Is running a Problem-Based Learning curriculum more expensive than a traditional Subject-Based Curriculum?

Abstract

Background: Running a problem-based learning (PBL) curriculum has been considered to be more expensive than a traditional Subject-Based Curriculum? This claim has not been well substantiated.

Aim: To identify faculty educational activities (FEA) related to PBL, calculate its cost (faculty number and time) and compare it with a traditional Subject-Based Curriculum.

Methods: A structured questionnaire was developed through focused group discussion using a Delphi method to identify FEA and ensure face and content validity. For cost comparison, a hypothetic model was developed based on “what if” the curriculum was traditional subject-based, and running within the frame of the current regulations of University of Sharjah.

Results: A total of 23 faculty (16 full-time basic medical sciences and 7 clinical tutors) equal to 19.5 full-time equivalent (FTE) responded to the questionnaire. About five major domains and 26 sub-domains of FEA were identified.

The calculated number of faculty needed for the hypothetical Subject-Based Curriculum should have been 19 FTEs. The average FEA hours per faculty per week per student in PBL was 17.41 and for the Subject-Based Curriculum would have been 17.85.

Conclusion: PBL does not require an increase in number of faculty. The time spent by faculty on educational activities was similar in the two curriculum models. Although the cost of two strategies was similar, but the educational roles and the faculty engagement in education in a PBL curriculum is broader than in the traditional curriculum.

Introduction

Over the past two decades, there has been a steady increase in the number of medical colleges with an integrated, Problem-Based Learning (PBL) curriculum (Barrows 1986). The educational value and impact of using small group learning, a student-centered approach and PBL have been supported by both practice and research (Albanese & Mitchell 1993; Schmidt 1993; Norman & Schmidt 2000).

PBL when implemented often means different things to different stakeholders particularly when it is described as a hybrid form (Hamdy 2008). Few people appear to agree on what PBL actually is and often programs contain a “potpourri of other pedagogical nostrums used in unspecified ways” (Norman 2008). There is inconsistency in the way it is or can be implemented (Maudsley 1999; Maudsley et al. 2008). The factors taken into account when calculating its cost vary from one institution to another depending on the country's system of healthcare, higher education, political, economic, and cultural environments (Mennin & Martinez-Burrola 1986; Finucane et al. 2009; Strobel & Van Barneveld 2009). Calculations of cost when made in order to establish a new medical college with a PBL curriculum or changing an existing curriculum to a PBL vary in their approach to the inclusion of new resource construction or new physical facilities (Finucane et al. 2009).

In most PBL curricula, the typical features of having weekly small group tutorial sessions, with the problem guiding the students’ learning and less didactic teaching, constitute the main strategy of learning in the first 2 or 3 years of the curriculum. Whether in a traditional or PBL curriculum, basic medical sciences (BMSs) learning needs faculty of good standing, suitable physical facilities and adequate leaning resources. It is expected that these resources (faculty, labs, and lecture rooms) will be the same whether the curriculum is PBL or conventional, except that the availability of small rooms for PBL tutorials is essential.

Reports from medical colleges about cost indicated that teacher's salaries were the single most significant cost factor in medical education (Mennin & Martinez-Burrola 1986). On the recurring costs for PBL, faculty payments were described to account for 89% of the total (Finucane et al. 2009).

Another important element which may affect the recurring cost is the student: tutor ratio. The number of faculty full time or full-time equivalent (FTE) and how many hours they contribute to teaching or educational activities related to the delivery of the curriculum can be important determinants in cost calculation. The complexity of measuring faculty work load in a PBL curriculum would be different from the traditional commonly used metric of the credit hour system which describes the credit weight of a subject and the expected teaching load of faculty. The changing faculty roles (Harden & Davis 1998) and time spent in education in a PBL curriculum are not well described, making it more complicated in estimating its cost (Donner & Bickley 1990; Nieuwenhuijzen-Kruseman et al. 1997). On the other hand, the number of lectures “theoretical hours” and laboratory “practical hours” expected to be delivered by a faculty in a given course/subject constitute the basis in calculating the needed number of faculty and calculate the program cost.

In this study, two hypotheses were tested in relation to the cost of faculty number and the time spent in education. The first is that time spent by faculty in educational activities related to PBL curriculum is more than the time spent in direct teaching in a Subject-Based Curriculum. The second, a PBL curriculum needs more faculty for the small group learning and tutorial sessions.

The aim of this study is to estimate the cost related to faculty numbers and time spent on educational activities related to a PBL curriculum and to compare it with a hypothetical model of a traditional Subject-Based Curriculum during the first 3 years (pre-clerkship phase) of the medical program.

Table

Practice points

PBL does not require an increase in the number of faculty. The time spent by faculty on educational activities was similar in the two curriculum models. Although the cost of two strategies was similar, educational roles and the faculty engagement are broader in PBL than in traditional curriculum. The claim that PBL is more expensive than traditional methods is not substantiated by this study.

Methods

Since its inception in 2004, the College of Medicine, University of Sharjah (UOS) in United Arab Emirates (UAE) has adopted a 5-year outcome-based curriculum. In Phase I (years 1, 2, and 3), it is integrated and organized into “units” each dealing with a major body system (e.g., Cardiovascular, Renal, etc.). The units range in length from 4 to 12 weeks duration.

In this phase, PBL underpins all teaching and learning. One problem is studied every week over two sessions each of 2 h. This phase is followed by a clerkship phase of 2 years structured around clinical rotations in different clinical disciplines.

Although the learned problems are based on clinical scenarios, the BMSs objectives constitute large number of the total problem objectives. This curriculum design led to the appointment in this phase of a majority of BMS faculty who are the main contributors to the development, teaching and management of the PBL curriculum in Phase I. About 16 full-time BMS faculty constitute the main body of the faculty (Anatomy – three, Physiology – four, Biochemistry – three, Microbiology – three, Pathology – two, and Pharmacology – one). All BMS faculty are medically qualified MDs except three in biochemistry with a PhD in their disciplines. In addition, seven clinical tutors functioned as PBL facilitators and trainers in the clinical skills program. Their contribution to the pre-clerkship phase of the curriculum was considered in calculating the total cost as equivalent to 3.5 FTEs.

Due to the nature of the integrated PBL curriculum, faculty were clustered in three departments (BMS, Clinical Science and Family and Community Medicine and Behavioural Sciences). All full-time faculty were involved in different aspects related to the development, implementation, and evaluation of the educational program. All 23 full time and part time, regardless of their academic rank functioned as PBL tutors for at least 12 weeks per year.

A descriptive cost analysis study design was used in calculating faculty numbers, teaching load, and related salaries which constituted a major part of the medical college recurring budget (Mennin & Martinez-Burrola 1986; Donner & Bickley 1990). In the UOS, College of Medicine, faculty salaries constitute about 72% of the college budget.

The changing roles of faculty from an information giver to a facilitator of learning, evaluator, advisor, subject matter expert, and scholar (Glassick 2000) were considered. Calculating the number of hours spent by faculty on educational activities in the PBL curriculum was based on data obtained from faculty, department chairpersons, and committee records.

A structured questionnaire was developed in order to survey and identify faculty educational activities (FEA) in the PBL curriculum and time spent on each activity. The items in the questionnaire were identified from the literature (Boyer 1990) and through a focused group discussion using a Delphi method. It was sent to 23 faculty in the medical college requesting them to review its face and content validity. Faculty comments led to reviewing the questionnaire to include time spent on faculty development activities and committee meetings. The revised questionnaire was resent to the same faculty. The questionnaire generated 5 main domains of FEA and 23 sub-domains in the PBL curriculum (Figure 1).

Figure 1. Questionnaire used to calculate FEA in a PBL curriculum.

The cost of running a PBL curriculum was expressed in terms of number of faculty, teaching time (contact and preparation) and other related educational activities (Figure 1). Results were expressed in terms of number of educational activity hours per curriculum week per faculty per student. This formula was guided by the approach devised by the National Academy of Sciences (Institute of Medicine 1974; Mennin & Martinez-Burrola 1986).

The cost of faculty involvement in teaching in a PBL environment was compared with a hypothetical model based on “what if” the college of Medicine runs a Subject-Based Curriculum in the same university. The teaching load of faculty in the hypothetical Subject-Based Curriculum was calculated based on the current UOS regulations which indicates that the faculty teaching load, contact, and preparation, should be 12 credit hours/week/faculty, and the published data from regional universities that implement a credit hour, subject-based medical curriculum, such as Jordan University of Science and Technology (2010, http://www.just.edu.jo) and the University of Jordan (2010, http://www.ju.edu.jo). The number of faculty needed for a traditional Subject-Based Curriculum was based on the total number of BMS subject credit hours in an academic year of 32 weeks, number of students and class size of 40 students for lectures and 20 students for practical/lab classes as recommended by UOS.

The time devoted for teaching in a traditional curriculum, i.e., faculty teaching load, was calculated as contact time and preparation time which is defined as time used for preparing educational material and other related requirements for student's contact. The ratio between contact and preparation time, used in the calculation was one contact hour needs two preparation hours (Mennin & Martinez-Burrola 1986).

Results

A total of 286 students were registered in the academic year 2009–2010 in the first 3 years of the medical curriculum – year 1, 113 students; year 2, 103 students; and year 3, 70 students. About 10–12 students were allocated to each PBL tutorial group, i.e., year 1 – nine groups, year 2 – nine groups, and year 3 – seven groups. PBL tutorials were conducted over 27 weeks in years 1 and 2 and 23 weeks in year 3. A total of 25 tutorial groups having 77 weeks of tutoring were scheduled in these 3 years.

The analysis of the survey questionnaire indicated that the average time spent on all educational activities for a BMS faculty ranged between 912 h (highest) in anatomy and 686 h in pharmacology (lowest). The average hours spent on the five domains of FEA ranged between 489 h per discipline on facilitation of learning and teaching and 53 h on curriculum revision, renewal and program development (Table 1). The total FEA hours per year was 4980; the average educational activity hours per domain per faculty per year was 1245, giving an average/faculty per week per student of 17.41 (number of faculty is equal to 19.5 FTEs). These calculations reflected the teaching load of a BMS faculty in years 1–3 (pre-clerkship phase).

Table 1.  BMSs FEA hours in the PBL curriculum

	Average EA hours per faculty per year by discipline
EA	Biochemistry N = 3	Anatomy N = 3	Physiology N = 4	Pathology N = 2	Microbiology N = 3	Pharmacology N = 1	Clinical tutors 7 equal to 3.5 FTEs	Total 23 faculty (19.5 FTEs)	Average EA hours per faculty per domain Per year
Facilitation of learning and teaching	542	629	373	498	317	572	259	3190	164
Programs development/renewal/implementation	31	70	55	60	45	58	0	319	16
Assessment	66	125	83	211	216	36	0	737	38
Curriculum management	107	68	171	114	144	0	0	604	151
Faculty development	20	20	20	20	20	20	10	130	33
Total	766	912	702	903	742	686	269	4980	1245

Note: EA, educational activities.

Applying the National Academy of Sciences equation would give:

In the hypothetical model of a traditional Subject-Based Curriculum with the same number of students, the number of faculty needed for teaching in the pre-clerkship phase following the University guidelines would need 19 FTEs teaching BMSs (Table 2). Thirteen of them should be PhD holders to teach theoretical/lecture classes and seven Master holders to teach practical/laboratory classes. Considering the number of students and UOS recommended class size for lectures and practical labs, the total credit hours required to deliver the BMS in the Subject-Based Curriculum would be 159.5 credit hours per week (Table 2). Translating this into contact hours would be equal to 5104 h of teaching per year. Based on this calculation, the average educational activity hours (contact and preparation) per faculty per week per student would be equal to 17.85.

Table 2.  Teaching load and number of faculty required to deliver a hypothetical discipline-based curriculum at UOS

		Credit hours
Discipline/subject	Year	Theory	Practical	Total	Teaching hours per week	Faculty (FTE)
Anatomy^a	First	6	2	8	18
	Second	6	2	8	16.5
	Total	12	4	16	34.5	4.0
Physiology^a	First	6	2	8	18
	Second	6	2	8	16.5
	Total	12	4	16	34.5	4.0
Biochemistry^a	First	4	2	6	15
	Second	4	2	6	13.5
	Total	8	4	12	28.5	3.0
Pathology^b	Second	4	2	6	13.5
	Third	4	2	6	13.5
	Total	8	4	12	27	3.0
Pharmacology^b	Second	4		4	6
	Third	4	2	6	11.5
	Total	8	2	10	17.5	2.0
Microbiology^b	Second	4		4	6
	Third	4	2	6	11.5
	Total	8	2	10	17.5	3.0
Total		56	20	76	159.5	19

Notes: Student number = 286. ^aSubjects taught in years 1 and 2; ^bSubjects taught in years 2 and 3.

Discussion

The results of this study indicated that a PBL curriculum as implemented at the UOS does not require an increase in the number of BMS full-time faculty. The claim that PBL is more expensive than traditional methods (Albanese & Mitchell 1993) is not substantiated by this study. The time spent on educational activities was similar to the hypothetical model of a subject-based medical program, 17.85 FEA hours for traditional and 17.41 FEA hours for PBL curriculum.

Similar results were reported from New Mexico University comparing a PBL tract with a traditional tract (3.07 FEA hours and 3.57 FEA hours) with 53 students (Mennin & Martinez-Burrola 1986). Adjusting for the number of students in the New Mexico results to Sharjah University (286 students) would give a value of 19.5 FEA hours for traditional tract and 22.5 FEA hours for PBL tract, showing comparable results to our study.

The methodology used in this study to calculate the teaching time of faculty in a traditional curriculum has taken into consideration the regulations and norms at UOS concerning class sizes, expected faculty teaching load of 12 credit hours per week and the credit hours of six BMS subjects. Although the numbers of credit hours per subject are context related but they are not far from other medical colleges adopting a credit hour system in the region.

Although there is disagreement about the reliability of estimates of teaching time and effort, calculating how much time is devoted by faculty to a particular educational activity has been the most widely used tool for assessing the relative costs of teacher activities (Hilles 1973).

The method adopted in this study to calculate FEA unique to a PBL strategy of learning, like tutoring and related activities, was based on self-reporting by faculty through the survey questionnaire. Other educational activities which can also take place in a traditional Subject-Based Curriculum as clinical skills training, community-based education, research methodology, and behavioral sciences were excluded in order to reduce the confounding factors and limit the comparison to the basic science disciplines. Lectures or “resource sessions” given by subject matter expert faculty in the PBL program were limited in numbers, not more than five to seven lectures/week using a team-based learning (TBL) strategy which is analogous to PBL (Koles et al. 2010). This guided discovery learning strategy does not change the nature and philosophy of PBL. In describing our curriculum, we have avoided using the term “Hybrid curriculum” which has been over-used and led to more confusion when describing PBL curriculum (Hamdy 2008). Researchers have shown that lectures can be used with PBL and can provide added value to students learning (Van Berkel & Schmidt 2005).

Concerning other competing duties of BMS faculty like teaching in postgraduate programs and were not calculated in this study.

Although the results in this study are context and culture specific, the description of FEA in PBL curriculum and the formula used in calculating the cost related to number of faculty and time spent on education rather than on direct teaching are simple and can be generalized and used in different contexts.

This study indicated that a curriculum built upon student centered, small group and PBL concepts does not increase the number of BMS faculty or time related to these educational activities during the first 3 years of the PBL curriculum. Arguments may arise that having a class size of 40 students may be small and leads to increase in the number of faculty in the Subject-Based Curriculum. Even if the size of the class is doubled, the number of faculty needed for teaching will not be reduced. There will always be a need for at least three faculty/discipline. A study comparing the cost in faculty time of problem-based and conventional pathology programs suggested that the PBL curriculum is not more expensive with classes up to 100 students (Donner & Bickley 1990). We have opted to exclude the initial cost related to construction or physical facilities, but it is important to take it in consideration when building a new medical college or in modifying an existing one in order to create classrooms for the small group tutorials (Finucane et al. 2000).

In summary, the present data do not support the two study hypothesis that PBL requires more faculty than a traditional discipline-based learning curriculum. In addition, the time spent by faculty on education in the PBL curriculum was not more than the traditional curriculum, but how this time is spent was different (Mennin & Martinez-Burolla 1986). In PBL curriculum, the whole learning and teaching environment enhances the quality of education and leads to the development of learning and teaching skills of faculty and their engagement in different aspects of the curriculum. This study provided indicators that using educational strategies which support student-centered education as PBL or other analogous strategies like TBL is not more expensive than traditional teacher-centered education.

The main limitation of this study is the hypothetical calculation of cost in a subject based curriculum. A comparative study with an actual subject-based curriculum in a comparable context would be most useful.

Declaration of interest: The authors report no conflicts of interest. The authors are responsible for the content and writing of this article.