The Foundation of Problem-based Learning in Medical Education: A Broader Concept of Integrative Learning

醫學教育問題導向學習的基奠：一個整合學習的廣闊概念

關超然(Chiu-Yin Kwan)；李孟智(Meng-Chih Lee)

Problem-based learning ； Medical education ； Integrative learning ； Self-directed learning ； Student-centered learning ； 問題導向學習 ； 醫學教育 ； 整合學習 ； 自主學習 ； 學生為本學習

醫學與健康期刊

8卷1期（2019 / 03 / 01）

1 - 14

英文

Problem-based learning (PBL) has remained the most innovative and effective educational concept in the health professions, not just limited to medical education, for nearly half a century since its official inception at McMaster University in Canada in 1969. The originally proposed philosophy of PBL commonly referred to by their PBL forefathers as ＂McMaster Philosophy＂ has still stood firm amidst many contemporary medical educational theories following half-a-century historical development, attesting to its time-proven, humanistic and inherently multi-strand solid foundation. In fact, PBL gave rise to the theoretical basis for the subsequent emergence of project-based learning, case-based learning, team-based learning, competence-based learning, flipped classroom learning, and interprofessional learning. It is also this intertwined multi-strand foundation that gives rise to the broader concept of integrative learning in PBL. Integrative learning in PBL occurs with rational thinking and compassionate humanity in real-life scenarios or cases. PBL case content is often approached from three perspectives. The Population perspective spans from individual needs to global issues, the Behaviour perspective ranges from life style to professional ethics and the Life Science perspective includes the exploration of life and the enrichment of a quality living, the true P-B-L triad. In preparing PBL, teachers help design the integrated platform of learning via real-life scenarios. Teachers (generally referred to as PBL tutors) no longer teach in the traditional way, instead they serve as facilitators encouraging students to learn to integrate what they learn. Thus, the broad concept of integration remains the solid foundation of PBL and continues to extend into other contemporary learning commodities. The arguments put forth in this study lead to the suggestion that PBL in the form of with team-based learning (TBL) with simulated cases may be most suitable for the earlier medical curricula, whereas interprofessional learning (IPL) combined perhaps with case-based learning using real-patient medical cases may be better suited for the later medical years, as students approach clinical training with more mature attitudes and greater desire for patient contact.

以問題為導向的學習模式（PBL）於1969年在加拿大的McMaster大學正式啟用已將近半個世紀了，它仍然是健康科學教育裡最具創新與成效的教育理念，而且它並不僅局限在醫學教育。原本最早提出來的PBL哲理，也就是先輩們常提到的所謂「McMaster哲理」，在這半個世紀中彼起此落的諸多應時的醫學教育理念發展過程中保持著穩如磐石的地位，見證了它通過時間歷練的，人性化的，與本生具有的多元性，且扎實的根基。事實上PBL也為了後來衍生出來的教育或教學模式墊下了相關的基礎理念，如專案導向學習，病例導向學習，團隊合作學習，勝任力導向學習，翻轉教室學習，與跨專業間學習等。也就是這種相互糾結在一起多元性的根基成就了一個廣闊的整合學習PBL概念。在PBL整合式的學習是發生在將理性的思考與感性的同理心應用在真實生活的情境或案例裡。PBL的案例經常以三種介面來展現的：群體的介面從個人的需要跨越到全球的議題，行為的介面從生活的習慣延伸到專業的素養，及生命科學的介面從包括對生命的探索與豐富一個有品質的生活。這就是真正的P-B-L三合一。在準備PBL的時候，老師通過真實生活的情境説明設計整合式的學習平臺。老師（通常被稱為PBL導師）不再進行傳統的授課，而是替代于協導學生學習去整合他們之所學。因此，一個廣泛性的整合概念一直都成為PBL扎實的根基,並延展到其他應時的學習模式。我們這些論述引領到以下的建議：PBL，也許添加上使用有擬真的案例的團隊合作學習（TBL），可以使用在較早的醫學課程，而跨專業間的學習（IPL），也許添加上利用真正病人的病歷學習法，可能對預備進入臨床培訓的高年級醫學生更為適合，因為他們應具有比較成熟的心態及與病人接觸的期待。

1. Achike, FI(2017).Interprofessional Education: Challenges and Interphase with Problem-based Learning.J Med Educ,20,2258-2268.
   連結：
2. Achike, FI,Lee, MC,Lin, HW(2015).Promoting Interprofessional Education (IPE) with PBL through the Biennial Asia-Pacific Joint Conference on PBL (APJC-PBL).J Med Educ,19,153-162.
   連結：
3. Kwan, CY(2017).Problem-based Learning (PBL) in Medical Education in Taiwan: Observations and a Commentary.J Med Health,6,1-12.
   連結：
4. Kwan, CY(2016).Commentary: Five Decades of Skepticism about PBL in Medical Education: a Reflection and outlook in the Asia Pacific Context.J. Med. Educ.,20,1-10.
   連結：
5. Kwan, CY,Lee, MC(2018).From problem-based learning in classrooms to holistic healthcare in workplaces with special emphasis in Chinese societies.J Med Health,7,1-15.
   連結：
6. Kwan, CY,Tam, L(2009).Commentary: Hybrid PBL-What Is In a Name?.J Med Educ,13
   連結：
7. Wang, WD,Leung, KK(2012).A Nomenclature System for Problembased Learning Curriculum.J Med Educ,16,55-62.
   連結：
8. Xin, G,Long, T,Zhang, ZF(2016).Designing and Evaluating of A Systematically Structured PBL Tutor Training Program.J Med Educ,20,250-257.
   連結：
9. Chou, FCC,Kwan, CY,Hsin, HC(2016).Examining the Effects of Interprofessional Problem-based Clinical Ethics: Findings from a Mixed Methods Study.J Interprofessional care,30,362-369.
10. Dorsey, JK(Ed.),Rangachari, PK(Ed.)(2012).Students Matter: The rewards of University teaching.SIU School of Medicine Press.
11. Huang, G,Kwan, CY(2014).PBL in medical education in China: theory and application.Beijing:People’s Health Publisher.
12. Kwan, CY(2003).So, You Will be a PBL Tutor in a Medical School.J Med Educ,7,313-322.
13. Kwan, CY(2001).A Note of Caution in Conducting PBL Tutorials: observations in a medical school that newly adopted a PBL curriculum.J Med Educ,5,87-93.
14. Kwan, CY,Hsin, HC(2018).Problem-based learning (PBL) Case Problems: Scenario Design, Writing Skills. Reference samples and Assessment.Beijing University Medical Press.
15. Kwan, CY,Lee, MC(2013).Books: Problem-based learning (PBL): Concept, application, experiences and lessons.Beijing University Medical Press.
16. Kwan, CY,Zhang, ZF,Lee, MC(2014).From PBL to OBE in Medical Education: What is the Catch in Pursuing Higher Education?.Clin Med Educ,1,19-45.
17. Lee, MC(2017).Education on Holistic Medical Care.JCT: Proceedings of 2017 Hospital Accreditation Surveyors CME Course,New Taipei City:
18. Lee, RMKW,Kwan, CY(1997).The Use of Problem-based Learning in Medical Education.J Med Educ,1,149-158.
19. Lee, WM,Wang, FK,Mok, ES(2004).Problem-based Learning: Ancient Chinese Educational Philosophy Reflected in a Modern Educational Methodology.Nurse Educ. Today,24,136-144.
20. Neufeld, BT,Barrows, H(1974).The "McMaster Philosophy": An Approach to Medical Education.J Med Educ,49,1040-1050.
21. Neville, AJ(2009).Problem-Based Learning and Medical Education Forty Years On A Review of Its Effects on Knowledge and Clinical Performance.Med Princ Pract,18,1-9.
22. Neville, AJ,Newman, GR(2007).PBL in the Undergraduate MD Program at McMaster University: Tree Iterations in Three Decades.Acad. Med,82,370-374.
23. Sayyah, M,Saki-Malehi, A,Rahim, F(2017).Use of a problembased learning teaching model for undergraduate medical and nursing education: a systematic review and metaanalysis.Adv Med Educ Pract,8,691-700.
24. Zhang, YQ,Zhou, L,Liu, XY(2015).The Effectiveness of the Problem-Based Learning Teaching Model for Use in Introductory Chinese Undergraduate Medical Courses: A Systematic Review and Meta-Analysis.PLoS One,10,e0120884.

1. Chiu-Yin Kwan(2019).PBL in Health Science Education: What is in a Name 50 Years after Inception?.醫學教育,23(3),137-142.
2. 關超然,周致丞,李孟智(2020)。Student-Centered Learning in Medical Education in Relationship to Patient-Centered Care in Clinical Settings。醫學與健康期刊，9(3)，1-11。