PBL: 21세기 보건의료전문직 교육을 위한 전략적 학습시스템 설계(Kaohsiung J Med Sci, 2009)

PBL: 21세기 보건의료전문직 교육을 위한 전략적 학습시스템 설계(Kaohsiung J Med Sci, 2009)

PROBLEM-BASED LEARNING: A STRATEGIC LEARNING SYSTEM DESIGN FOR THE EDUCATION OF HEALTHCARE PROFESSIONALS IN THE 21ST CENTURY
Matthew Choon-Eng Gwee

 

의학교육의 암흑시대
THE DARK AGES OF MEDICAL EDUCATION

19세기에 걸쳐, 그리고 20세기의 마지막 2~30년까지, 학부 의학 커리큘럼의 설계는 분야 간 교차 대화가 거의 없는, 고도의 학문 분야별discipline-specific이었다. 당시 교육 전달은 교사 주도(교사 중심)가 높았고, 강의 기반도 높았다. 이때는 교육/학습 과정에서 학생의 역할이 주로 교사가 전달하는 풍부한 콘텐츠 지식(또는 정보)의 수동적 수신자(Sage-in-center stage)의 역할이었던 교육 패러다임의 시대였다.
Throughout the 19th century, and until about the last 2–3 decades of the 20th century, the design of the undergraduate medical curriculum was highly disciplinespecific with little cross talk across disciplines. The delivery of instruction was then highly teacher-directed (teacher-centered) and also highly lecture-based. This was the era of the instructional paradigm in which the student role in the teaching/learning process was mainly that of a passive recipient of abundant content knowledge (or information) delivered by the teacher (“sage-in-center stage”).

그렇다면 우리는 전통적인 교육 환경에서 어떤 결과를 기대할 수 있을까? 다음과 같은 몇 가지 주요 제한 사항[1,2]이 이미 확인되었다.
What then can we expect as the educational outcomes from such a traditional educational environment? Several major limitations [1,2] have already been identified, including:

• 학생이 풍부한 콘텐츠 지식을 습득함에 따라 발생하는 정보 과부하("…메모리에 부담을 주는 정보이지만 지성이 아닌 정보") [1].

• MRR(암기, 회상, 재귀)을 통한 학생에 의한 단순암기 학습 습관 개발—사실 컨텐츠 지식(정보)의 리콜에 대한 테스트에 의해 종종 개선되고 강화된다.

• 학생의 학습 성과에는 거의 주의를 기울이지 않고 투입만이 강의의 주요 초점이 된다.

• 학생이 무엇을, 어떻게, 언제 배워야 하는지 등 학습 요구에 대한 교사 의존도가 높다.

• 고차 인지(지적) 기술(중요한 사고, 추론 및 문제 해결) 및 학습 태도(대인관계, 커뮤니케이션, 팀워크 및 리더십) 영역에서 일반적인 "부드러운" 기술을 습득하는 등 보다 지속적인 교육 과정 및 생활 기술 습득에 관한 부적절한 관심

• Information overload resulting from student acquisition of abundant content knowledge (“…information that taxes the memory but not the intellect.”) [1].

• Development of rote-learning habits by students through MRR (memorize, recall, regurgitate)—often abetted and intensified by tests on recall of factual content knowledge (information).

• Teaching inputs as the primary focus of instruction with little attention to student learning outcomes.

• High dependency of students on teachers for their learning needs, including what, how, and when to learn.

• Inadequate attention to student acquisition of more enduring educational process and life skills, including: higher-order cognitive (intellectual) skills (critical thinking, reasoning, and problem-solving); and some generic “soft” skills in the attitudes (affective) domain of learning (interpersonal, communication, teamwork, and leadership).

 

맥마스터 대학 이니셔티브: 의료 교육의 새로운 추세 설정
THE MCMASTER UNIVERSITY INITIATIVE: SETTING A NEW TREND IN MEDICAL EDUCATION

1960년대 중반 예외적인 사건이 발생했다. 맥매스터 대학교는 의과대학원을 너무 다르게 낳아 교육계에 경악의 파문을 일으켰다. [3]
“In the mid-1960s, an exceptional event occurred. McMaster University gave birth to a medical school so different it sent ripples of astonishment throughout the educational world” [3].
 

1960년대에 캐나다 정부는 온타리오주 해밀턴에 있는 맥마스터 대학에 의과대학 설립의 필요성을 확인했다. 처음에, 이 프로젝트를 담당하는 교육 기획자들은 의학 교육과정을 설계하고 전달하는 데 급진적인("신선하고 새로운") 접근 방식을 취할 것이라고 선언했다. "표준적인 빌딩 블록 구조에서 벗어나라"며 "많은 콘텐츠를 오래 보유하지 못하기 때문에 목구멍으로 내던지는 않을 것이다. 그들이 적극적으로 참여하도록 노력합시다…" [3].
In the 1960s, the Canadian government identified a need to establish a medical school in McMaster University in Hamilton, Ontario. At the outset, the educational planners responsible for this project declared that they intended to take a radical (“fresh and new”) approach to the design and delivery of their medical curriculum to “…get away from the standard building-block structure…from shoving a lot of content down their throats because they don’t retain it very long anyway. Let’s try and get them actively involved…” [3].
 

실제로 1969년 맥마스터 대학 의과대학은 새로운 의학 커리큘럼을 시행하여 새롭고 급진적이며 혁신적인 트렌드를 수립하고 의학 교육에 대한 대안적인 학습 경로를 제공했다. McMaster 커리큘럼은 (주로 교육 계획자들이 현재의 (전통적인) 의료 커리큘럼의 많은 단점이라고 인식하는 것을 극복하기 위한) 문제 기반 학습(PBL)으로 구현되었다. [1–3] 사실, 거의 30년이 지났는데도 Boud와 Feletti[4]는 여전히 PBL을 "…다년간 직업 교육을 위한 가장 중요한 혁신으로 생각하고 있다. 전문교육을 교육기관으로 옮긴 이후 가장 중요한 발전이라는 주장도 있다."

Indeed, in 1969, McMaster University Medical School implemented its new medical curriculum, which set a new, radical and innovative trend, and offered an alternative pathway for learning in medical education. The McMaster curriculum was implemented as problem-based learning (PBL), primarily aimed at overcoming what the educational planners perceived to be the many shortcomings of the then current (traditional) medical curriculum [1–3]. In fact, even after almost three decades, Boud and Feletti [4] still consider PBL as “…the most significant innovation in education for the professions for many years. Some argue that it is the most important development since the move of professional training into educational institutions.”

 

PBL이란 무엇인가?
WHAT IS PBL?

PBL은 본질적으로 [강의 전달을 위한 몇 가지 보완적 교육 원칙을 결합한 전략적 학습 시스템 설계]이다. PBL은 특히 학습자 중심, 협업, 맥락, 통합, 자기 주도 및 성찰적 학습의 교육 결과를 개선하고 최적화하는 것을 목표로 한다. Barrows and Tamblyn [5]는 PBL에 대한 간단한 운영 정의를 제공했습니다. "…문제의 이해 또는 해결을 위해 노력하는 과정에서 비롯되는 학습입니다. 이 문제는 학습 과정에서 가장 먼저 마주치는 것이다."

PBL is, essentially, a strategic learning system design, which combines several complementary educational principles for the delivery of instruction. PBL is specifically aimed at enhancing and optimizing the educational outcomes of learner-centered, collaborative, contextual, integrated, self-directed, and reflective learning. Barrows and Tamblyn [5] provided a simple operational definition of PBL as “…the learning that results from the process of working toward the understanding or resolution of a problem. The problem is encountered first in the learning process.”

 

PBL: 주요 기능과 학습 전략은 무엇입니까?
PBL: WHAT ARE ITS KEY FEATURES AND ITS LEARNING STRATEGY?

PBL의 중요하고 기본적인 원칙은 그것이 problem-first learning이라는 것이다. 즉, 학생들이 이 주제에 대한 공식적인 학습을 받기도 전에 의료 사례를 해결하려고 시도한다는 것이다. 일반적으로 실제 의료 사례(문제)는 학생들의 학습 과정을 촉발한다. 즉, 문제는 문제 사례와 관련된 다양한 문제를 이해하거나 해결하는 데 필요한 관련 콘텐츠 지식을 학습하는 출발점 역할을 한다. 따라서 문제 해결에서 규칙적인 실천regular practice은 PBL 프로세스의 또 다른 주요 특징이다 [6,7]. 또한 사례 작성자는 학문에 걸쳐 학습을 [맥락화하고 통합하는] PBL 문제 사례를 구성하는 경우가 많으므로 문제 사례에는 대개 임상 과학뿐만 아니라 인구, 행동 및 생명 과학과 관련된 문제가 포함된다.
An important and basic tenet of PBL is that it is problem-first learning, i.e. students attempt to problem-solve a medical case even before receiving any formal learning on the subject matter. Usually, a real-life medical case (a problem) triggers the learning processfor students, i.e. the problem serves as the starting point for learning relevant content knowledge required to understand or resolve various issues related to the problem case. Thus, regular practice in problem-solving is another key feature of the PBL process [6,7]. Moreover, case-writers often construct PBL problem cases that contextualize and integrate learning across disciplines and, therefore, a problem case usually includes issues relating topopulation,behavioral and thelife sciences, as well as the clinical sciences.

전형적으로, 집중적인 소그룹 튜토리얼은 "그룹을 위한 지적 및 대인관계 프로세스를 촉진하는" 역할을 하는 튜터(또는 촉진자) 교사와 함께 PBL 과정의 instruction을 전달하기 위해 사용된다. [8] PBL 튜토리얼은 보통 약 2시간의 세션으로 구성되며, 각 세션은 각 문제 사례에 할애되며, 정보 검색 및 수집을 위해 약 4-5일의 자체 학습 기간이 주어진다. 자율학습 기간은 학생들이 자기주도학습[6,7]을 수행할 수 있는 기회를 만들어 평생 지속적 자기교육을 위한 확고한 기반을 마련한다.
Typically, intensive small-group tutorials are used for the delivery of instruction in the PBL process with the teacher serving as the tutor (orfacilitator) whose role it is“to expedite the intellectual and interpersonal process for the group”[8]. The PBL tutorials usually consist of two sessions of about 2 hours, each devoted to each problem case, with an intervening self-study period of about 4–5 days for information searching and gathering. The self-study period creates opportunities for students to undertake self-directed learning[6,7] and, therefore, laying a firm foundation for lifelong continuing self-education.


각 튜토리얼 세션에는 "구체적인 프로세스, 목표 및 결과"가 있습니다 [6]. 첫 번째 튜토리얼(자습 세션 1)은 주로 다음과 같은 브레인스토밍으로 구성됩니다.
Each tutorial session has its “specific process, goals and outcomes”[6]. The first tutorial (tutorial session 1) consists mainly of brainstorming as follows:

• 그룹 구성원의 [문제 사례 제시]

• 문제 사례의 사실 검토를 통한 [문제 분석]

• 사례의 다양한 측면을 설명하기 위한 아이디어를 개발하기 위한 [가설 생성]

• 생성된 가설을 반박하거나 확인하기 위해 학습해야 하는 콘텐츠 지식의 식별을 안내하는 [학습 문제의 공식화(학습 목표)]

• 사례와 관련된 정보를 검색하고 수집할 수 있는 [적절한 학습 리소스(예: 교과서, 인터넷 또는 전문 지식)의 식별]

• 그룹 구성원에게 공식화된 학습 문제와 관련된 정보를 검색하는 [과제 할당]

• Presentation of the problem-case by a member of the group

• Problem analysis through reviewing the facts of the problem case

• Hypothesis generation to develop ideas to explain various aspects of the case

• Formulation of learning issues (learning objectives) to guide identification of the content knowledge that needs to be learned in order to either refute or confirm any hypothesis generated and, thus, to have a better understanding of the case

• Identifying the appropriate learning resources (e.g. textbooks, internet, or professional expertise) from which to search for and gather information relevant to the case

• Assigning tasks to group members to search for information related to the learning issues formulated

 

따라서 튜토리얼 세션 1은 주로 문제 분석을 통해 사례의 사실을 확인하고, 사례에 대한 가설(아이디어)을 생성하고, 사례를 설명하거나 해결하는 데 필요한 관련 학습을 안내하는 학습 문제를 공식화하고, 정보 검색 및 수집을 위한 학습 자원을 식별하는 것을 목표로 한다.
Tutorial session 1 is, therefore, primarily aimed at identifying the facts of the case through problem analysis, generating hypotheses (ideas) about the case, formulating learning issues to guide relevant learning that is required to explain or resolve the case, and identifying the learning resources for information search and gathering.


두 번째 튜토리얼(세션 2)에서 학생들은 자율 학습 기간이 끝난 후 각 그룹에 다시 모여 다음을 수행합니다.
In the second tutorial (session 2), the students reconvene in their respective groups after the self-study period to perform the following:

• 그룹 구성원이 획득한 새로운 지식 및 정보(새로운 증거)의 [공유 및 평가]

• 이용 가능한 새로운 증거를 고려하여 [문제를 재분석]

• 생성된 예비 가설의 [재구성 및 개선]

• 생성된 정제된 가설을 [통합하고 적용하여] 문제 사례와 관련된 주요 문제 설명

• [문제 해결]

• Share and evaluatethe new knowledge and information (new evidence) acquired by group members

• Reanalyze the problem in the light of new evidence available

• Reformulate and refine the preliminary hypotheses generated

• Integrate and apply the refined hypotheses generated to explain the key issues related to the problem case

• Resolve the problem case

따라서 튜토리얼 세션 2의 주된 목적은 문제 사례를 설명 및 해결하기 위해 얻은 새로운 증거를 재분석, 평가, 통합 및 적용하는 것이다.

The primary purpose of tutorial session 2 is, therefore, to reanalyze, evaluate, integrate and then apply the new evidence obtained to explain and/or to resolve the problem case.

 

PBL 자습서 프로세스의 역학
DYNAMICS OF THE PBL TUTORIAL PROCESS

 

"…목적이 비판적 사고… 또는 문제 해결… 그리고 발견을 위한 민감성, 협력 및 열정과 같은 자질의 개발일 때, 토론 페다고는 상당한 이점을 제공합니다." [9].
“…when the objective is critical thinking…, or problemsolving…, and the development of qualities such as sensitivity, cooperation and zest for discovery, discussion pedagogy offers substantial advantages” [9].
 

PBL 튜토리얼 프로세스는 토론 페다고지를 이용한 상호작용적 교수 및 학습 원칙을 적용한다[9]. 소규모 그룹 학습 설계는 "공동 목표, 상호 보상, 공유 리소스 및 그룹 구성원 간의 상호 보완적 역할"로 특징지어지는 학생 중심적이고 협력적인 학습 기회를 창출합니다 [10].

The PBL tutorial process applies the principles of interactive teaching and learning using discussion pedagogy [9]. The small group learning design creates opportunities for student-centered and collaborative learning characterized by “…joint goals, mutual rewards, shared resources, and complementary roles among members of a group” [10].

이 과정은 기본적으로 학생들끼리 건설적인 대화에 참여하고 지도교사에 의해 촉진되는 학생들로 구성되는데, 주로 학생들이 아이디어와 이슈를 비판적으로 분석하고 토론하고 명확히 한 다음 상호 합의에 도달하여 문제를 설명하거나 해결하는 브레인스토밍을 통해 이루어진다. 따라서, PBL 튜토리얼 프로세스의 역학은 특히 학생들이 서로로부터 그리고 서로로부터 그리고 함께, 즉 "All teach All learn" 모드에서 가르치고 배우는 데 적극적으로 참여하는 것을 목표로 한다.
The process essentially consists of students engaged in constructive conversation among themselves and facilitated by their tutor, mainly through brainstorming in which students critically analyze, debate and clarify ideas and issues, and then mutually reach consensus to explain or resolve a problem. The dynamics of the PBL tutorial process is, therefore, specifically aimed at actively involving students in teaching and learning from and with one another, i.e. in peer teaching and learning in an “All teach All learn” mode.
 

따라서, PBL 튜토리얼 과정에서는, 학생들은 사회적 상호 작용을 통해 학습해야 하는 지식의 의미와 이해를 "이미 조직된 형태로 지식을 전달하는 것이 아니라…." [11] 동료 교육 및 학습은 그룹의 구성원들 사이에서 고차 인지 프로세스를 강화하기 위한 강력한 교육학적 전략으로 인정받고 있다. 이는 브룩필드[12]가 "…이러한 노력을 하려는 다른 그룹들에 의해 제공되는 [동료 지원peer support]은 비판적 사고 노력에 대한 강력한 심리적 밸러스트"라고 분명히 강조해 왔다.
Thus, in the PBL tutorial process, students learn through social interaction in which they are required to co-construct their own meaning and understanding of knowledge that needs to be learned, “…rather than having knowledge delivered to them in already organized form” [11]. Peer teaching and learning is recognized as a powerful pedagogical strategy to enhance higher-order cognitive processes among members of a group. This has been clearly emphasized by Brookfield [12] in his statement “…the peer support provided by a group of others also trying to do this is a powerful psychological ballast to critical thinking efforts.”

더욱이, 아베크롬비[13]에 따르면, 그러한 논의 교육학은 임상적 판단을 촉진하고, 그는 다음과 같이 분명하게 표현했다. "그룹별로 토론하는 것은 실제 사물에 대한 테스트가 [보는 것seeing]에 어떤 역할을 하는지 생각하는 데 도움이 됩니다. 전통적인 학생-교사 관계에서처럼 의심받지 않는 권위의 진술과 대조해 우리 자신의 실수를 보는 대신, 우리는 동일한 자극 패턴에 대한 다양한 해석을 보게 되며, 각각의 유용성은 그 자체로 시험되어야 한다고 말했다. 

Furthermore, according to Abercrombie [13], such discussion pedagogy promotes clinical judgment, and he has clearly expressed that “Discussion in a group does for thinking what testing on real objects does for seeing… Instead of seeing our own mistakes by contrast with the statements of an unquestioned authority, as in the traditional pupil-teacher relationship, we see a variety of interpretations of the same stimulus pattern, and the usefulness of each must be tested in its own right.”
 

 

피드백 제공 및 수신
Providing and receiving feedback

PBL에서 중요한 관행은 개인교사와 학생이 각 개인교습 세션이 [끝날 무렵에 약 10-15분을 할애하여 서로 피드백]을 제공하고 받는 것이다. 이것은 자기 자신의 행동이 다른 사람과 그룹 기능에 미치는 영향을 포함하여 자습서에서 과제의 그룹 성과와 개인 성과를 향상 또는 억제하는 요소에 초점을 맞춘다. 그러한 정기적인 피드백 세션은 학생들의 성찰적 학습의 발전을 촉진하고, 결과적으로 자기 주도적 교정 조치(즉, 메타 인식)로 이어지는 더 큰 자아 인식의 개발에 도움이 될 것으로 기대된다. 따라서, 학생들은 주어진 학습 영역에 대한 자신의 강점과 한계에 대한 개인적인 통찰력을 개발할 수 있다. Halpern[14]과 Maudsley and Strivens[15]에 따르면, 그러한 자기 인식(메타 인식)은 비판적인 사상가들의 중요한 속성이다.

An important practice in PBL is for tutors and students to devote about 10–15 minutes near the end of each tutorial session to provide and receive feedback from each other. This focusing on what factors enhanced or inhibited group achievements of tasks and individual performance in tutorials, including the perceived impact of one’s own behavior on others and on group functioning. It is expected that such regular feedback sessions help nurture the development of reflective learning in students and, consequently, the development of greater self-awareness leading to selfinitiated remedial action (i.e. metacognition). Thus, students can develop personal insights of their strengths and limitations with respect to a given area of learning. According to Halpern [14] and Maudsley and Strivens [15], such self-awareness (metacognition) is an important attribute of critical thinkers.

 

PBL: 그것의 관행을 지지하는 어떤 이론이 있나요?
PBL: ARE THERE ANY THEORIES SUPPORTING ITS PRACTICE?

맥락 학습 이론은 종종 Boud와 Feletti에 의해 강조되어 온 PBL의 주요 이론적 토대로서 주장되어 왔다. [4]: "문제 기반 학습은 학생들이 [적극적으로 참여]하고 지식을 [사용해야 할 맥락]에서 배울 때 가장 효과적이라는 믿음에 기초한다." 그러나 알바니아[10]에 따르면, 다음과 같은 PBL 전략에 대한 강력한 지원을 제공하는 다른 이론적 토대가 있다.
The Contextual Learning Theory has often been advocated as the main theoretical underpinning for PBL, which has been highlighted by Boud and Feletti [4]: “problem-based learning is grounded in the belief that learning is most effective when students are actively involved and learn in the context in which knowledge is to be used.” However, according to Albanese [10], there are also other theoretical underpinnings, which provide stronger support for the PBL strategy, including:
 

• 정보 처리 이론: 사전 지식 활성화, 인코딩 특정성(즉, 컨텍스트에서의 학습) 및 지식 상세화(즉, 활발한 토론을 위한 기회 창출)와 관련

• 협력적 학습 이론: 협력적 소그룹 학습 프로세스와 관련

• 자기 결정 이론: 학습의 외부 및 내부 동기와 관련

• 통제 이론 (인간의 행동) : 소속감, 사랑, 힘, 자유, 재미를 포함한 생존에 대한 기본적인 욕구를 충족시킴으로써 인간의 행동에 영향을 미치는 것과 관련된다.

• Information processing theory: relating to prior knowledge activation, encoding specificity (i.e. learning in context), and knowledge elaboration (i.e. creating opportunities for active discussion)

• Cooperative learning theory: relating to the process of collaborative small group learning

• Self-determination theory: relating to external and internal motivators of learning

• Control theory (of human behavior): relating to influencing human behavior (including the desire to learn) through satisfying one’s basic needs for survival, including belonging, love, power, freedom, and fun.

 

PBL: 몇 가지 문제, 과제, 기회
PBL: SOME ISSUES, CHALLENGES, OPPORTUNITIES

의료 전문가의 교육을 책임지고 학생들을 위한 학습 방법으로 PBL을 구현하는 것을 고려하고 있는 모든 기관은 교육학적 전략으로서 PBL의 강점과 한계를 명확히 이해해야 한다. 이 섹션에서는 PBL의 실행과 관련된 문제, 과제 및 기회에 대한 몇 가지 통찰력을 제공합니다. 이러한 것들이 교육과정 기획자와 개발자들의 의사 결정에 도움이 되기를 바란다.

Any institution responsible for the education of healthcare professionals and contemplating implementing PBL as a way of learning for their students must have a clear understanding of the strengths and limitations of PBL as a pedagogical strategy. This section will provide some insights on the issues, challenges, and opportunities associated with the practice of PBL. These will hopefully guide curriculum planners and developers in their decision-making.

 

커리큘럼 선택사항
Curriculum options

PBL은 20세기의 고도로 교사 지향적이고 강의 기반이며 분야별 커리큘럼의 경우와 마찬가지로 의료 전문가 교육을 위한 전체(또는 거의 전체) 커리큘럼이 PBL을 통해 설계되고 전달되는 전체(완전 또는 혈통) 커리큘럼으로 구현될 수 있다. 암스트롱은 "모든 강의를 토론 그룹이나 튜토리얼로 대체하는 것은 단지 한 쪽 편파적인 시스템을 다른 편파적인 시스템으로 대체하는 것"이라고 경고했기 때문에 이미 이 문제에 관심을 끌었다. [16]. 학생들이 다양한 학습 스타일을 가지고 있으며, PBL을 통해 학습하는 한 가지 방법만을 제공하는 것이 일부 학생들에게 불리할 수 있다는 것도 잘 알려져 있다. 여러 기관은 다른 학습 전략(예: 강의, 실습 수업)과 결합된 하이브리드 커리큘럼으로 PBL을 성공적으로 구현했다. 암스트롱은 사실 "하이브리드들은 보통 힘과 적응력을 보여준다"고 주장해왔다. [16].

PBL can be implemented as a full (complete or pedigree) curriculum in which the entire (or almost entire) curriculum for the education of healthcare professionals is designed and delivered through PBL, just as in the case of the highly teacher-directed, lecture-based and discipline-specific curriculum of the 20th century. Armstrong has already drawn attention to this issue, as she cautioned “replacing all lectures with discussion groups or tutorials would merely substitute one lop-sided system with another” [16]. It is also well recognized that students have a diversity of learning styles and offering only one way of learning through PBL may disadvantage some students. Several institutions have successfully implemented PBL as a hybrid curriculum combined with other learning strategies (e.g. lectures, practical classes). Armstrong has, in fact, made the point that “hybrids usually display strength and adaptability” [16].

 

PBL 구현
Implementation of PBL

특히 학생 교육에 있어서 20세기의 전통적인 교육과정에 이미 깊이 자리 잡고 빠져 있는 기관들에서, PBL의 실행에 있어서 신중하고 전략적인 계획이 요구된다. 다음 사항에 주의를 기울일 필요가 있다
Careful and strategic planning is required in the implementation of PBL, especially in institutions that have already been deeply entrenched and entrapped in a traditional 20th century curriculum in the education of students. Paying attention to the following will pay dividends:  

• PBL 커리큘럼을 설계하기 전에 PBL의 실무와 철학을 포함한 기본 교칙을 명확히 이해한다.

• PBL 구현이 어려운 작업이 될 수 있으므로 계획 및 개발에 대한 깊은 약속 보장

• 기초과학 위원 및 임상의원을 포함한 다양한 분야의 위원으로 구성된 PBL 위원회 구성

• 실행 전에 학생과 교사가 중요한 사고방식을 바꿀 수 있도록 준비합니다. 이는 부담스러운 작업일 수 있습니다. 무어는 이미 하버드 의과대학의 경험에서 "계획 과정 중에 상당한 저항, 회의, 노골적인 적대감이 나타났다"고 경고했다. [17]. 따라서, 학생과 교사가 PBL 과정에서 새로운 역할을 할 수 있도록 준비하기 위해 특정한 훈련과 교수진 개발 프로그램이 마련되어야 한다.

• Have a clear understanding of the basic tenets of PBL, including its practice and philosophy, before attempting to design a PBL curriculum

• Ensure a deep commitment to planning and development as implementing PBL can be a daunting task

• Form a PBL committee consisting of members from various disciplines, including members from the basic sciences as well as clinicians

• Prepare students and teachers for a significant mindset change prior to implementation; this can be an onerous task. Moore has already cautioned that, in the experience of Harvard Medical School, “considerable resistance, skepticism and outright hostility emerged during the planning process” [17]. Thus, specific training and faculty development programs must be organized to prepare students and teachers for their new roles in the PBL process.

 

PBL 튜터
The PBL tutor

"문제 기반 학습(PBL) 튜터는 PBL에서 가장 중요한 요소 중 하나입니다." [18].
“The problem-based learning (PBL) tutor is one of the most important elements in PBL” [18].

PBL 튜토리얼의 성패는 종종 PBL 튜터의 헌신과 튜터링 기술에 의해 결정된다. 뇌파를 움직이게 하고, 따라서 토론의 맥박과 톤을 조절하는 것은 튜터이다. 실제로 지도교사의 열정은 학습 과정의 촉진자 역할에서 지도교사의 열정을 반영하는 경우가 많기 때문에, 지도교사는 대개 '거울 효과'를 만들어낸다[8]. PBL 강사의 역할과 관련된 몇 가지 중요한 문제가 있는데, 여기에는 강사가 전문가가 되어야 하는지 아니면 다른 사람이 되어야 하는지 등이 포함된다. 따라서 PBL을 구현하고자 하는 기관은 "교사의 선택과 훈련… PBL의 중요한 구성요소"에 특히 주의를 기울여야 한다[18,19]. 몇몇 학자들은 PBL 강사의 역할과 선택에 대한 주장을 다루었으며, 이슈에 대한 많은 통찰력을 제공했다 [18–22].

The success or failure of PBL tutorials is often determined by the commitment and tutoring skills of the PBL tutor. It is the tutor who sets the brainwaves in motion and, therefore, the pulse and tone of discussions. In fact, the tutor usually creates a “mirror effect”, because the enthusiasm of students in tutorials often reflects the enthusiasm of the tutor in his/ her role as the facilitator of the learning process [8]. There are several important issues relating to the role of PBL tutors, including whether tutors should be experts or otherwise. Institutions intending to implement PBL must therefore pay particular attention to the “selection and training of tutors… a critical component of PBL.” [18,19]. Several scholars have addressed the arguments over the role and choice of PBL tutors and have provided much insight on the issues [18–22].  

인력지원 등 물류
Logistics, including manpower support

PBL은 광범위한 물류 지원이 필요한 고도로 자원 집약적인 교육 전략임을 인식하는 것이 중요하다. 여기에는 

• 잘 훈련되고 헌신적인 교사의 가용성 및
• 숙련되고 헌신적인 사례 작성자의 지원
• 신체적, 기술적 지원의 관점에서 볼 때론
• 적절한 튜토리얼 강의실의 가용성을 고려해야 합니다(특히 학생 수가 많을 경우).
• 적절한 기술 자원(예: 인터넷 시설)의 가용성뿐만 아니라.

It is important to appreciate that PBL is a highly resource-intensive educational strategy requiring a large range of logistical support. This includes:

the availability of well-trained and committed tutors and
the support of skilful and dedicated case writers;
from the viewpoint of physical and technical support,
one needs to consider the availability of suitable tutorial rooms (particularly when student numbers are large),
as well as the availability of appropriate technological resources (e.g. internet facilities).

지속적인 PBL 프로그램 유지
Sustaining ongoing PBL programs

기관에서 PBL의 성공적인 구현을 보장하는 것은 중요할 뿐만 아니라 지속적인 성공적인 프로그램이 유지될 수 있도록 보장해야 한다. 따라서, 학생과 지도 교사로부터 정기적인 피드백을 얻는 것은 새로 발생하는 문제를 조기에 식별하고 필요하다고 판단될 때 취해야 할 교정 조치를 위해 중요하다. PBL의 관행을 지속시키기 위해 새로운 학생 및 교사를 위한 지속적인 훈련도 포함되어야 한다.
Not only is it important to ensure the successful implementation of PBL in an institution, but one also has to ensure that an ongoing successful program can be sustained. Thus, obtaining regular feedback from students and their tutors is critical to identify emerging problems early, and for remedial action to be taken when deemed necessary. Ongoing training for new cohorts of students and teachers should also be included to help sustain the practice of PBL.

문화와 학문
Culture and learning

PBL의 기본 교리는 PBL 튜터리얼에서 공개적 토론 스타일을 필요로 하지만, 이는 좀 더 내성적인 아시아 통신 스타일과 상충될 수 있다. 비록 아시아적인 의사소통 방식이 장벽이 될 수 있고, 따라서 PBL에서의 학습에 장애가 될 수 있지만, 교사와 학생들이 PBL 과정의 역학을 알고 명확하게 이해한다면, 그것은 PBL에서의 학생 학습을 극복할 수 있고, 결과적으로 강화시킬 수 있는 문제이다. 또 다른 관련 이슈는 언어의 문제이다. 아시아의 많은 고등 교육 기관들은 비록 많은 학생들이 영어가 모국어도 아니기 때문에 영어에 능숙하지 않지만 PBL 자습서에서 영어를 사용하는 것을 선호하고 기대하고 있다. Gwee는 이미 이전 출판물에서 이러한 문제를 다루었습니다 [23].
A basic tenet of PBL is the need for an open discussion style in PBL tutorials, but this may conflict with the more reserved Asian communication style. Although the Asian communication style can be a barrier and, therefore, a hindrance to learning in PBL, it is a problem that can be overcome and, consequently, enhance student learning in PBL, if teachers and students are informed about and clearly understand the dynamics of the PBL process. Another related issue is that of language. Many higher education institutions in Asia now prefer and expect their students to use the English language in PBL tutorials, although many students lack proficiency in English, as it is neither their spoken nor national language. Gwee has already addressed these issues in a previous publication [23].

PBL: 이름은 같지만 게임은 다릅니다.
PBL: same name but different game

"…PBL은 매우 다른 방식으로 해석됩니다. 현재 PBL의 실행은 많은 다른 전략으로 특징지어진다. 한 PBL 기관의 연구 결과가 해당되지 않거나 문제 기반 접근방식을 채택한 다른 기관과 관련이 없을 수 있기 때문에 이러한 다양성은 평가와 연구에 중요한 영향을 미친다." [24].
“…PBL is interpreted in widely different ways. PBL in action is currently characterized by many different strategies. This variety has important consequences for evaluation and research since findings from one PBL institution may not be applicable or relevant to another also employing the problem-based approach” [24].

PBL은 이제 전 세계로 광범위하게 퍼져나갔고, 의학 및 다른 보건 과학 커리큘럼의 원래 한계를 넘어 다른 많은 분야로 퍼져나갔다. [25,26] 아시아의 의료 교육자들은 1990년대 중반부터 PBL을 적극적으로 채택하고 구현하기 시작했습니다 [23]. 21세기 학생들을 위한 적극적인 학습 전략으로 수많은 학문 분야와 기관에 의한 PBL의 채택은 실제로 개인 요건에 맞게 적응하도록 이끌었다. 결과적으로, 현재 서로뿐만 아니라 원래의 맥마스터 모델과는 상당히 다른 많은 다른 버전의 PBL이 존재한다. 따라서 서로 다른 기관의 PBL 실무자들이 보고한 결과 연구의 결과를 비교하면 심각한 어려움이 발생할 수 있으며 그러한 연구의 결과 해석에 많은 혼란을 초래할 수 있다[24,27,28].
PBL has now spread widely across the globe, and beyond the original confines of medicine and other health sciences curricula into many other disciplines [25,26]. Asian healthcare educators started adopting and implementing PBL with much vigor in the mid- 1990s [23]. The adoption of PBL, as an active learning strategy for students in the 21st century, by so many disciplines and institutions, led to its adaptation to suit individual requirements in practice. As a consequence, there are now many different versions of PBL which may differ quite considerably from the original McMaster model, as well as from each other. Comparisons of the results of outcome studies reported by PBL practitioners in different institutions can therefore pose serious difficulties and cause much confusion in the interpretation of the results from such studies [24,27,28].

PBL: 평가의 필요성
PBL: the need for assessment

"[설계할 필요가 있다] …PBL 원칙을 존중하고 신뢰할 수 있고 유효하며 [학생 학습에] 부정적인 조향 효과가 없는 평가 계획" [29].
“[There is a need to design] …an assessment plan that respects PBL principles, is reliable and valid, and has no negative steering effect [on student learning]” [29].

모든 교육자는 평가가 학생 학습에 미치는 영향과 "평가가 학습을 주도한다"는 일반적인 격언을 알고 있습니다. 또한 "학생들은 여러분이 기대하는 것을 존중하지 않고, 여러분이 조사하는 것을 존중한다"고 강조되어 왔다. 이러한 맥락에서 평가는 PBL 커리큘럼의 진행 중인 부분ongoing part이 되어야 한다. 
All educators are aware of the steering effect of assessment on student learning and the common adage that “assessment drives learning”. It has also been emphasized that“students don’t respect what you expect, they respect what you inspect”! In this context then, it is imperative to ensure that assessment must also be an ongoing part of any PBL curriculum.

첫째, 고차 사고 능력과 문제 해결 능력의 시험을 통합한 임상, 시나리오 기반 다중 선택 질문 유형이 목적에 적합한 학생에 의한 지식 습득(즉, 학습의 인지 영역 평가)이 필요하다. "…우리는 분명히 객관식 문제를 중요하게 생각합니다." [30,31]. 문제 해결 능력은 문제 해결 과정에서 검색을 용이하게 하기 위해 사실 지식을 구성, 맥락화 및 개념 프레임워크로 구성하는 방법에 따라 좌우된다는 점에서 적절하고 관련 있는 지식 기반을 갖는데 크게 좌우된다는 점에 유의해야 한다[30].

First, there is a need to assess knowledge acquisition by students (i.e. assessing the cognitive domain of learning) for which a clinical, scenario-based, multiple choice question type, which incorporates testing of higher-order thinking skillsand problem-solving skills would serve the purpose:“…we are unequivocally on the side of multiple-choice questions”[30,31]. It should be noted that the problem-solving ability is highly dependent on having an adequate and relevant knowledge base, in the sense that it is dependent on how factual knowledge is constructed, contextualized and organized into a conceptual framework to facilitate retrieval in the problem-solving process [30].


PBL의 평가는 단순한 인지 학습 테스트 이상의 것이어야 한다. 또한 PBL 커리큘럼의 부가 가치 결과인 정서적(태도) 영역에서 학습 결과의 평가를 포함해야 한다. 이러한 평가는 가능한 한 정확하게 주어진 상황이나 상황 또는 실제 작업 환경에서 관찰된 특정 행동과 태도에 대한 문서화를 포함해야 한다. 튜토리얼 종료 피드백 세션(셀프-피어-튜터)은 유용하고 비공식적인(형식적인) 평가 절차의 역할을 하며, 대인관계, 커뮤니케이션 및 팀워크(그룹) 기술과 관련된 특정 항목에 대한 더 공식적인(보완적인) 자아, 동료 및/또는 튜터 등급을 필요로 한다. 학습의 정서적 영역에서 그러한 평가의 주요한 한계는 본질적으로 심리학적 신뢰성과 타당성이 결여될 수 있다는 것이다. 따라서 엄격한 평가 전략의 설계 및 선택과 해당 평가에서 관련 시험 항목의 공식화에 각별한 주의를 기울여야 한다 [32].

Assessment in PBL must go beyond just testing cognitive learning—it must also include the assessment of learning outcomes in the affective (attitudes) domain, a value-added outcome of the PBL curriculum. Such assessment will need to involve, as precisely as feasible, documentation of specified observed behaviors and attitudes in a given situation or context, or in the actual work environment. The end-of-tutorial feedback session (self–peers–tutor) serves as a useful and informal (formative) assessment procedure, often with the need for more formal (summative) self, peer and/or tutor ratings on specific items relating to, for example, interpersonal, communication and team-work (group) skills. A major limitation of such assessment in the affective domain of learning is that they may inherently lack psychometric reliability and validity. Special attention must therefore be paid to the design and selection of a rigorous assessment strategy together with the formulation of relevant test items in such assessment [32].

투자수익률
Returns on investment

특히 PBL이 고도로 자원 집약적인 교육 전략이라는 관점에서 PBL로부터의 투자 수익은 상당히 논쟁적인 문제가 될 수 있다. (문헌에서 입증한) 실제 교육 결과와 (설계 원칙에서 의도한 대로), 이론적 고려에 기초한 기대 결과)를 비교함으로써 이 문제를 검토하는 것이 최선일 수 있다. PBL은 학습자 중심, 협업, 맥락, 통합, 자기 주도 및 성찰적 학습을 개선하고 최적화하는 것을 목표로 하기 때문에 많은 교육자들은 PBL의 교육 결과에 큰 기대를 걸고 있다. 따라서 PBL의 교육 성과는 단순한 지식 획득을 넘어설 것으로 예상된다. PBL은 대인관계, 커뮤니케이션, 팀워크, 리더십 등 정서적인 학습 영역의 '부드러운' 기술뿐만 아니라 비판적 사고와 추론의 고차원의 인지 능력, 문제 해결 능력을 포함한 보다 지속적인 교육 과정과 삶의 기술을 학생들에게 제공할 것으로 기대할 수 있다.

The returns on investment from PBL can be quite a contentious issue, especially in view of PBL being a highly resource-intensive educational strategy to implement. Perhaps it is best to review this issue through a comparison of the actual educational outcomes (as substantiated in the literature) with the expected educational outcomes (as intended in the design principles, i.e. the expected outcomes based on theoretical considerations). Many educators have great expectations of the educational outcomes from PBL because it is aimed at enhancing and optimizing learner-centered, collaborative, contextual, integrated, self-directed, and reflective learning. Educational outcomes from PBL are therefore expected to go beyond just knowledge acquisition. PBL can be expected to equip students with a more enduring educational process and life skills, including the higher-order cognitive skills of critical thinking and reasoning, and problem-solving, as well as “soft” skills in the affective domain of learning such as interpersonal, communication, team-work, and leadership.

그러나, 문헌의 검토는 PBL의 실제(문학에서 보고된 바와 같이) 교육 결과와 예상(사용된 교육 전략에 근거) 교육 결과 사이에 불일치가 있음을 강력히 시사한다. 실제로 과거의 여러 연구는 학생들이 고차적 사고를 위해 시험받는 경우에도, 전통적인 접근법의 학생과 PBL 커리큘럼의 학생 사이에 일반적으로 [지식 습득 및 임상 기술 차이가 거의 없거나 전혀 없다]고 결론지었다 [33]. 그의 사설에서 노먼은 이 문제에 대한 비판적이고 훌륭한 개요를 제공했는데, 특히 "…개념이 어떻게 학습되는가"와 관련하여 "……PBL을 넘어설 수 있는 것"에 관심을 끌었다. 그럼에도 불구하고, Norman은 "해결책은 전통적인 학문적 교육과정으로의 복귀를 옹호하는 것이 아니다"라고 분명히 말했다. [34]. 그러나, 알바니아어 진술에서 증명된 바와 같이, 학생 대인관계 기술의 습득과 PBL 커리큘럼을 통한 학습의 즐거움은 잘 문서화되어 있다. "PBL에 의해 지식 습득과 임상 능력이 향상되지 않더라도 PBL과 함께 꾸준히 발굴해 온 학생과 교직원의 업무 환경 강화가 가치 있는 목표이다."

However, a review of the literature strongly suggests that there is a mismatch between the actual (as reported in literature) and expected (based on educational strategies used) educational outcomes from PBL. In fact, several studies in the past have concluded that there is generally little or no difference in knowledge acquisition and clinical skills between students from traditional approaches and those from PBL curricula, even when students are tested for higher-order thinking [33]. In his editorial, Norman provided a critical and excellent overview on this issue [34], in particular drawing attention to “…what may lie beyond PBL” with respect to “…how concepts are learned”. Nevertheless, Norman clearly stated that “the solution is not advocacy of return to a traditional, discipline oriented curriculum” [34]. However, student acquisition of interpersonal skills and the joy of learning from a PBL curriculum are well documented, as attested to in the statement of Albanese: “Even if knowledge acquisition and clinical skills are not improved by PBL, the enhanced work environment for students and faculty that has been consistently found with PBL is a worthwhile goal” [35].

• 주목할 점은 고씨 등이 "…의대 문제 기반 학습이 졸업 후 의사 역량에 미치는 영향에 대한 증거"[36]를 검색한 최근의 체계적인 검토가 이루어졌다는 점이다. 저자들은 "…의대 시절 PBL은 주로 사회적, 인지적 차원에서 졸업 후 의사 역량에 긍정적인 영향을 미친다"고 결론지었다.
• 노먼은 고 씨와 그의 동료들의 연구에 대한 논평에서 "우리는 수년간 문제 기반 학습의 상대적 장점과 약점에 대한 논쟁을 견뎌왔다. 이제 이 방법이 중요하다는 좋은 증거가 있습니다. 다음 단계는 이 방법이 왜 효과가 있는지 결정하는 것입니다." [37]
• 마찬가지로, Wood는 "리뷰는 (대부분의 교육자들이 기존의 학습과 비교하여) 문제 기반 학습이 학부 의학적 교육의 일부 심리학적 결과에 일부 유익한 영향을 미친다는 (수백 개의 덜 엄격한 보고서에 기초하여) 믿음을 확인시켜 준다"고 표현했다. [38]

It is noteworthy that a more recent systematic review was undertaken by Koh et al in which they searched for “…evidence of the effects that problem-based learning in medical school had on physician competencies after graduation” [36]. The authors concluded that PBL “…during medical school has positive effects on physician competency after graduation, mainly in social and cognitive dimensions.”

In his commentary on the work of Koh and his colleagues, Norman expressed that, “For years we have endured debate about the relative merits and weaknesses of problem-based learning. Now there is good evidence that the method delivers on some very important issues. The next step is to determine why the method works.” [37].

Similarly, Wood expressed “The review confirms what most educators have come to believe on the basis of hundreds of less rigorous reports that, compared with traditional learning, problem-based learning has some beneficial effects on some psychosocial outcomes of undergraduate medical education” [38].

 

과제들
Challenges

PBL은 여러 학습 원리를 결합한 전략적 학습 시스템 설계를 나타내며 교육 이론과 원칙에 의해 강하게 뒷받침되지만 [10] 돌맨스 외 연구진도 "…교육 실무에서 너무 지시적인 교사, 너무 잘 구조화된 문제, 그리고 제대로 작동하지 않는 그룹 등과 같은 문제에 직면하는 경우가 많다"고 지적했다. [39]. 따라서, PBL의 성공적인 구현에 대한 가장 큰 과제는 21세기 의료 전문가 교육에 유익한 결과를 가져오는 일관된 실천으로 PBL의 핵심 학습 원칙을 성공적으로 결합하는 최선의 방법이다. (위에서 논의한 바와 같이) PBL의 실무에 영향을 미치는 중요한 문제는 이러한 맥락에서 몇 가지 지침을 제공해야 한다.
Although PBL represents a strategic learning system design which combines several learning principles and is strongly underpinned by educational theories and principles [10], Dolmans et al also pointed out that “…in educational practice, problems are often encountered, such as tutors who are too directive, problems that are too well structured, and dysfunctional tutorial groups”[39]. Thus, the greatest challenge to the successful implementation of PBL is how best to successfully combine the key learning principles of PBL into a coherent practice which would result in beneficial outcomes in the education of healthcare professionals in the 21stcentury. Important issues, which impact on the practice of PBL (as discussed above), should provide some guidance in this context.

Wood[38]는 훨씬 더 근본적인 문제를 제기하였다. Wood가 제기한 과제는 다음과 같다: "소통 기술과 심리사회적 영역에서 가르치고 배우는 것은 여러 가지 방법으로 달성될 수 있으며, [적시에 건설적인 피드백과 함께 소규모 그룹으로 일하는 것]은 [문제 기반 학습]만큼 효과적일 수 있습니다." [38]. 그렇다면, 문제는, 우리가 [여전히 정서적 영역에서 학생 학습을 육성하기 위해 PBL 전략을 채택하고 구현할 필요가 있는가] 하는 것이다.

Wood [38] has raised an even more fundamental issue. The challenge posed by Wood is in her statement: “Teaching and learning in communication skills and the psychosocial domains can be achieved in many ways, and working in small groups—coupled with timely and constructive feedback—may be just as effective as problem-based learning” [38]. The question is, then, do we still need to adopt and implement a PBL strategy to nurture student learning in the affective domain?

 

기회
Opportunities

"21세기에 필요한 대학을 만들기 위해서는… 우리는 의식적으로 교육 패러다임을 거부하고 학습 패러다임에 기초하여 우리가 하는 일을 재구성해야 한다." [41]
“To build the colleges we need for the 21st century… we must consciously reject the Instruction Paradigm and restructure what we do on the basis of the learning paradigm” [41].

"[의대] 학교는 관심 있는 교수진의 긴밀한 지도 아래 능동적이고 자기 주도적인 학습을 경험의 핵심으로 만드는 진정한 학습자 중심의 환경을 아직 만들지 못했습니다." [42].

“[Medical] Schools have yet to create a truly learnercentered environment that makes active, self-directed learning under the close tutelage of interested faculty members the core of the experience” [42].

교육 패러다임의 큰 전환이 필요하다는 데 전통적인 교사 주도형 교육에서 학생 중심의 학습으로 전 세계적인 공감대가 형성되고 있다. 주요 패러다임의 변화는 학생들이 21세기에 세계화된 지식 기반 경제의 요구와 과제를 충족시킬 수 있는 더 나은 교육 준비를 제공할 것으로 기대됩니다 [41,42]. 이러한 맥락에서, PBL은 거의 40년 동안 시간의 시험을 견뎌온 고도로 학생 중심적인 학습 패러다임을 나타내며, 여전히 전 세계로 널리 퍼지고 있다(일부 비판에도 불구하고). [22]. 이 기간 동안 지속된 다른 교육 혁신은 없는 것으로 알려졌다.
There is now global consensus on the need for a major shift in the educational paradigm, from the traditional teacher-directed instruction to more student-centered learning. The major paradigm shift is expected to provide better educational preparation for students to meet the demands and challenges of a globalized knowledge-based economy in the 21stcentury [41,42]. In this context then, PBL represents a highly student-centered learning paradigm that has stood the test of time for almost four decades now, and is still spreading widely across the globe (some criticisms notwithstanding) [22]. No other educational innovation is known to have lasted this period of time.


따라서, PBL은 의료 전문가 및 학생의 교육자에게 학생의 학습 성과와 학습 과정에 대한 학생의 적극적인 참여에 중점을 두고 교육을 설계하고 전달할 수 있는 훌륭한 기회를 제공합니다. 또한, 전략적 학습 시스템 설계로서, PBL은 PBL에서 기대하는 학습 결과에 더 많은 교육적 가치를 더하는 협업, 상황별, 통합적, 자기 주도적 및 성찰적 학습을 개선하고 최적화하는 것을 목표로 한다.

Therefore, PBL offers educators of healthcare professionals and students excellent opportunities to design and deliver instruction to their students with a primary focus on student learning outcomes and on active student participation in the learning process. Moreover, as a strategic learning system design, PBL is also aimed at enhancing and optimizing collaborative, contextual, integrated, self-directed, and reflective learning which add further educational value to the learning outcomes expected from PBL.

 

결론
CONCLUSION

"의학 교육의 중심 사명은 [의사가 제공하는 의료 서비스의 질을 향상시키는 것]입니다… 환자가 기술을 습득하는 가운데, 의사가 무엇을 하고, 어떻게, 언제 하는지는 의학교육의 질에 달려 있습니다. 우리는 이것을 제대로 해야 한다" [43].

“The central mission of medical education is to improve the quality of health care delivered by doctors… [with] patients as the recipients of our skills… what doctors do, and how and when they do it, depends on the quality of medical education. We need to get it right” [43].

PBL은 본질적으로 전통적인 교사 주도(교사 중심) 교육에서 학생 중심(학습자 중심) 학습으로 교육 패러다임의 큰 변화를 나타내는 전략적 학습 체계로, 21세기 학생들의 교육 준비에 더 적합하다고 여겨지는 패러다임이다. PBL의 구현은 매우 어려운 작업이 될 수 있다. PBL의 강점과 한계에 대한 명확한 이해뿐만 아니라 학생과 교사들의 사고방식에도 상당한 변화가 필요하다. [7,17,44] PBL의 시행은 특히 시행 초기에는 교사와 학생 모두에게 불편과 동요를 포함하여, 일부 어려움을 야기시킬 수 있으며, 그러한 기관들은 전통적인 교사 주도적이고 고도로 규율이 높은 특정 커리큘럼에 깊이 자리 잡고 관여할 수 있다.
PBL is essentially a strategic learning system which represents a major shift in the educational paradigm from the traditional teacher-directed (teacher-centered) instruction to student-centered (learner-centered) learning, a paradigm considered more appropriate for the educational preparation of students in the 21stcentury. Implementation of PBL can be a tremendously daunting task: not only will it require a clear understanding of the strengths and limitations of PBL, but also a significant change in the mindsets of students and teachers [7,17,44]. Implementation of PBL is likely to cause some difficulties, including discomfort and agitation to both teachers and students, especially in the early phase of its implementation, and in those institutions deeply entrenched and entrapped in the traditional teacher-directed and highly disciplinespecific curriculum.


의료 전문가의 교육자로서, 학생들이 원하는 지식, 기술 및 미래의 전문적 실무에 대한 태도를 배우고 습득하는 것을 가장 잘 설계하고 전달하는 것은 우리의 책임입니다. 우리는 학생들을 육성하고 그들이 유능하고 배려하며 윤리적인 의료전문가가 되기 위해 원하는 "마음, 행동, 행동 습관"을 개발할 수 있도록 도와야 한다. PBL은 21세기의 학생 학습에 활력을 불어넣기 위해 보다 전체적인, 부가가치 및 양질의 교육을 제공할 수 있다. 의료 분야의 학생들에 대한 PBL의 혜택을 최적화하고 국가의 의료 향상에 기여하기 위해, 우리는 제대로 할 필요가 있다.
As educators of healthcare professionals, it is our responsibility to design and deliver instruction to our students which best enhances their learning and acquisition of desired knowledge, skills, and attitudes for their future professional practice. We should nurture our students and help them develop the desired “habits of mind, behavior and action”to become competent, caring, and ethical healthcare professionals. PBL can offer a more holistic, value-added and quality education to energize student learning in the 21stcentury. To optimize the benefits from PBL for students in the healthcare professions and to contribute to the improvement of the healthcare of a nation, we need to do it right.


만약 우리가 미래의 의료 전문가들을 가르치는 교육자로서 우리의 책임을 잘 완수하지 못한다면, 그것은 우리의 학생들뿐만 아니라 우리 사회와 우리 자신을 위해서도 끔찍한 결과를 초래하게 될 것이다: 에반스가 분명히 표현했다:

"어려움을 극복하는 것을 말하기는 쉽다. 하지만 우리는 노력을 해야 합니다. 그렇지 않으면 졸업생들은 우리의 지식만 갖고, 이해력은 거의 없고 응용, 분석, 합성, 평가 능력도 훨씬 더 떨어질 것이다. 우리가 학생들을 위한 학습 환경을 개선하기 위해 어떤 조치를 취할 수 있는가를 선택하지 않는다면, 그들의 잠재력은 부분적으로만 실현될 것이고, 우리 자신의 눈과 사회의 눈에 대한 우리의 지위는 줄어들 것이고, 궁극적으로는 사회 자체가 더 가난해질 것이다" [45].

If we fail to complete our responsibility well as educators of future healthcare professionals, it will result in dire consequences, not only for our students, but also for our society and for ourselves, as clearly expressed by Evans:

“overcoming difficulties is easier said than done. But we must make the effort, or graduates will leave our institutions full of knowledge, but with little comprehension and even less ability to apply, analyze, synthesize or evaluate. Unless we take what steps we can to improve the learning environment for our students, their potential will only be partly realized, our standing in our own eyes and in the eyes of society will be diminished and, ultimately, society itself will be the poorer” [45].

 

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Kaohsiung J Med Sci. 2009 May;25(5):231-9.

 doi: 10.1016/S1607-551X(09)70067-1.

Problem-based learning: a strategic learning system design for the education of healthcare professionals in the 21st century

Matthew Choon-Eng Gwee 1

Affiliations collapse

Affiliation

• 1Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. phcmgce@nus.edu.sg

• PMID: 19502143

 

• DOI: 10.1016/S1607-551X(09)70067-1

Free article

Abstract

Problem-based learning (PBL) was first implemented by McMaster University medical school in 1969 as a radical, innovative, and alternative pathway to learning in medical education, thus setting a new educational trend. PBL has now spread widely across the globe and beyond the healthcare disciplines, and has prevailed for almost four decades. PBL is essentially a strategic learning system design, which combines several complementary educational principles for the delivery of instruction. PBL is specifically aimed at enhancing and optimizing the educational outcomes of learner-centered, collaborative, contextual, integrated, self-directed, and reflective learning. The design and delivery of instruction in PBL involve peer teaching and learning in small groups through the social construction of knowledge using a real-life problem case to trigger the learning process. Therefore, PBL represents a major shift in the educational paradigm from the traditional teacher-directed (teacher-centered) instruction to student-centered (learner-centered) learning. PBL is firmly underpinned by several educational theories, but problems are often encountered in practice that can affect learning outcomes. Educators contemplating implementing PBL in their institutions should have a clear understanding of its basic tenets, its practice and its philosophy, as well as the issues, challenges, and opportunities associated with its implementation. Special attention should be paid to the training and selection of PBL tutors who have a critical role in the PBL process. Furthermore, a significant change in the mindsets of both students and teachers are required for the successful implementation of PBL. Thus, effective training programs for students and teachers must precede its implementation. PBL is a highly resource-intensive learning strategy and the returns on investment (i.e. the actual versus expected learning outcomes) should be carefully and critically appraised in the decision-making process. Implementation of PBL can be a daunting task and will require detailed and careful planning, together with a significant commitment on the part of educators given the responsibility to implement PBL in an institution. PBL can offer a more holistic, value-added, and quality education to energize student learning in the healthcare professions in the 21st century. Successful implementation of PBL can therefore help to nurture in students the development of desired "habits of mind, behavior, and action" to become the competent, caring, and ethical healthcare professionals of the 21st century. Thus, PBL can contribute to the improvement of the healthcare of a nation by healthcare professionals, but we need to do it right.