Constructivism as a Learning Theory as Applied to
Problem-Based Learning (PBL)
By Shane Beggan, GP
In this article, I will introduce you to the theory of Constructivism with some attempt at
critically evaluating it. I will then show you how you can develop PBL based on
constructivist principles.
Introduction to constructivism
In 1710, two philosophers, an Italian named Vico and an Irishman, named Berkeley,
separately made deplorable assertions that went against the grain of thousands of
years of ancient philosophy. They dared to fundamentally change the concept of what
knowledge is and what it means to exist. The human mind can only know what it
constructs for itself and to be able to say something exists it must be first perceived
by the human mind (von Glaserfeld, 2007).
These bold thinkers portrayed the early beginnings of constructivism. A constructivist
theory of cognition was first described by Piaget (von Glaserfeld, 1989), who
described how learners construct their knowledge by building on what they already
know and have experienced. The way we interpret this experience ‘constitutes the
only world we consciously live in’ (von Glaserfeld, 1995, p.18).
The breadth and depth of literature dedicated to constructivism is mind-boggling and
the nature of the theory’s application to education I have found complex and difficult
to understand. This is perhaps because it is more of a philosophy of human
knowledge than a blueprint for learning and as such is open to many interpretations.
Philips (1995) describes constructivism as a ‘secular religion’ with many sects, each
with a distrust of the other on the basis of differences in their beliefs, underlining the
lack of cohesiveness among constructivist theorists. There are several described
forms of constructivism such as cognitive as explored by Piaget, social constructivism
as pioneered Vygotsky often cited as an alternative to Piaget but is arguably
complementary (Shayer, 2003) and radical constructivism as coined by its originator
von Glaserfeld (2001) which builds on Piaget’s life work. From an education
perspective, the philosophical basis for constructivism theory can be difficult to
understand and apply to learning but a more pragmatic philosophy has been neatly
distilled into three propositions as described by Savery and Duffy (2001):
1. We cannot separate how we learn from what we learn: the interaction
between learner and the environment is what forms understanding.
2. The learner needs a goal or ‘puzzle’ to stimulate learning (cognitive conflict):
these goals can be both practical i.e. to pass an exam; and intellectual i.e. to
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wish to advance one’s knowledge and understanding. The new information
needs to be reconciled with prior knowledge and discrepancies addressed to
inform new understanding.
3. Social interaction is key to developing knowledge: sharing our individual
understanding with others allows our understanding to be tested and creates
further puzzles to continue to stimulate learning.
These propositions take elements from both cognitive and social constructivism,
which certainly helps clarify the approach that can be adopted in an education
context without overcomplicating things with complex philosophical ideologies. Davis
and Sumara (2002) in fact argue that constructivist theory was never intended to be a
practical guide for educators, describing it ‘not educational in any pragmatic sense’
and contrast this with behaviourist theory which ‘speaks more directly to the
concerns of educators’ (Davis & Sumara 2002 p.417). Gordon (2009) argues however
that behaviourism is open to criticism in its application to education just in the same
way as constructivist theory. He asserts difficulties with a constructivist approach
arise from a lack of coherent literature on what it means to be constructivist and a
lack of engagement with the skilled educators who use it without necessarily having a
deep understanding of the philosophical base.
Gordon (2009) makes a real attempt to develop a ‘pragmatic constructivism’ where
there is interconnectedness between educational theory and practical teaching. He
argues that educational theory has a lot to learn form the skilled constructivist
teachers and both can influence each other to create mutual benefits. Gordon’s
(2009) attempt to synthesise the main theories of constructivism into common
shared values to provide a pragmatic approach is an attractive one and helps me as
an educator to think practically about how I can enhance learning and understanding
in my teaching. He uses an example where a teacher realises her constructivist
approach failed because she had not made the overall big picture clear at the outset.
This highlights the importance, for constructivists, of examining the topic or concept
as a whole first before dividing into its component parts (Gordon 2009).
There are other interpretations of the educational application of constructivism such
as Caine and Caine’s 12 principles of constructivism (Caine & Caine, 1991). They
provide a detailed view of how the body, brain and mind participate in the learning
process. This certainly provides a comprehensive and thought provoking approach
with practical tips for teachers to improve the effectiveness of their teaching but the
statements are wide-ranging and could cover many different educational approaches,
which may be at odds with each other. There are similarities with Savery and Duffy’s
(2001) propositions within the 12 principles, for example, ‘learning involves both
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focused attention and peripheral perception’ [the interaction between learner and
environment] and ‘learning is enhanced by challenge and inhibited by threat’
[cognitive conflict] (Caine & Caine, 1991, p.7). Neither is a model for how to teach but
are more of an approach, which I think importantly focuses on the learner rather than
the teacher.
This in contrast to traditional higher education approaches, which tend to focus on
the teacher (Tynjälä, 1999). Lebow (1993, p.5) contrasts traditional educational
values like ‘replicability’ and ‘control’ against what he describes as primary
constructivist values which include ‘collaboration, personal autonomy, generativity,
reflectivity, active engagement, personal relevance and pluralism’. These values are
used by Savery and Duffy (2001) to provide an instructional framework for problembased learning (PBL), a learning approach that is often considered a model example of
a constructivist theory in practice (Savery & Duffy 2001). It could be argued that
Lebow’s (1993) values are not purely constructivist ideas and overlap other
educational theories such as andragogy (Knowles, 2005), Maslow’s Hierarchy of
Needs (Maslow, 1987) and Gibbs Reflective Cycle (Gibbs, 1998). This is probably
inevitable with theories that explore how we learn as adults and shift focus to the
learner.
Constructivism and Problem-Based Learning
Constructivism is not for everyone and much of the literature is critical of the
approach. It seems various interpretations of the term within an educational context
has led to confusion about the best ways to use constructivist theory to plan effective
teaching (Taber, 2011). One of the arguments against social constructivism is that it
leads to ‘group thinking’ where a few extroverts dominate the group and the quieter
students feel compelled to conform or the learners develop misunderstandings or
misconceptions which go left unchecked (Kozloff, 1998).
Research by Kirschner et al (2006) suggests that constructivist approaches to learning
such as problem-based learning (PBL), do not work as well as direct instruction for
changing long-term memory. The also argue that unguided instruction which occurs
in self-directed learning (SDL) within PBL environments can lead to misconceptions or
knowledge that is fragmented. This is a potential risk but from my own experience of
a PBL medical degree, there was little evidence of minimal or unguided instruction
but mostly skilful facilitation by tutors to prevent this very problem. It is this
facilitation by experienced teachers that prevents a dominant individual dictating
where the learning goes and guides students to avoid misconceptions and
misunderstandings. Hemlo-Silver et al (2006) in fact published a paper in riposte to
Kirschner et al’s (2006) controversial article. They argued that PBL and inquiry
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learning (IL) are both ‘powerful and effective models for learning’ (Hemlo-Silver et al
2006, p. 99) because they use ‘scaffolding’ to guide learners though complex tasks
and learning goals. They also highlight how PBL emphasises soft skills important to a
constructivist approach such SDL and collaboration.
Problem-based learning and PBL curricula
From my experience of a pure PBL medical degree at Liverpool, as a learner it feels
more natural to construct my knowledge within the context of my clinical practice
and life experience and to collaborate with colleagues, students and patients to test
and develop my knowledge.
PBL has its origins in 1969 in McMaster University medical school in Canada and has
been used as the instructional method in over 60 medical schools including Harvard
University (Hendry et al, 1999; Neville, 2009). Hendry et al (1999) concludes that an
optimal PBL teaching environment includes:
1. Realistic problems
2. Tutor facilitation that support reflection and cooperation
3. Sufficient scheduled time for independent study
4. Formative and summative assessment that is aligned with learning issues,
problem packages and other integrated, interactive teaching sessions.
These incorporate some of the values like cognitive conflict and goals within Savery
and Duffy’s (2001) propositions for constructivism. It also matches my own
experience of tutor facilitation to support learning alluded to earlier. Clearly, as
already discussed with Kirschner et al’s (2006) paper, PBL is not without controversy
and a pilot systematic review by Newman (2003) concluded there were no
comprehensive systematic reviews to say PBL is effective. Neville (2009) however
argues the conflicting studies in the literature could not be judged without delving
into all methodologies and heterogeneous definitions of PBL. Dolmans (2003) also
took exception to Newman’s approach to systematic reviews, suggesting inclusion
criteria were too rigorous, by including only randomised control trials or experimental
studies meant many educational studies were omitted. She argued that to believe
only experimental studies could yield useful reliable evidence was to lack insight into
educational research. Dolmans’s (2003) and Neville’s (2009) assertion that a
constructivist approach to educational research, using different methodological
approaches is likely to yield improvements, makes sense. There are so many variables
within PBL environments that to rely only on quantitative studies misses out valuable
narrative studies that can help build on its effectiveness as a teaching environment
(Dolman 2003). This view is also supported by Oliver-Hoyo and Allen (2006) who talk
about triangulation of research where qualitative and quantitative research is
combined in an attempt to reduce bias.
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Colliver (2002) warns that theories underpinning PBL are at best ‘conjecture’ rather
than evidence-based and that medical faculties should beware of using it to inform
practice. He reiterates his previous concerns that constructivism ‘muddles the
distinction between philosophy and science, between episte- mology and learning’
(Colliver 2002 p.1217), which reflects earlier comments about the confusing nature of
the literature on constructivism. In an earlier critical review, Colliver (2000) also
concludes that educational theory is poorly supported by research where PBL is
concerned and that there is little evidence it is better than traditional models in
medical education. He argues that the outcomes in terms of knowledge base and
clinical acumen do not justify the significant resources being ploughed into PBL
curricula. Colliver (2003) does acknowledge ‘PBL may provide a more challenging,
motivating, and enjoyable approach to medical education’ (Colliver 2000 p.266) but
gives no credence to these benefits. It seems intuitive that even if PBL has limited
evidence to support its superiority to traditional courses, if the outcomes are similar,
then the above benefits are worth having.
Hendry et al (1999) suggests that if the only difference in outcomes of a PBL course is
greater student satisfaction, this alone is enough to warrant the adoption of PBL. He
also cites research which shows medical students on PBL courses have a greater
interest in curriculum content, have a more positive outlook on their course and
enjoy it more compared to traditional courses.
From my own perspective, there were three difficulties I encountered with PBL:
1. Uncertainty about depth required when addressing learning objectives
generated during small group work.
2. An over-emphasis on self-directed learning (SDL) in basic sciences
3. A lack of explicit curriculum to refer to and compare goals with
There are different methods of PBL described in the literature, some using more SDL
than others. Barrows (1986) proposed a taxonomy of PBL to help developers of
curricula understand which methods would suit their students best. In my course,
closed-loop problem-based learning was used beginning with small-group analysis of
a carefully worded case to generate learning objectives, followed by a period of SDL
and completed by a re-evaluation of learning in the last group session. My experience
of uncertainty about depth was assuaged to a large degree by facilitation at the
second group session. Here the facilitator guided everyone towards what an
acceptable level of detail should be. The process of deciding how much depth was
necessary during the self-directed learning developed skills needed as an
independent practitioner. Albanese and Mitchell (1993) identified research, which
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showed that PBL students often feel uncomfortable about getting the right breadth
and depth of content. One of the ways this was addressed was to reassure student
that their objectives were compared against faculty objectives in line with the
curriculum and any gaps are addressed in the small groups (Albanese & Mitchell,
1993).
There needs to be a balance between fostering SDL and the right amount of guidance
and one of the areas I found this difficult was in basic sciences such as anatomy and
physiology. A Dutch study by Prince et al (2003) found no difference in anatomy
knowledge between PBL and traditional medical courses. Albanese and Mitchell also
discuss poorer performance of PBL students in basic science tests compared to
traditional curricula. They argue however that this is not always the case and may
depend on variations in PBL as well as differences in students’ approach to SDL. There
was perhaps an over reliance on SDL at Liverpool and as certain subjects like anatomy
and basic sciences had optional attendance, they were sometimes not given due
attention. A recent curriculum review report by Liverpool Medical School (University
of Liverpool 2014) announced that PBL was being discontinued as the main
curriculum design. They cited the main reasons as inadequacies in basic science
knowledge such as anatomy and physiology and uncertainty and confusion about the
level of depth required. They give a few reasons as follows for why the PBL curriculum
has become unsustainable (University of Liverpool 2014):
1. Increased medical students numbers
2. Variation in quality of PBL facilitators
3. Lack of clinical academics and NHS consultants offering to become PBL
facilitators
4. Difficulties in designing learning outcomes and assessment blue print due to
the lack of structure in the curriculum
The curriculum at Liverpool was designed as a spiral PBL curriculum designed to
construct and layer learning within the basic sciences across all 5 years but this meant
clinicians felt students weren’t adequately grounded in these subjects once they
started clinical placements. In addition, as there were no explicit learning objectives
for placements, clinicians were unclear what they were supposed to be covering. As
discussed earlier, good facilitation to guide students and avoid pitfalls is important, so
it is understandable that variation in quality would be a cause for concern.
There is no consensus, evidence-based or otherwise on what is the best way to shape
a curriculum so curricula tend to be based more on ideology than hard evidence
(Grant J 2010). PBL curricula have allowed educators to move away from thinking only
about content and more about the delivery and application of knowledge (Prideaux,
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2007). Bligh et al (2001) developed the PRISM acronym to assimilate the qualities
required for twenty-first century medical school curricula. This stands for Product
focused; Relevant; Inter-professional; Shorter, smaller; Multi-site and Symbiotic. PBL
courses which focused on outcomes, working with other health professionals and
advocating small group working across multiple sites fit this model of curriculum
development well (Prideaux 2007).
The outcomes of medical curricula need to be broad overview statements rather than
narrower specific knowledge, skills and attitudes (Harden 2002). These need to be
aligned with the learning objectives which are generated by students in group work in
each part of the course and with assessments which are used to test whether these
outcomes have been achieved (Biggs 2003). The use of outcomes has been criticised
as a ‘teacher-controlled ideology’ (Rees 2004), which seems plausible but there is a
need to satisfy the requirements of the GMC to allow doctors to reach an acceptable
standard (Harden et al, 1999). If PBL curricula are designed in the right way they can
foster greater learner co-operation and empowerment, rather than focusing purely
on outcomes (Rees, 2004).
PBL and other learning theories
Although PBL is most associated with constructivism, there are other learning
theories which overlap such as andragogy and reflective practice. Knowles (2005)
describes six assumptions about how adults learn:
1. The need to know
2. The learners self-concept
3. The role of experience
4. Readiness to learn
5. Orientation to learning
6. Motivation
In andragogy there is a move away from dependent learning as in pedagogy to selfdirected learning [changing the self-concept] which as discussed earlier forms a major
part of constructivism in PBL courses (Knowles 2005). The role of experience is
emphasised as a rich resource for learning in a similar way that learning is constructed
on our previous experiences and knowledge (von Glaserfeld 1989). PBL uses cases or
problems in the context of real-life so that learning can be seen as relevant to future
practice and goals. This creates the readiness to learn as described by Knowles (2005).
Knowles (2005) also states that people are performance-centred in their orientation
to learning so in the case of medical students they want to be become competent
doctors and achieve their full potential.
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Gibbs reflective cycle (Gibbs 1988) was developed as a tool to help learners to reflect
on their experience and evaluate it in a structured way. Where constructivism says
that knowledge is built on existing knowledge and experience, it is the reflection on
new experience that develops learning and understanding. The new experiences
create cognitive conflict, which drives learning (Savery & Duffy, 2001). Schön (1991)
describes how practitioners allow themselves to experience puzzlement and reflect
on this puzzlement to apply previous knowledge and understanding to create new
knowledge. This is much like the proposition by Savery and Duffy (2001) described
earlier in constructivist theory but underlines how it is actually reflection that creates
the new knowledge.
Conclusion
Constructivism has useful application to education and particularly in PBL
environments. Above all it focuses on the learner and how they learn, something
which Andragogy also does in its assumptions about learners. Clearly for
constructivism to work well in PBL courses there must be the necessary support like
good facilitators, adequate scaffolding and explicit learning outcomes within a wellstructured curriculum (Hemlo-Silver et al 2006). Camp et al (1996) produced a list of
the values, which a ‘pure’ PBL course should afford the learner, namely: problembased learning is active; adult-oriented; problem-centred; student-centred;
collaborative; integrated; interdisciplinary; utilizes small groups; and operates in a
clinical context. This approach is not just constructivism but takes elements of adult
learning principles.
No learning theory is a panacea and will not fit every purpose, so for example even
pedagogy has a place for certain elements of course content and could be viewed as
the other end of the spectrum to andragogy (Mehay, R et al, 2012, p.115). Knowles
(1989) argues that learning theories should not be viewed an ideology that must be
adhered to at all costs. The arguments about which learning theory is better is not the
question; there is general agreement that focusing on the learner is paramount but a
better question may be, how can elements from different learning theories be used
to enhance the way educators’ facilitate learning.
Acknowledgements
This article has been modified from an assignment submitted by the author as part of their
Post Graduate Certificate in Medical Education, University of Leeds. Many thanks for
guidance received from Drs. Jane Kirby and Ramesh Mehay, Academic Unit of Primary Care,
University of Leeds. Acknowledgements also to the Yorkshire and the Humber Deanery for
funding the certificate.
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