Effects of tutor-related behaviours on the process of problem-based learning

Impact of Clinical Anatomy Peer Mentorship Program on Student Leaders: A Mixed-Methods Study

INTRODUCTION

Clinical Anatomy Mentorship Program (CAMP) was developed as a student-led approach to providing hands-on surgical experience and mentorship to third-year medical students during their surgery clerkship at an academic institution. Fourth-year medical students were selected to lead these educational events, teaching underclassmen surgical curriculum and skills in a near-peer method of clinical teaching.

METHODS

A focus group and survey were administered to the fourth-year medical students who served as CAMP leaders from fall 2021 to spring 2022 to assess how their leadership role impacted their personal and professional development.

RESULTS

A 10-question survey was administered to 19 students, with 14 responding, for a response rate of 74%. Serving as a mentor facilitated the development of students' professional interests, including increased interest in future teaching roles (93%) and leadership positions (86%), particularly as surgical clerkship director (70%) and program director (90%). All students reported that their involvement in CAMP increased their confidence in teaching and surgical knowledge, and 86% reported improved surgical skills. A subset analysis of seven CAMP leaders via the focus group demonstrated several reported benefits to serving as a peer mentor in CAMP, including increased interaction with peers, improved sense of comradery and support, more authentic peer-mentorship connections, and increased confidence and perceived preparedness for surgical residency.

CONCLUSIONS

The confidence, leadership, and improved surgical knowledge and skills obtained through the CAMP leadership role led to improved personal and professional development of student leaders.

Measuring Personalization, Embodiment, and Congruence in Online Learning: A Validation Study

PURPOSE

Instructional designs promoting personalization (conversational style and visible author), embodiment (human-like mannerisms and presence), and social and cognitive congruence have been shown to enhance learning. However, measurements of these instructional design features are lacking. The authors sought to develop and validate an instrument to measure personalization, embodiment, and congruence in an online course, collecting evidence of content, internal structure, and relationships with other variables.

METHOD

Through literature review, expert review, and pilot testing, the authors developed a 15-item, 5-domain instrument. Participants completed this instrument along with assessments of motivation (Instructional Materials Motivation Survey and Motivated Strategies for Learning Questionnaire), knowledge, and course satisfaction immediately after a 30-minute online multimedia learning module comprising slides with voiceover and (for some participants) short video clips, from January to April 2021. Participants included pharmacists, physicians, and advanced practice providers at academic and community hospitals. Confirmatory factor analysis (CFA) was used to examine model fit, followed by structural revisions guided by exploratory factor analysis (EFA) and tested in a new CFA using a split-sample approach. The authors evaluated associations between the revised instrument scores and motivation, knowledge, and satisfaction.

RESULTS

There were 406 participants. CFA of the original 15-item instrument revealed poor model fit. EFA using 214 randomly selected participants suggested a 2-domain structure. CFA of the revised structure using the other 192 participants revealed good fit for a 9-item, 2-domain instrument: the Congruence-Personalization Questionnaire (CPQ). Linear regression confirmed positive, statistically significant associations for most hypothesized relationships (R 2 ≥ 0.12 and P < .001 for 14 of 18 associations with motivation and satisfaction). Associations with knowledge were weak and nonsignificant (R 2 ≤ 0.004, P > .23).

CONCLUSIONS

Evidence of content, internal structure, and relationships with other variables support the validity of CPQ scores for measuring personalization and congruence in an online module.

Near-peer teaching in problem-based learning: Perspectives from tutors and tutees

INTRODUCTION

This study explores how tutors and tutees perceived their teaching and learning experience in a near-peer teaching programme within a formal undergraduate medical-education curriculum.

METHODS

This mixed-methods study was conducted in an Asian medical school. First, a survey was administered to two groups of students, one that had been tutored by near-peers, and another with faculty tutors. Then, the near-peer tutors were interviewed and wrote reflection essays that the researchers collected. Quantitative analysis was used to analyse the survey responses, and qualitative analysis to analyse the interview and reflection data.

RESULTS

Our study found no difference between near-peer tutees' and faculty tutees' perceptions of either tutor facilitation or tutor behaviours. Also, when near-peer tutors explained how their experience of delivering tutoring had influenced their professional-identity formation, they highlighted that they had gained skills important to their future careers as medical educators.

CONCLUSION

Integrating near-peer teaching into undergraduate medical curricula could be beneficial to both tutors and tutees because of the social, cognitive, and professional congruence between these two groups, and due to its likely positive influence on their professional-identity formation.

Problem based learning in radiography education: A narrative review

OBJECTIVES

Radiography practice is fast developing with new imaging updates and challenging scenarios to deal with on a frequent basis. There is a need to equip students with the skill to be independent learners and develop critical thinking skills, so they can change their practice as the profession evolves. Problem Based Learning (PBL) has widely been adopted in medical and nursing training worldwide as a result of its desirable benefits. In order to ascertain the efficacy of the technique, this paper presents a review of the essential aspects of PBL, such as the theories, process, key roles and implication for radiography education and practice.

KEY FINDINGS

The use of a defined model provides a useful structure to the PBL exercise with the addition of reflection, which is a pertinent inclusion within the process. The role of the facilitator in PBL is significant to students' learning as they help guide the students to the learning outcomes and provide support to the group; however, their skills development is an important factor to consider in PBL.

CONCLUSION

This teaching approach has key benefits in radiography education and training in particular, its impact on preparing students for autonomous clinical practice.

IMPLICATIONS FOR PRACTICE

The application of PBL in developing students' critical thinking and decision-making abilities support the narrowing of the spoon-feeding expectation of students and render it a useful pedagogical implementation within radiography programmes.

Effect of constant versus variable small-group facilitators on students' basic science knowledge in an enquiry-based dental curriculum

INTRODUCTION

The role of small-group facilitators is of pivotal importance for the success of curricula based on active learning. Disorganised tutorial processes and superficial study of the problem have been identified as main hindering factors for students' learning. The aim of this study was to evaluate the influence of consistency of facilitation on students' performance in knowledge-based basic science assessments in a hybrid, enquiry-based (EBL) undergraduate dental curriculum.

MATERIALS AND METHODS

This was a retrospective study of 519 first- and second-year undergraduate dental students, enrolled at Peninsula Dental School between 2013 and 2018. Twice in each academic year, students sat a 60-item single-best-answer, multiple-choice examination. Percentage and Z-scores were compared between students whose EBL groups had the same facilitator throughout the academic year, and those whose EBL group was facilitated by different members of staff. All EBL facilitators were dentally qualified but with different levels of expertise in basic dental sciences, prior EBL facilitation, involvement in the curriculum design and university affiliation.

RESULTS

No statistically significant difference was observed in the percentage or Z-scores of students whose EBL sessions were supported by consistent or variable facilitators in any of the 18 MCQ tests. Z-scores of first-year students were more variable than for second-year students. In addition, pairwise comparisons revealed no statistically significant differences in students' Z-scores between any of the permanent facilitators' groups.

CONCLUSIONS

The results of our study may influence the design and delivery of enquiry-based curricula as well as human resources management by shifting the focus from maintaining facilitator consistency to ensuring comparable training and approaches across facilitators.

Cognitive and social congruence in peer-assisted learning - A scoping review

This scoping review presents an overview of cognitive and social congruence in peer assisted learning (PAL), as the positive effects of PAL have been shown to rely on these critical factors. The scoping review followed the guidelines of the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Databases were systematically searched for articles that focus on PAL and cognitive and social congruence. Participants of the studies included were medical, health science, polytechnic, law and paramedic students. Studies that assessed cognitive and social congruence by questionnaires with a 5-point Likert scale were regarded for meta-analytic pooling. Sixteen of 786 identified articles were included in the review, whereof 9 studies were considered for meta-analytic pooling. The meta-analytic pooling showed that tutees tend to see their student tutors as cognitively (M_weighted = 3.84; range of M_weighted= 2.69–4.56) and socially congruent (M_weighted = 3.95; range of M_weighted = 2.33–4.57). Further, characteristics of student tutors are summarized. This scoping review presents an overview and operationalization of cognitive and social congruence in PAL. Based on the presented meta-analytic pooling, cognitive and social congruence were found to represent relevant key factors in the PAL context. Thus, this theoretical background should be acknowledged as a core concept for tutorials within the medical curriculum.

Influence of critical thinking disposition on the learning efficiency of problem-based learning in undergraduate medical students

BACKGROUND

Problem-based learning (PBL), a pedagogical approach, is widely accepted in medical education. Manipulated by many factors, the internal motivation of learner is the most crucial determinant that affects the nature of the outcome, in which the influences of critical thinking (CT) remained elusive.

METHODS

One hundred two third-year undergraduate medical students at Peking University were involved in this study. A Chinese version of the Critical Thinking Disposition Inventory (CTDI-CV) was used to assess the CT disposition, and the performance scores of students in PBL tutorials were compiled. A parametric bivariate correlation analysis was performed between the students' CT scores and their PBL average scores. The PBL scores were compared between the strong and weak CT disposition groups using independent t-test. The analysis of numerical data was conducted using SPSS 16.0.

RESULTS

CT disposition of third-year undergraduate medical students at Peking University was at a positive level, with an average score of 297.72. The total CT scores had a positive correlation with the scores of the PBL performance and its five dimensions significantly. In the majority, students with Strong-CT disposition obtained higher scores in PBL tutorials compared with students with Weak-CT disposition. The performance of these two groups was significantly different in the Late-Half but not in the Early-Half PBL tutorials. Furthermore, a significant improvement was observed in the students with strong CT but not weak CT dispositions.

CONCLUSION

CT disposition positively correlates to a students' PBL performance. Students with stronger CT dispositions perform better in the PBL process and obtain higher scores. Our work suggested that the open-mindedness of the CT disposition is the primary factor that determines the improvement of the preparation dimensions in the PBL process.

How do undergraduate STEM mentors reflect upon their mentoring experiences in an outreach program engaging K-8 youth?

BACKGROUND

Many university students are becoming involved in mentoring programs, yet few studies describe the impact of mentoring on the mentor. Additionally, many studies report that students graduating from college are not prepared to enter the workforce in terms of key career skills and/or content knowledge. Herein, we examine the impact of our program, NE STEM 4U (Nebraska Science, Technology, Engineering and Math for You), in which undergraduate (UG) mentors engage K-8 youth in after-school STEM experiments. The UGs reflected upon their experiences using post-mentoring evaluations, 12- and 24-week interviews, and exit surveys. Many of the questions asked of the mentors related directly to their own professional development, such as self-evaluation of communication, organization, and problem-solving skills, while other questions related to content knowledge and reflection.

RESULTS

Post-mentoring, UGs reflected on the delivery/teaching significantly more (p ≤ 0.001 for each) than other variables (i.e., their own content knowledge gains, the students' content knowledge gains, scaffolding the lessons, or overall professional growth). By analyzing the evaluations and interviews together, some significant, self-reported gains emerged. For example, 94.15% of the UG reported that the experience was beneficial to their education. Additionally, UG mentors self-reported significant gains (p ≤ 0.01 for each) moving from 12- to 24-weeks in the program in the categories of organization, STEM content knowledge, preparedness to teach, and engagement in the program. However, UG did not report significant gains in dependability. Importantly, when mentors ranked themselves at 24-weeks, they were blinded to (unaware of) the ranking they gave themselves at 12-weeks.

CONCLUSIONS

This study helps to fill a gap in the literature by providing insight into the gains UG mentors report attaining after mentoring to K-8 students. These data suggest that participation by UGs in this program promoted self-reflection as well as self-reported gains related to career preparedness and STEM content knowledge.

To what extent can PBL principles be applied in blended learning: Lessons learned from health master programs

INTRODUCTION

Maastricht University has been actively exploring blended learning approaches to PBL in Health Master Programs. Key principles of PBL are, learning should be constructive, self-directed, collaborative, and contextual. The purpose is to explore whether these principles are applicable in blended learning.

METHODS

The programs, Master of Health Services Innovation (case 1), Master Programme in Global Health (case 2), and the Master of Health Professions Education (case 3), used a Virtual Learning Environment for exchanging material and were independently analyzed. Quantitative data were collected for cases 1 and 2. Simple descriptive analyses such as frequencies were performed. Qualitative data for cases 1 and 3 were collected via (focus group) interviews.

RESULTS

All PBL principles could be recognized in case 1. Case 2 seemed to be more project-based. In case 3, collaboration between students was not possible because of a difference in time-zones. Important educational aspects: agreement on rules for (online) sessions; visual contact (student-student and student-teacher), and frequent feedback.

CONCLUSION

PBL in a blended learning format is perceived to be an effective strategy. The four principles of PBL can be unified in PBL with a blended learning format, although the extent to which each principle can be implemented can differ.

Problem-Based Learning as an Effective Learning Tool in Community Medicine: Initiative in a Private Medical College of a Developing Country

BACKGROUND

Knowledge of community medicine is essential for health care professionals to function as efficient primary health care physicians. Medical students learning Community Medicine as a subject are expected to be competent in critical thinking and generic skills so as to analyze community health problems better. However, current teaching by didactic lectures fails to develop these essential skills. Problem-based learning (PBL) could be an effective strategy in this respect. This study was hence done to compare the academic performance of students who were taught Community Medicine by the PBL method with that of students taught by traditional methods, to assess the generic skills of students taught in a PBL environment and to assess the perception of students toward PBL methodology.

MATERIALS AND METHODS

This study was conducted among seventh-semester final-year medical students between June and November 2014. PBL was introduced to a randomly chosen group of students, and their performance in an assessment exam at the end of postings was compared with that of the remaining students. Generic skills and perception toward PBL were also assessed using standardized questionnaires.

RESULTS

A total of 77 students took part in the brainstorming session of PBL. The correlation between self-assigned scores of the participants and those assigned by the tutor in the brainstorming session of PBL was significant (r = 0.266, P = 0.05). Out of 54 students who took part in the presentation session, almost all 53 (98.1%) had good perception toward PBL. Demotivational scores were found to be significantly higher among males (P = 0.024). The academic performance of students (P < 0.001) and success rates (P = 0.05) in the examination were higher among students who took part in PBL compared to controls.

CONCLUSION

PBL helped improve knowledge of students in comparison to those exposed only to didactic lectures. As PBL enabled students to identify the gaps in their knowledge and enhanced their group functioning and generic skills, we recommend PBL sessions: They would help optimize the training in Community Medicine at medical schools. Good correlation of tutor and self-assessment scores of participants in the brainstorming session suggests that the role of tutors could be restricted to assessment in presentation sessions alone. Demotivation, which hinders group performance in PBL, needs to be corrected by counselling and timely feedback by the tutors.

Group interaction in problem-based learning tutorials: a systematic review

INTRODUCTION

This review aimed at identifying studies on group interaction in problem-based learning (PBL) and elucidate methods used, factors affecting group interaction and the relationship between interaction and student's learning.

MATERIALS AND METHODS

PubMed, EMBASE, PsycINFO and HighWire were searched (January 1999 to June 2013) using a combination of pre-specified search terms. The search words were also used in searching nine journals in dental and medical education. Also edited research books on PBL were searched. Both qualitative and descriptive studies of group interaction were selected and critically appraised.

RESULTS

Finally, 42 of 10,606 papers were included (35 journal articles and seven from research books). The materials used in assessing group interaction varied depending on the methodology design. Forty-three percent of the studies used video recording to evaluate group interaction. Other studies used indirect approaches such as focus groups, interviews and questionnaires. Factors affecting group interactions were students' and tutors' perceptions, tutor's subject-matter expertise, training students, tutor's group dynamics. There was no conclusive evidence about the impact of interaction in PBL on learning. Most studies were from medicine (64%), and 35 papers were published in the last 10 years. The majority of studies were conducted in Europe, North America and Asia.

CONCLUSIONS

Although there is a progressive increase in publications on PBL group interaction during the last 10 years, there are knowledge gaps and deficiencies in this area and most studies are lacking solid theoretical basis and are descriptive. There is a deficiency in the literature in this area from dentistry and other allied health disciplines.

Brazilian medical students' perceptions of expert versus non-expert facilitators in a (non) problem-based learning environment

BACKGROUND

In problem-based learning (PBL), the facilitator plays an important role in guiding the student learning process. However, although content expertise is generally regarded as a useful but non-essential prerequisite for effective PBL facilitation, the perceived importance of content knowledge may be subject to cultural, contextual, and/or experiential influences.

AIM

We sought to examine medical students' perceptions of subject-matter expertise among PBL facilitators in a region of the world (Brazil) where such active learning pedagogies are not widely used in university or pre-university settings.

RESULTS

Of the 252 Brazilian medical students surveyed, significantly (p≤0.001) greater proportions viewed content expert facilitators to be more effective than their non-expert counterparts at building knowledge (95% vs. 6%), guiding the learning process (93% vs. 7%), achieving cognitive learning (92% vs. 18%), generating learning goals (87% vs. 15%), and motivating self-study (80% vs. 15%).

DISCUSSION/CONCLUSION

According to Brazilian medical students, subject-matter expertise among PBL facilitators is essential to the learning process. We believe this widespread perception is due, in large part, to the relative lack of prior educational exposure to such pedagogies.

To what extent do tutor-related behaviours influence student learning in PBL?

The purpose of this study was to investigate how tutor behaviours influence learning in problem-based learning (PBL). A previous study had indicated a significant influence of the tutor's social congruent behaviour on the PBL process and this study further investigates this finding by examining two groups of tutors displaying differences in social congruence. The participants were 77 students under the tutelage of four tutors and a self-report questionnaire ranked two tutors to be more socially congruent as compared to the other two. Student learning was measured by a concept recall test and the results from the analysis of covariance indicated a significant impact of the tutor's social congruent behaviour on learning after the problem analysis phase but not on the self-directed learning and reporting phases. It was concluded that the academic abilities of students and the small number of tutors involved may have affected the results, which led to the second part of this study. A group of 11 tutors were selected and the impact of their behaviours on student achievement measured by the module grade was examined. Results indicated that the tutor behaviours had a greater influence on average students as compared to the academically stronger and weaker students. This finding suggests that students who are academically stronger are not as reliant on the tutor while average students may depend more on the tutor to guide and motivate them in order to achieve the learning goals.

Student feedback on problem-based learning processes

BACKGROUND

Problem-based learning (PBL) sessions consist of a brainstorming phase, search phase, individual study, and reporting phase. At the Xavier University School of Medicine, Aruba, PBL is a new learning modality first introduced in May 2013.

AIMS

PBL processes have not been studied previously at the Xavier University School of Medicine, hence the present study was carried out to obtain information about the PBL processes and note differences, if any, among different groups of students.

METHOD

The study was conducted among first- to fourth-semester undergraduate medical students during July 2014 using a previously validated PBL processes instrument developed by van den Hurk et al. Information about gender, semester, weekly hours of study, and learning resources used was obtained. Respondents' agreement with a set of 23 statements was noted using a Likert-type scale, which was scored as 1=totally disagree with the statement, 2=disagree, 3=neutral, 4=agree, and 5=totally agree with the statement. Mean scores were compared among different groups of respondents.

RESULTS

Fifty-one of the 58 students (87.9 per cent) participated. The weekly average study time was 29.9 hours. Lecture handouts and textbooks were commonly used information sources. The mean scores (scale 1 to 5) for learning-issue-driven searching, and extensiveness of searching were 3.49 and 3.45, respectively. The score for explanation-oriented preparation was 3.94, while those for breadth and depth of discussion were 3.75 and 3.62, respectively. Most scores were higher among second-semester students, but the difference was not significant.

CONCLUSION

The self-reported scores were comparable to those reported in previous studies done using the same PBL processes instrument in other medical schools. At Xavier University School of Medicine interactive lectures are the major teaching method and topics covered during PBL are also likely to be covered during lectures, which could influence the scores. The findings of our study providing information about how students function during PBL brainstorming and presentation sessions and how they use different learning resources would be of interest to other medical schools worldwide following a hybrid curriculum. Further studies are required.

How do tutors intervene when conflicts on knowledge arise in tutorial groups?

Recent research on problem-based learning (PBL) has shown that students need support when dealing with conflicting ideas in PBL-tutorial discussions. In the present study, we examined tutor facilitation during tutorial discussions, and particularly how the facilitation helped students to collaboratively resolve conflicts on knowledge. The study involved four PBL-tutorial sessions that included altogether 33 first-year medical and dental students. The sessions were videotaped and analysed using qualitative interaction analysis. Our aim was to find out how the tutor interventions encouraged students to elaborate on conflicting ideas, and how the interventions differed between conflict and non-conflict situations. We also examined how the tutors intervened during conflicts about factual or conceptual knowledge. The tutorial discussions included 92 tutor intervention episodes and 43 conflict episodes. The tutors intervened during 24 of the conflict episodes and resolved 13 of these episodes. Generally, the tutors often intervened by confirming what the students had said or by giving explanations, but they rarely asked questions that would stimulate the elaboration of knowledge. During conflicts on knowledge the tutors gave more explanations, but did little to encourage the students to deal with conflicting ideas. The tutors more often resolved conflicts on factual knowledge than conceptual knowledge. The findings suggest that tutor training should focus on promoting tutors' understanding on when to give direct explanations, and when and how to encourage students to collaboratively elaborate on conflicting ideas.

An exploration of novice and experienced problem-based learning facilitators' perceptions of their roles in a speech-language pathology programme. Does experience matter?

Recruitment and training of skilled facilitators is critical to the success of a problem-based learning (PBL) curriculum. However, facilitation skills do not come naturally to all staff and it remains unclear whether experience in the role contributes to competency. PBL facilitators in a Speech Pathology Masters programme were surveyed via questionnaire and open ended questions regarding their perceptions of the competencies needed to facilitate. Novice and experienced facilitators responses were then compared. The survey response rate was 82% (7/14 experienced and 7/14 novices). Two significant differences were evident between the groups consistent with the amount of facilitation experience. Role conflict, challenges associated with managing group dynamics, knowledge of the curriculum and the significance of social congruence were themes that emerged. Our findings suggest that both novice and experienced PBL facilitators benefit from continuing learning opportunities and mapping of facilitators' perceptions can be useful in delineating professional development needs.

Comparison of tutored group with tutorless group in problem-based mixed learning sessions: a randomized cross-matched study

BACKGROUND

Problem-based learning (PBL) involves discussions among students who resolve loosely-structured problems to facilitate learning. In the PBL curriculum, faculty tutors are employed as facilitators for small groups of students. Because of lack of time and staff shortage, the effectiveness of tutorless PBL has been discussed as an alternate option.

METHODS

Sessions in which tutored and tutorless PBL groups are mixed were presented by 1st-year medical students, who experienced both tutored and tutorless groups alternately in the two sessions of a year. To examine the effectiveness of tutored and tutorless PBL, written examination scores (WES) and self-contentment scores (SCS) were statistically analysed.

RESULTS

WES averages did not significantly differ between the tutored and tutorless groups; however, a significantly greater variation was observed in WES in the tutorless group. SCS averages tended to be higher in the tutored PBL than in tutorless PBL groups.

CONCLUSIONS

Students in these tutorless PBL groups performed well in their written examinations, whereas those in the tutored PBL groups, achieved this and reported better self-contentment with their learning experience. Tutorless PBL sessions were considered to be comparable to tutored PBL sessions at least in the early stages.

Evolutionary trends of problem-based learning practices throughout a two-year preclinical program: a comparison of students' and teachers' perceptions

Implementation of a pedagogical approach is a continuous and evolving process. As an institution with more than 15 years problem-based learning (PBL), we studied how the learning and teaching processes are currently practiced in a 2-year preclinical basic sciences program to assess whether they still match the intended objectives. Using both students' and tutors' evaluations, we analyzed and compared their perceptions on the program content and its organization, on tutors' functioning and on the duration of PBL sessions throughout 11 instructional units of the second and third-year of a 6 years medical curriculum. Whereas both tutors and students indicated that the content and problems selected for the curriculum were well adapted to the PBL process, they felt the references as well as the self-study time as moderately appropriate. Over the course of the 2-year program, tutorial sessions got linearly shorter, whereas reporting sessions got longer. While tutors knew well the PBL approach and were suitably prepared to their tutorials, they however, became less regular in providing feedback and in evaluating group functioning over the 2 years. Our results suggest that the practice of the PBL process evolves within and throughout a 2-year preclinical program and moves away from the original intentions. Possible underlying reasons and their implications are discussed within the context of tutors' and students' concepts of teaching and learning, the medical schools' learning environment and teaching practices and the difficulty of developing and maintaining in the long term a deep and self-directed learning approach.

The process of problem-based learning: what works and why

OBJECTIVES

In this review, we portray the process of problem-based learning (PBL) as a cognitive endeavour whereby the learner constructs mental models relevant to problems. Two hypotheses are proposed to explain how learning is driven in PBL; an activation-elaboration hypothesis and a situational interest hypothesis.

METHODS

Research relevant to these hypotheses is discussed. In addition, research studying the effects of various support strategies used in PBL is reviewed. Finally, we summarise a number of recent studies in which a new 'micro-analytical' methodology was used to trace the process of PBL in the natural classroom setting.

CONCLUSIONS

We conclude that there is considerable support for the idea that PBL works because it encourages the activation of prior knowledge in the small-group setting and provides opportunities for elaboration on that knowledge. These activities facilitate the comprehension of new information related to the problem and enhance its long-term memorability. In addition, there is evidence that problems arouse situational interest that drives learning. Flexible scaffolding provided by cognitively and socially congruent tutors also seems to be reasonably effective, as opposed to 'hard' scaffolding represented by, for instance, worksheets or questions added to problems. Small-group work protects against dropout and encourages students to study regularly. Initially, students do not study much beyond the learning issues generated; the development of personal agency in self-study needs time to develop. The extent of learning in PBL results from neither group collaboration only (the social constructivist point of view) nor individual knowledge acquisition only; both activities contribute equally to learning in PBL.