A Handbook for Teaching and Learning in Higher Education Enhancing academic and Practice

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Teaching in the disciplines
Case study 1: Problem-based learning – progressive
release version
Problem-based learning (PBL) takes many forms, but there are really only two
types of pure PBL – the short case version and the progressive release version. The
short case format is generally used in courses designed for school leavers; the
progressive release version for graduates or more mature students. Both versions
use the same underlying principles (see below).
In the short case format, students are given a short trigger (e.g. a clinical case, a
photograph, a newspaper or journal article), usually no more than a page long.
In the progressive release version, the facilitator gives the students a much longer
scenario in stages (see Figure 26.1). Students discuss each stage fully, before
moving on to the next part of the scenario. Key to the process is the ‘inquiry
strategy’ where students have to decide what history, examination, investigations
and treatment would be appropriate, prior to receiving the results of their inquiries
(i.e. students are required to think like doctors).
An example (each paragraph is a separate trigger and the whole PBL is much
condensed):
Michael Hennessy, a 55-year-old architect, presented to his GP with stomach pain.
He said he had been violently sick the night before after attending a celebration
dinner with some friends at a local curry house.
Students hypothesise possible causes and suggest questions to ask Mr Hennessy which
would help them distinguish between their hypotheses.
Mr Hennessy explained that the severe pain lasted for about five hours and
then slowly subsided. He felt perfectly healthy again after a good night’s sleep.
He put it down to ‘something he ate’. He admitted that the same thing had
happened a few days before, but the pain had not lasted for quite so long.
When asked where the pain was, he pointed to the epigastric region and right
hypochondrium. He described the pain as colicky and griping and it seemed to
move around to his back. He had taken paracetamol and that had helped the pain
somewhat.
Students debate how this information has helped them and suggest what examination the
doctor might carry out.
Mr Hennessy’s height was 178cm and his weight was 105kg. His oral temperature
was 36.6 o C. Dr Oshima, the GP, noted that his sclerae were yellow, though
there was no pallor of the conjunctivae. There were no signs of chronic liver
disease. His mouth was dry. He had tenderness in the right upper quadrant
of his abdomen and Dr Oshima could not press too deeply here. There was no