In Harden’s SPICES model (1), the P stands for differing educational approaches, either one based on problem-based learning or one based on an information gathering model. In a traditional educational approach, we impart a large volume of basic and clinical science information and facts, and then expect students to be able to synthesize that information in order to effectively apply it to patient care. Most health care institutions have followed this model, which has also been much the norm in chiropractic education. But many believe this approach is inadequate preparation for the challenges of life-long learning physicians must engage in. Thus, there has been a movement toward a problem-based approach, which focuses on integration of knowledge and on problem-solving skills.
In a problem-based approach, students are given clinical cases to use as a stimulus for learning both basic and clinical science skills. Cases have to be developed very carefully, so that the specific learning objectives (which may mix basic and clinical science information) are covered properly. Thus, in earlier years of training, the cases may focus more on delineating basic science concepts, while the later years may focus more on clinical skills and information. The primary advocate for this approach is Howard Barrows (2). The primary objective of a problem-based learning (PBL) approach is problem-solving skills, while the primary objective of an information-gathering approach is acquisition of facts and principles.
There are, of course, benefits to both methods. Factors that support a move toward a problem-based approach include that it helps develop problem-solving skills, may help develop an integrated body of knowledge, has general educational advantages, and may help mitigate the presence of an overcrowded curriculum. Problem-solving is essential to the effective delivery of health care, and perhaps the greatest problem-solver of all is Dr. Gregory House, of the TV program House, MD. Developing a body of knowledge is a desirable educational educational outcome as well, in that such integration is necessary for effective care delivery. Students get far greater feedback in a PBL approach than they do in an information-gathering one, and such a program help overcome the fact that our curricula have significant amounts of irrelevant or unnecessary information.
Factors that support a move toward an information-gathering approach include the fact understanding the fundamentals and vocabulary of each discipline is important, that the development of a logical progression of concepts in a discipline is also important, that there is resource availability, that teacher training in delivering a PBL approach may be lacking, and that students are more comfortable with the information-gathering approach. A PBL approach takes time, requires a completely different set of skills on the part of the instructor or facilitator, and requires more personnel to deliver the program effectively. Some students do not like a problem-based approach because it is an active form of learning and requires significant commitment. Finally, the general research comparing these approaches has not shown better outcomes for either, though it has shown greater amounts of student satisfaction with a problem-based approach. Balance may be necessary.
1. Harden RM, Sowden S, Dunn WR. ASME Medical Education Booklet No. 18. The SPICES Model. Med Educ 1984;18:284-297
2. Barrows HS, Tamblyn RM. Problem-based learning: an approach to medical education. New York, NY; Springer Publishing Company, 1980