few terms in 2019 and 2020 as a PBL Tutor for medical students. To be clear, I have no clinical training — and in this way resembled the medical students themselves. Unfamiliar with both the PBL approach and content being discussed, there was a learning curve I had to experience for myself. As I sought to establish a repeatable strategy of reviewing materials and the PBL Tutor guide to become an effective PBL Tutor for medical students, I also began to observe the learners and their learning processes. Three of my recurring observations were that:
1. There is a disconnect between what the PBL process proposes to learners and what the learners propose to themselves.
The PBL process encourages learners to navigate information independently and then in a group setting to build enough content knowledge to elicit critical thinking. Not surprisingly, the learners instead sought the path of least resistance. Due to time constraints, they found what they referred to as “high yield” sources that were most likely to provide the “correct” answer. Using these sources was common, leading to few differences in perspectives being shared during PBL discussions.
2. Learners are generally uncomfortable with ambiguity.
This one was not surprising in an academic environment, especially considering the perfectionism that we routinely reward in higher education. Even when challenged to propose an approach or make inferences based on existing knowledge, there was a clear hesitation to build off the ideas of others or pose question unless there was a “credible” (read: peer-reviewed) source to back up their claims.
3. The presence of a tutor can in itself be disruptive.
In group settings, the learners would “perform” in alignment with what was being evaluated. Given the need to fulfill learning objectives and ensure cohesion (and equal contributions) in the PBL group, this sometimes created tensions between individual and group level processes.
Can PBL be adapted to non-clinical areas?
Through being a PBL Tutor for medical students, I became curious about whether the PBL process itself could be adapted to teach health entrepreneurship. I wondered if it could be crafted to explicitly build critical thinking, teamwork, and communication skills. I wondered how it would work with interdisciplinary groups of learners with vastly different learning experiences and career goals. I wondered if the PBL process could be tweaked to break down learners’ discomfort with ambiguity. And as the COVID-19 pandemic struck, I wondered if this could all be done virtually.
But why did I want to do this in the first place?
As educators we are challenged to develop teaching philosophies. As a new faculty member, this concept can be intimidating. It can be intensely personal. I saw it as a call to highlight a piece of my professional value proposition. Having to develop a teaching philosophy sounded almost like a professional raison d’être — a reason for existing in the educational system and contributing to learning journeys in the first place. From my personal experiences, I knew how impactful a good or poor learning experience could be when our personal and professional identities are still in their infancy. Reflecting on the experiences that contributed to my identities, I concluded that educational experiences should build self-efficacy and eventually realize what Mihaly Csikszentmihalyi calls flow.
Educational experiences should increase our “intellectual courage.” They should challenge us to generate innovative ideas through logical leaps or hypotheses, engage with others in critical conversations, and learn how to understand (and seek out) perspectives that disagree with our own. To mimic “real life,” education needs to embrace learning from “failure” because, as many of us eventually come to understand, we learn the most from our mistakes.
In Fall 2020, I sought to test a hypothesis: virtual PBL experiences are possible and, in fact, instrumental to the health entrepreneurship learning experience. I designed an undergraduate course called INSPIRE 3EL3 C01 Health Ventures specifically to explore the use of inquiry- and problem-based techniques. The learners were senior undergraduate students from a variety of academic backgrounds in the Faculties of Business, Engineering, Social Sciences, Health Sciences, Humanities, and Science. They had no previous exposure to health innovation or entrepreneurship.
The constraint of a virtual experience during COVID-19 made it particularly intriguing. Not due to technological barriers, but due to the trust-building that is required in a productive learning environment. My biggest challenge was not in education delivery but in convincing these learners to join me in this triply uncharted territory of PBL learning experiences, online education and health entrepreneurship.
Below is an excerpt from a conversation between me and six learners at the end of the Fall 2020 semester. I am an avid believer in fielding course improvement advice (yes, I frame this as advice for it to be action-oriented) from learners throughout the courses and programs that I teach. I regularly encourage learners to challenge course design elements and, by doing so, stress-test my offerings to maximize learning outcomes. I truly believe that courses and programs are learning labs for education, and that an ongoing collaboration between educators and learners is required to create the best educational experience.
I wanted to share this closing conversation with learners before I welcome the new cohort to HTH SCI 3PP3 (new course code for the INSPIRE 3EL3 learning experience) in Winter 2021. The learners named below contributed to the conversation directly. Several others reviewed the document and provided feedback. All advice was incorporated into the Winter 2021 offering.
Interviews: Barjot Gill is a fifth-year student in the Life Sciences program, specializing in Human Behavior. Jason Surendran is a fourth-year student in the Mechatronics Engineering program. Joshua Iskander is a fourth-year student in the Life Sciences program. Gaurev Singh is a fourth-year student in the Life Sciences program. Marwo Suleiman is a third-year student in the Life Sciences program. Safia Meskiry is a third-year student in the Life Sciences program.
Additional Feedback: Joseph Farag Alla is a first-year student in the Health Sciences program. Mackenzie Cullip is a fourth-year student in the Integrated Biomedical Engineering (HESE) program. Fahad R. Butt is a third-year student in the Integrated Biomedical Engineering (HESE) program.
What were your first impressions of PBL and how did this change over time?
BG: PBL is a learning experience where students have an active role in their learning. A lot of the PBL courses I have taken in the past we were given the freedom to choose any topic and present whatever we wanted on that topic. For one of my courses we could choose any issue in medicine and create a video on that. It was a lot more open-ended. In this course we were given specific challenges we had to address. This was more challenging however the learning objectives were more valuable because we were forced to come out of our comfort zone to explore topics that we had no exposure to previously. My first impression in other courses was that PBL is easy however with this course I realize that PBL is a valuable learning tool that can help me take an active role in my learning. Reflections help me modify what I am doing in class to help my specific learning needs. The Six Thinking Hats survey we completed at the beginning of the term was extremely helpful in describing the roles we took on in the group. And even then, we still had to adjust! At the beginning, we all wanted to be leaders across the roles, which did not lead to good collaboration. When we switched groups (which we did three times throughout the term) we were able to collaborate more effectively as we learned from our previous experiences that we had to intentionally cycle through the roles. This led to there being no specific “leader” which helped us collaborate and become more mindful of each other’s ideas and views. It helped us take each other more seriously. The smaller group size of 3–4 people was easier to navigate online. Larger groups can work with in-person PBL environments because you can notice non-verbal cues more easily. Even with only 3–4 people there was an adjustment period with conflict and frustration due to virtual communication challenges (even when video is being used). I don’t know if we could address these challenges in a larger group setting!
GS: This course’s PBL was entirely different. As this course started it was hard to wrap my mind around finding a solution to the case that was presented. There were learning objectives specified through the high-level components that were required in the solution however there was no clear step-by-step process to reach the solution. The PBL case was really asking us to design an approach for getting from Point A to Point B. The problem that we all ran into at first was that we thought that we required a specific skill set and approach to solve the problem, when really we needed to take the course learnings to-date and build upon our learning gaps through our own group process. We were confused at first because not receiving more specific details was new however we became more comfortable in expanding on what we learned in lessons and taking on roles over the semester. We became comfortable in proposing solutions, especially when other course components, including structured reflections, reinforced our learning.
JS: PBL is a method of learning that involves collaboration with fellow peers and engages learners in real world scenario-based problems. It encourages learning through multiple avenues (i.e reading articles, watching videos, etc.), and encourages learners to challenge their biases by gathering as many facts as possible to make informed decisions as a group with intergroup debate occurring to better flesh the ideas out. My first impression of PBL was that it was just a group project that somehow incorporates a scenario that tried to mimic a current situation in the world. However, as the course progressed, I would say that my impression revolved around the idea that PBL is focused on applied learning, and using the strengths and weaknesses of your group members to learn better together as a cohesive unit instead of everyone working in silos.
JI: To problem solve we needed to be seeing each other and bouncing ideas off one another, however, the virtual experience left some teams working on it apart and simply texting which person does what part. This does not work efficiently because everyone has a different style and unless you know the person, the PBL is not going to flow well. We learned through these mistakes. Once we knew each other (i.e. our writing/working style) we could optimize the group process. This greater cohesion yielded much higher performance. Having a session where all groups could work on the PBL at the same time would be helpful to enhance collaboration and allow the professor to engage with learners as needed.
SM: To be honest, I was not that excited about PBL based on previous experiences. I did not feel like I got anything out of it. I felt like I wasted time working with teammates on something that did not really work. For this course however I learned a lot through PBLs. Compared to even other parts of the course, the PBLs are what I will remember the most!
MS: This is the second course in which I did PBL. I would say it is a group project in which there is a problem that people need to work together to solve. In my previous experiences, we did not receive a specific case. In this course there was a specific challenge we had to address however we had to find various sources of information and use a group-based approach to rationalize our final presentation. From previous PBL experiences, I did not have a good outlook however with this course we were able to meet people during the online term (we still talk!) and you really learned a lot. I noticed that with PBL you cannot make things up — you need to do your work, you need to rationalize your conclusions, etc. You can learn a lot and you retain the information.
How did PBL enhance your health entrepreneurship learning experience?
BG: PBL translates very well into health innovation and entrepreneurship because you will be working in teams as an entrepreneur, and these teams will change over time based on needs. It helped to get exposure to multiple groups/teams over the semester as you learn something from each group of people. Bringing in a competition element for PBL cases could draw further parallels with entrepreneurship thinking.
GS: In the PBL cases, it is designed to be collaborative however it always comes down to someone proposing an idea and others listening to this idea and contributing to its expansion, or flat-out rejecting it for specific reasons. In this course, the dynamics changed throughout the semester. Once we became comfortable with each other and with our groups, it became easier and more effective to be constructive and generative in our group process. The PBL cases were critical to the learning experience. If it were not for the PBL all the learning would be theoretical. This was as close to real-life entrepreneurship experience as we are going to get — an industry-sourced PBL case would further enhance the experience. This would also be very memorable!
JS: This enhanced my health innovation and entrepreneurship learning experience by allowing me to apply the core concepts of the course towards an applied scenario and have my ideas be challenged by my peers instead of gathering feedback retrospectively (after being graded). It made for a much more iterative learning process where assumptions were constantly reviewed, and our ideas were improved upon as more information was gathered.
JI: The PBLs helped me structure the steps necessary to implement an innovation. I also did the questions provided before the PBL case prompt was released, which helped my entrepreneurship learning experience as I got to use my mindset to answer those questions, and later compared my answers to different views from my group members. The different perspectives and feedback from the PBLs helped formulate my current understanding of priorities in a health venture atmosphere
MS: This course is very “outside the box” and with PBLs you learn a lot because you know right away whether you do (or do not) understand a particular concept. Then you do more research to obtain more information until you and your team identify the best approach to move forward. This challenged us in new ways and because of the “struggle” associated with the PBL cases, it became very memorable.
SM: A lot of the research for the case studies required us to investigate new companies, the technologies, and the science (to explain the value of the innovation), etc. We learned even more in the PBL cases because we were given specific questions to answer (the learning objectives) which steered us in specific ways to amplify our learning. These learning objectives built on what was discussed in other components of the course. To further our presentation skills throughout the semester, having a competitive synchronous presentation component (rather than recorded presentations submitted) would be helpful. This would help us get to know even more people in the course!
Why were you afraid of being “wrong”?
BG: This is how our education system has been set up. For most assignments we receive we get marks because we are “correct.” We rarely solve a problem that can have multiple solutions. This might be a difficult concept for many students to grasp because in our minds the way to get to an “A” is to be “right”. This is challenging to adapt to. It could also be associated with the stigma — intelligence and “correctness” are correlated in our training. Perhaps if we are “wrong” we are not ready for a specific program, for example. If the education system were to place a larger emphasis on PBL earlier on, it may lead to students being more collaborative on open-ended problems.
GS: It is simple. We get penalized for being wrong. Being wrong can impact your chances later — we may not fulfill our career aspirations, etc. Our academic programs do not always create structured opportunities for “trouble-shooting” or “reflecting” both of which were extremely helpful in this course.
JS: I am sometimes afraid of consistently being disagreed with because I believe that it may start to create preconceived notions for my group mates that my ideas are already “bad” and thus their interest in fully understanding my future ideas may decrease as they already discounted them as something they wouldn’t be interested in. This can cause complications in future assignments and decrease my willingness to contribute if I already know my ideas wouldn’t be given a fair chance.
JI: Students rarely diverge from the obvious path that gets them a good grade; simple as that. This limits a student’s creativity and willingness to take risks in their education. As a result, students are discouraged from finding passion in courses, and instead they take courses to boost their GPA. INSPIRE 3EL3 was initially a course I took because I was unable to find new “bird” courses, and I could not be more grateful for it. This course is not particularly easy or difficult, however, putting sufficient time and effort into its learnings helped open my mind to taking risks. Students were able to discuss their concerns with the professor directly on Microsoft Teams, who answered almost instantly (demonstrating how important our learning and this course was to her). Likewise, every other week students answered reflection questions to voice their concerns on the course. At first, I figured this was just a task that a professor assigns to make up a full course load, or to sort of boost their own work/credibility. Of course none of this I’d be saying if it wasn’t for the confidence this course gave me. My first reflection limited the concerns I had and focussed on how great I think the course was so far. My PBL group mates told me what concerns they wrote down, and soon after the professor created alternatives to certain assignments that gave students more opportunities to fulfill a project’s requirements. Sarrah Lal created a decentralized learning experience that was unique and mutually beneficial for both students and educators. Students had a say in how the course would operate, and quite frankly other professor’s should adopt this education plan in their courses. Implementing this decentralized approach in modern day learning is vital for unfortunate incidents like our current COVID-19 situation, where learning must be refashioned to adjust for life events. Overall, this course brought out my interest in health innovation, challenging me to be more creative and outgoing in my academic career.
What advice would you give to others when engaging in PBL for the first time?
BG: It is important to remember that there are many possible solutions! The rationale is what matters. Uniqueness and individuality is rewarded. Going to see what your friend is doing is not extremely helpful. These are one of the only types of learning environments where creativity is rewarded. Remember that most of the problems we have in real life will have multiple solutions so it is important to develop critical thinking skills that can help you even when there is no firm grounding for one solution being better than another. Do not assume that the work of others is better — rationalization is important and a very key learning. Confidence in my own abilities led to greater confidence in these cases. Making mistakes and learning from them is not commonly accepted in education however this is an active component of this course (and entrepreneurship in general). This is refreshing as students always feel the need to back up their ideas just in case they are “wrong.” In this course we had to identify what is and what is not substantiated with evidence. We always had to explain our logic however the acceptance of multiple approaches enhanced critical thinking skills.
GS: There is no one way to get to the solution. You need to have confidence in collaborating with students, re-watching lectures, and being open to new learning. Over the semester it becomes easier. What it boils down to is experience. There is no confidence or self-efficacy before you have experience. We have been hard-wired to always support our claims — unlike in this course, there is not much room for innovation or throwing ideas out there without any backing (e.g. research articles).
JS: I would encourage others to keep an open mind and not be afraid to challenge the ideas of your group mates while also being resilient to having your own ideas be challenged. It is important to realize that the best solutions come from being a conglomeration of everyone’s contribution, and success for one is success for all. Additionally I would advise to try and gather additional information from as many sources as possible as this will help with providing extra context, while also recognizing that it is impossible to have a 100% complete picture of a situation and certain judgement calls will need to be made.
JI: PBL requires you to work with your group to identify times to work on the assignment. The professor scheduled times to meet with us (which helped to avoid procrastination) however there is still a temptation to procrastinate! I would definitely recommend that you stay on top of the work and find time to work on the assignment together rather than separately (to get different Thinking Hats that can tackle a given problem together).
MS: Time management is key! This is not something you can do the night before. Communication is important. Effective communication means you make yourself heard and that others are heard as well. We need to respect other viewpoints and understand different viewpoints (really seek to understand where people are coming from).
SM: You must communicate your thoughts very well. If you’re not communicating well with your group, it is not going to be effective. It is easier to be quiet online but don’t do it! You need to be open to taking the lead if you see the group not making decisions. Sometimes you need to be “that person” who is reminding everyone of deadlines.
