PBL과 TBL 중 반드시 선택을 해야 할까? 둘의 장점을 결합해보자! (Medical Teacher, 2015)

PBL과 TBL 중 반드시 선택을 해야 할까? 둘의 장점을 결합해보자! (Medical Teacher, 2015)

Should we choose between problem-based learning and team-based learning? No, combine the best of both worlds!

DIANA DOLMANS1, LARRY MICHAELSEN2, JEROEN VAN MERRIE¨ NBOER1 & CEES VAN DER VLEUTEN1

1School of Health Professions Education (SHE), Maastricht University, The Netherlands, 2Department of Management,

University of Central Missouri, Warrensburg, USA

Introduction

변화는 사회와 보건의료의 항구한 특성이기에, 끊임없는 교육과정의 개선은 흔한 의과대학의 풍경이다. 20세기 경영학 교육에서 처음 기원한 TBL은 지난 10년간 보건의료 교육 영역으로 들어와 빠르게 퍼지기 시작했다.

Change being a stable characteristic of society and health care, continuing curriculum renewal is a familiar process in medical schools. In fact, medical schools all over the world regularly transform or modify their curricula to offer students optimal preparation for their work in the changing world of the health professions. Team-based learning (TBL) is presented as an attractive instructional approach especially for the acquisition of teamwork skills. Originating in business education in the 20th century, in the past decade TBL has made its entrance in health sciences education where its use is spreading rapidly Haidet et al. (2012).

1960년대에 시작된 PBL은 전 세계의 의과대학에서 도입한 혁신적 교육법이었다. 교수중심 교육을 학생중심 교육으로 바꾸게 되면서 교육과정 개혁의 핵심 돌파구가 되었다. PBL은 이미 많은 의과대학에서 활용되고 있으며 TBL은 교수법으로서 입지를 구축하고 있다.

Developed in medical education in the late 1960s, problem-based learning (PBL) was heralded as an innovative educational approach and adopted by medical schools all over the world. As a student-centered as opposed to a teacher-centered approach, it was a major breakthrough in curriculum reform (Frenk et al. 2010), and many medical schools embraced it as an alternative to the then dominant discipline-based, teacher-centered approach, characterized by content that was less relevant to practice, a strong emphasis on one directional transmission of knowledge and not enough emphasis on clinical reasoning and problem solving. PBL is used in many schools today, and TBL is strongly advocated as an instructional approach that is eminently suitable to prepare students for effective collaboration (Frenk et al. 2010).

PBL과 TBL의 공존은 몇 가지 질문을 던진다. 

The co-existence of PBL and TBL in medical education raises several questions: 

• What exactly are the differences and similarities? Is TBL the new breakthrough in education? 
• What can we learn from these two instructional approaches? 
• And, even more importantly: how do both approaches fit with current instructional design principles? Are there benefits to be gained from combining these approaches’ unique strengths? 

PBL과 TBL의 많은 변형이 있기 때문에, 최고의 교육적 효과를 내기 위하여 두 가지를 합하는 것이 가능할 것인가를 점검하기에 앞서서 각각의 특징을 알아보고자 한다.

Since there are many variants of PBL and PBL is understood and practiced differently in many institutions (Taylor & Miflin 2008), it seems logical to first describe our main characteristics before moving on to an examination of the possibilities for combining elements of PBL and TBL to maximize their joint educational powers (Table 1).

PBL의 주요 특징 

The main characteristics of PBL

주요 특징은 다음과 같다. 

PBL is a student-centered approach in which problems are the stimulus for learning. It is characterized by: 

• (1) learning through problems, 
• (2) small group sessions, 
• (3) group learning facilitated by a teacher, and 
• (4) learning through self-study (Barrows & Tamblyn 1980; Barrows 1996; Hmelo-Silver 2004). 

모든 학생이 직무와 관련된 동일한 문제를 놓고 토론함. 한 명의 교사가 촉진자 역할을 함. 문제를 논의하는 동안 더 공부할 이슈를 만들어냄. 개별학슴동안 모든 학생이 동일한 주제로 공부함. 개별학습 다음에 다시 모여서 개별학습에서 공부한 내용을 논의하고 서로 합함. 학생들은 무작위로 배정되고 6~10주동안 같은 조로 유지됨. 주당 2회, 2시간 정도 만남. 6~10주가 지나면 그룹은 다시 구성됨. 강의는 제한됨. 강의는 개별 학습 이후나 최종 토론 이후에 배치됨.

The problems are professionally relevant and discussed in small groups in which all students work simultaneously on the same problem. One teacher facilitates each group. During the initial discussion of the problem in the group, students generate issues that need further self-study. All group members study the same set of learning issues during individual self-study. After self-study the group reconvenes to discuss the findings from self-study and synthesize what they have learnt. Students are randomly assigned to these groups (six to ten students per group) and usually stay together for a period of six to ten weeks during which they meet twice a week during two-hour sessions. After six to ten weeks the groups are reformed. A limited number of lectures are scheduled. These lectures are scheduled after individual self-study and after the final discussion in the group.

사전에 논의된 문제를 토론하면서, 기존에 가진 지식을 활성화시키고, 자신의 지식과 문제 사이의 간극을 확인하고, 이 간극에 대한 자율학습을 한다. 자율학습과 최종 토론을 하는 동안 새로운 내용에 노출된다. 최종토론을 하면서 학생들은 다른 구성원이 공부해 온 내용을 접하면서 불확실했거나 자신이 아느느 것과 반대되는 내용을 확인한다. 교사는 촉진자의 역할을 하면서 핵심적 질문을 통해 토론을 장려한다. 타당한 추론을 하고, 인지적 불일치를 건설적으로 토론하고, 새로운 지식을 자신의 언어로 표현하고, 새로운 지식을 적용하고, 질문을 통해 문제를 해결하는 통찰을 얻는다.

By discussing a pre-set problem students activate their prior knowledge, identify gaps in their knowledge vis-à-vis the problem and use these gaps to generate issues for self-study. During self-study students are exposed to new content and during the final discussion after self-study. During the final discussion, students listen and explain to other group members what they have learnt, discuss issues that were unclear or contradictory and apply their knowledge to the pre-set problem. The teacher plays an important role as facilitator by encouraging students to ask critical questions, engage in sound reasoning, constructively discuss cognitive disagreements, explain new knowledge in their own words and apply new knowledge and insights to solve the problem in question.

TBL의 주요 특징

The main characteristics of TBL

TBL은 학습자 중심, 교수 지도의 교수법으로서, 모든 교실의 학생들이 5~7명의 소그룹으로 나누어 현실적 문제를 해결하게 된다. 한 명의 교사가 모든 팀의 촉진자 역할을 하며(20개 이상의 팀일 때도 있음), 그룹 세션이 있기 전에 학생들은 의무적으로 읽기과제를 하고 MCQ를 통해서 자신의 지식을 점검한다. 

TBL is a learner-centered, teacher-directed instructional approach for entire classes of students who are divided into small teams of between five and seven students to solve authentic problems (Michaelsen et al. 2008; Parmelee & Michaelsen 2010; Parmelee et al. 2012). One teacher facilitates various small teams, 20 or even more. Before group sessions students have to complete a mandatory reading assignment and their individual knowledge of the materials is assessed in a multiple-choice test. 

팀 단위에서 학생들은 개개인의 정답을 다른 팀원들의 답과 비교하면서 즉각적 피드백을 받는다. 이후 교사는 학생들이 어려워한 시험에서 나온 개념을 설명해준다. 학생들은 같은 팀 내에서 직무과 관련된, 보다 복잡하고 어려운 문제를 논의하며 동시에 자신들의 토론 결과를 다른 팀에 밝히게 된다. 교사는 전체토의 시간에 서로 다른 팀들이 서로 다른 답을 가지고 토론하는 과정에서 촉진다 역할을 한다. TBL에서 팀 내의 토론은 자율이나 팀 간 토론은 교사가 촉진자 역할을 한다. 팀 내에서 학생들은 서로 피드백을 주고받는다. TBL의 주요 특징은 다음과 같다.

In the teams, students discuss their individual answers to the exact same test items with each other to reach team consensus and receive immediate feedback on the team answers. Thereafter the teacher clarifies the concepts related to the test questions that students struggled with. Students then work in the same teams to resolve professionally relevant, challenging and complex problems and simultaneously reveal the solution or decision they have reached to the other teams in the class. The teacher facilitates the discussion in which the different teams challenge the decisions of other teams and defend their own decision in a plenary session. In TBL, the teams are self-managed but, the inter-team discussions are facilitated by one teacher. Within the teams, students exchange feedback on their performance in the group (Haidet et al. 2012). The main characteristics of TBL are: 

• (1) professionally relevant problems, 
• (2) small self-managed teams, 
• (3) mandatory pre-class preparation by students, 
• (4) an individual and a team test to determine students’ readiness for dealing with complex decision-based professionally relevant problems, and 
• (5) working on problems in teams (Parmelee et al. 2012). 
• Peer evaluation and feedback is another important characteristic (Haidet et al. 2012). Students are purposefully assigned to teams using a stratified random sampling process.

Similarities between PBL and TBL

두 가지 중요한 특성을 공유한다.

As learner-centered instructional approaches based on constructivist learning theory, PBL and TBL share two important characteristics: 

• (1) learning around professionally relevant problems and 
• (2) learning in small groups or teams. 

교육의 다섯 가지 원칙에 부합한다.

Both instructional approaches fit well with the first five principles of instruction of many current instructional approaches as defined by Merrill (2012): 

• 학습의 촉진에 대한 원칙 learning is promoted when (1) learners are engaged in whole or real-world problems; (2) existing knowledge is activated; 
• 학습한 내용의 활용에 대한 원칙 (3) new learning is applied and (4) integrated or transferred. In both PBL and TBL students are encouraged during group work to apply their new knowledge to problems and to integrate or transfer their new knowledge by reporting it to peers in their own words. 
• 시범사례 제시의 원칙 Furthermore, learning is promoted when (5) new knowledge is demonstrated to learners, e.g. by providing worked-out or modeling examples (Merrill, 2012). 

비록 demonstration이 PBL이나 TBL의 주요 원칙은 아니지만, 완전히 배제되는 것도 아니다. 따라서 PBL과 TBL은 Merrill이 정의한 교육의 다섯 원칙에 부합한다

Although demonstration is not a primary instructional principle in PBL and TBL as opposed to many teacher-centered instructional approaches, demonstration, e.g. in terms of lectures, is not fully neglected in both curricula. So both PBL and TBL fit well with current first principles of instructional design as defined by Merrill (2012). Despite these similarities there are differences as well (Table 2).

PBL과 TBL의 차이

Differences between PBL and TBL

촉진자 역할을 하는 교수의 수와 진행법

A first major difference is that in TBL one teacher runs various groups simultaneously (even twenty teams or more with hundred students), while in PBL there is one teacher for each group. So in PBL a teacher is physically present for each group discussion, whereas the teacher is not physically present for each team discussion. Students in PBL work in groups in different small rooms, whereas TBL teams work simultaneously in the same large room in small teams.

사전시험(iRAT, tRAT). 새로운 내용에 대해 노출되는 시점

Another difference relates to the way students attain the knowledge and insight to address the problem they are working on. TBL students are given a mandatory pre-class reading assignment while PBL students are given no preparatory reading assignment. Exposure to new content in PBL takes place after initial group discussion, mainly during self-study but also during the final group discussion. Exposure to new content in TBL takes place before team discussion.

TBL에서는 토론 전에 사전 지식을 점검함

PBL students start with an initial discussion in which they activate their prior knowledge in the group. TBL students fill out a test individually and as a group to check whether they understand the pre-assigned reading materials; so prior knowledge is checked prior to the small group discussion.

학습 문제를 누가 정해주는가

Furthermore, where PBL students identify their own issues for self-study after the initial group discussion, in TBL it is the teacher who decides based on the nature of the application problems he or she will be requiring students to solve and the conclusion of the instructional units. Further, based on the test results, the instructor decides which issues need further explanation before students work in small teams to tackle the application problems.

피드백을 받는 시점과 원리

Feedback (both confirmatory and corrective) to the students is given by peers within the group or team in both PBL and TBL. Furthermore, in both PBL and TBL the teacher gives corrective feedback to students when needed. However, in TBL students receive immediate feedback (confirmatory and corrective) from: 

• (1) fellow team members while reaching consensus during the team discussion, 
• (2) on the correctness of each team decision on the team test (via an scratch-off answer sheet), and 
• (3) from members of other teams during inter-team discussions of the application problems. 

Testing and inter-group discussion are not part of regular PBL tutorials.

동료평가

Peer evaluation and peer feedback are another difference between the approaches. Although peer feedback is also implemented in PBL in some schools, peer feedback is a structural component of TBL, with each team member having to give feedback to each of the other team members on their contributions to group learning. We will elaborate on this difference in the next section.

추론을 유도하는 기전

Learning in both PBL and TBL centers on reasoning around problems relevant to future professional practice. However, in TBL the mechanism through which the reasoning occurs is by requiring students to make questions and defend decisions to questions. TBL teams simultaneously reveal their answers in a plenary session and the teams discuss the decisions of the other teams and defend their own decision, facilitated by a teacher (Parmelee et al., 2012). Thus, students in TBL work on problems with associated questions, whereas students in PBL work on problems with no specified questions. Students in PBL discuss problems and generate their own issues or questions that need further self-study; so questions are not given.

In summary, the overall similarities between PBL and TBL relate to the use of professionally relevant problems and small group learning that both fit well with current instructional design principles, while the main difference relates to one teacher facilitating interactions between multiple self-managed teams in TBL, whereas each small group in PBL is facilitated by one teacher. Further differences are related to mandatory pre-reading assignments in TBL, testing of prior knowledge in TBL and activating prior knowledge in PBL, teacher-initiated clarifying of concepts that students struggled with in TBL versus students-generated issues that need further study in PBL, inter-team discussions in TBL and structured feedback and problems with related questions in TBL.

PBL과 TBL의 강점

Strengths of PBL and TBL

다양한 강점을 공유한다. 그럼 서로의 장점으로부터 배울 점은 무엇일까?

PBL and TBL share various strong points. They both emphasize the importance of learning around professionally relevant problems in small groups. Both instructional approaches fit well with the five first principles of instruction of many current instructional approaches as defined by Merrill (2012) and explained above. The question is can PBL and TBL benefit from each other’s unique strengths and, if the answer is affirmative, how do we achieve this?

어떤 점을 서로 제공해야 할 것인가?

What do the two approaches have to offer each other?

In addition to shared strengths, TBL and PBL have unique strengths. What can the two approaches offer each other or, to put it differently, how can PBL and TBL achieve mutual benefit by sharing strong points? How can the two approaches be combined?

PBL이 TBL로부터 배울 점은? 

How can PBL profit from TBL?

An important characteristic of TBL that might transfer to PBL is structured peer evaluation and feedback. In TBL, team members conduct mutual peer evaluation of their contributions to the success of the group and their own learning (Parmelee et al. 2012). 

Peer feedback의 긍정적 측면 

• Peer feedback has been shown to have positive effects on students’ contributions to the team and on students’ commitment to group work (Kamp et al. 2013). 
• Also, it enhances awareness of desired behaviors in the group and positive social interdependence, and it increases intrinsic motivation, mutual support and collaboration among group members (Hattie & Timperley 2007; Johnson et al. 2007). 
• Borges et al. (2012) showed that, combined with peer feedback during a traditional clerkship, TBL enhanced students’ awareness of their own emotions and recognition of the emotions of others, thereby promoting empathy. 
• Peer feedback is also a helpful strategy for promoting individual member accountability. 

In short, peer feedback is a unique strength of TBL that could prove beneficial to PBL curricula in which peer feedback is not yet implemented as a routine and structured activity.

학습목표에 대한 전체토론 도입

Another aspect of TBL that could be used in PBL is that the initial small group discussions could take place in a large class setting with one facilitator instead of a facilitator for each small group. The small groups discuss a professionally relevant problem and generate issues that need further self-study. The leader of each small group lists the learning issues generated and brings it to the teacher. Thereafter the teams report their learning issues in a plenary session. The teacher subsequently moderates a discussion in which teams challenge the choices of other teams and defend their own choices. In the end students have a list of learning issues for self-study. 

장점

An advantage of this approach is that one teacher is needed for the discussion preceding the generation of learning issues. Another advantage is that the prior-knowledge base is expanded to an entire class consisting of several small teams and that inter-team discussions are facilitated.

TBL이 PBL로부터 배울 점은? 

How can TBL profit from PBL?

An important characteristic of PBL which may be of benefit to TBL is the small group discussion before self-study in which students activate their prior knowledge, a strategy that has been shown to have positive cognitive effects on learning (Dolmans & Schmidt 2006; Van Blankenstein et al. 2011). In other words, although TBL does encourage the activation of prior knowledge by means of pre-reading assignments and does test students’ prior knowledge by asking students to answer test items, either individually or in the team, TBL could benefit from encouraging students to activate their prior knowledge by actively contributing to the group discussion before pre-reading assignments.

Another characteristic of PBL that might be of benefit to TBL is encouragement of self-directed learning. In PBL, during small group discussions, students are encouraged to generate their own questions or learning issues for self-study, which they report on and discuss in the subsequent group discussion. In other words, students plan and monitor their own learning. Encouraging students to generate their own learning issues is assumed to have positive effects from a motivational perspective and on top of that may enhance the development of lifelong learning skills. So, TBL can encourage students to generate learning issues by themselves.

The proposed exchange of characteristics between PBL and TBL as discussed is summarized in Table 3.

Conclusions and discussion

하이브리드 접근법이 가능할 수 있다.

(...)

몇 가지 추가 논의점

Some issues call for further discussion. 

• TBL은 경제적이고 자원이 많이 들지 않는다는 방식이라는 의견이 있다. PBL은 튜터가 더 많이 필요하다. 그러나 정말 TBL이 비용이 덜 드는가?
  Firstly, TBL is often claimed to be an economical or resource friendly instructional approach because one instructor can oversee the work of and ensure timely feedback to as many as twenty or more teams (Hrynchak & Batty 2012; Parmelee et al. 2012). In times of resource shortages and increasing student numbers, this claim may have been instrumental in the breakthrough of TBL. PBL requires sufficient numbers of well-prepared tutors; one for each group which requires a lot of resources (Taylor & Miflin 2008). But is TBL really less expensive than PBL? Further research will have to bring clarity on this issue.
• PBL에 TBL의 특성을 적용하는 것이 정말 가능할까? 한 명의 교수자가 동시에 여러 PBL 그룹을 운영할 수 있을까? 어느 정도까지 줄일 수 있을까? 학생선생님은 가능할까? 
  A second discussion point is the transferability to PBL of the TBL characteristic of one teacher for many small groups. Can one teacher run various PBL groups simultaneously? In other words, can a group or team work well without a teacher? This would mean losing the advantage of having a teacher available to give just-in-time information or feedback during the group discussion. However, it may be worthwhile to consider the possibility of one teacher running groups simultaneously, once students have become familiar with the PBL approach; this would mean alternate group sessions with and without a teacher as described above. Further research will have to evaluate the impact of this way of reducing teacher support in PBL. Another way of cutting back on teacher support may be to employ student teachers. Although preferably practicing physicians are involved as teachers since they know what is relevant to learn (Dolmans et al. 2013), selected and motivated senior students trained to facilitate small groups can be as effective as teachers (De Rijdt et al. 2012). The question is whether senior students will be much cheaper than experienced teachers, in view of the considerable expenses for ongoing selection and training.
• 강의, 토론, 자습, 기타 활동의 적당한 수준이 어느정도인가? TBL에 비해서 PBL에 얼마나 교수의 지원이 필요한가?
  Thirdly, there is little clarity regarding the differential amounts of time devoted to lecturing, group discussion, self-study and other activities in PBL and TBL. Also, how much teacher support is given in PBL versus TBL? To what extent are students encouraged to self-direct their learning in PBL versus TBL? These issues deserve further exploration.
• PBL에 적합한 문제와 TBL에 적합한 문제가 서로 다를 것인가?
  A fourth issue that needs further research is whether PBL and TBL differ in terms of problems that are used. Both approaches emphasize the importance of reasoning around problems. In TBL problems are associated with questions, in PBL there are no specified questions? But how do both approaches differ in terms of developing critical thinking and decision-making?
• TBL이 과연 돌파구가 될 수 있을 것인가? (특히 팀워크능력의 개발 측면에서)
  The fifth issue to be discussed is whether TBL will be the next breakthrough in health care education. Developing students’ team work skills is crucial for the health care system and will become increasingly urgent as health care is facing an increase in problems of increasing complexity requiring multi-disciplinary team work. So the urgency of paying more attention to the development of teamwork skills in curricula and educational research is undeniable; both PBL and TBL can equip students with these skills.
• PBL과 TBL중 선택해야 한다면 어떤 것을 골라야 할까? 정말 골라야 하는 것은 맞을까?
  Finally, we are faced with the choice between PBL and TBL. Which should we choose? Should we choose? In this paper, we have tried to argue that it is neither necessary nor desirable to make this choice. It may be more profitable to optimize student learning if we look for ways to combine the best of both worlds: PBL with structured peer feedback, PBL with study teams, TBL with initial group discussion before pre-reading assignment or testing or TBL with students generating their own learning issues. Choose an instructional approach that fits well with current design principles, such as the five first principles of Merrill (2012) emphasizing the importance of learning around problems, activation of prior knowledge, demonstration of new knowledge, and application and integration of knowledge. Ensure variability in problems to be discussed, order problems from simple to complex and gradually reduce teacher support (Van Merriënboer & Kirschner 2013). Start with TBL, thereafter alternate TBL and PBL to decrease teacher support, and subsequently use PBL. Start with explanation problems and gradually add decision or strategic problems. Start with paper problems; thereafter use real patient problems so as to augment the fidelity of problems. There is a range of options to include real patient problems both in the pre-clinical and clinical phase (Harden et al. 2000; Diemers et al. 2008). Combine the strengths of PBL and TBL. In sum, think win-win when designing curricula in order to optimize student learning and use varied instructional approaches that fit well with current instructional design principles.

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Med Teach. 2015 Apr;37(4):354-9. doi: 10.3109/0142159X.2014.948828. Epub 2014 Aug 26.

Should we choose between problem-based learning and team-based learning? No, combine the best of both worlds!

Dolmans D1, Michaelsen L, van Merriënboer J, van der Vleuten C.

Author information

• 1School of Health Professions Education (SHE), Maastricht University , The Netherlands .

Abstract

Abstract Background: To meet changes in society and health care, medical curricula require continuous improvement. A relatively new development in medical education is team-based learning (TBL). In the previous century, problem-based learning (PBL) emerged as an exciting new method.

AIMS:

What are the similarities and differences between PBL and TBL? How do both approaches fit with current design principles? How might PBL and TBL benefit from each other's unique strengths?

METHODS:

Analysis of the literature.

RESULTS:

The overall similarities between PBL and TBL relate to the use of professionally relevant problems and small group learning, both fitting well with current instructional design principles. The main difference is that one teacher in TBL can run twenty or even more study teams, whereas in PBL each small group is run by one teacher.

CONCLUSION:

In this paper we advocate for a joining of forces. By combining elements of PBL and TBL, we could create varied instructional approaches that are in keeping with current instructional design principles, thereby combining the best of both worlds to optimize student learning.

PMID:

 

25154342

 

[PubMed - in process]