Thesis on PBL: partly formed in Maastricht

If you write a dissertation on the history of Problem-Based Learning (PBL), you cannot avoid discussing Maastricht University. You also cannot avoid the work of Professor of Psychology Henk Schmidt, who, from 1974, contributed to the development of PBL at the country's eighth medical faculty in Maastricht, came up with the ‘seven-step approach’ and conducted a great deal of academic research into this teaching method. Since 2001, Schmidt has been part of Erasmus University Rotterdam, and it is also there that on 18 November, Virginie Servant will defend her PhD thesis on ‘Revolutions and Re-iterations: An Intellectual History of Problem-Based Learning’. ‘Maastricht has contributed at least as much to changes in medical education as McMaster’, Servant concludes.

McMaster University in Canada is where it all began in 1963. The founding dean of McMaster School of Health Sciences, John Evans, actually outlined the initial ideas for a new form of teaching, not Howard Barrows, who it has always been attributed to. The latter did give the system the name ‘Problem-Based Learning’ in 1974, but it had already been conceived and implemented by Evans, along with four other ‘founding fathers’. ‘Actually, it stemmed from dissatisfaction with their own medical training’, said Servant. ‘They had no or not many theoretical inclinations and were more concerned with experimenting by trial and error. Because the definition of PBL came after the practice, the model is open to interpretation, which would not necessarily be the case if you had a “little red book” about PBL.’ But more on that later...

The meeting

Henk Schmidt had already made a tentative attempt to determine the philosophical roots and psychological basis of PBL, ‘but I soon found out that to do this you had to conduct a huge amount of source research and I lacked the time for that’. Servant was working as an education consultant and researcher in Singapore when she kept coming across the name of Henk Schmidt in publications on PBL. At the time, Schmidt was rector in Rotterdam and a friend of hers knew his secretary well. ‘He could arrange an appointment for me’, Servant says, ‘but he had one condition: I would have to ask Schmidt to do a PhD with me. Initially, I had no intention to do so, but once I actually met Henk I was immediately convinced’. Schmidt laughs heartily: ‘A PhD was indeed discussed during our first conversation.’ Servant turned out to be the ideal candidate for an in-depth research project that Schmidt had in mind, with her bachelor's degree in philosophy and political science and master's degree in law.

The disagreement

She went to McMaster and found a wealth of archival material: records of the study programme committee at McMaster, correspondence and more. She did not really uncover a single clear source for the ideas of the five founders, though the humanistic psychology movement led by Carl Rogers of the University of Chicago in the 1940s and 50s probably played a role.

Because ‘oral history’ is the least reliable source, Servant never blindly went off of what the many interviewees still remembered. Only information that was confirmed by historical documents was used in her thesis. Schmidt was even surprised by some correspondence with Barrows that they found, which he had completely forgotten about. ‘It seemed from very early on that I differed in opinion from him.’ That difference of opinion was about the purpose of PBL and is reconstructed in the thesis. While Barrows saw PBL as a way to teach students to think and reason, Schmidt was convinced, based on cognitive psychological literature, that all thought arises from knowledge. ‘So I thought that the aim of PBL is to help students acquire knowledge, which then helps them to solve problems’. Servant: ‘Schmidt won the debate in the mid-80s and I’m not saying this because he's my supervisor. Anyone can come to this conclusion based on the academic literature. But to this day, a lot of people who develop PBL curricula are not aware of this. For example, I was setting up PBL at the Duy Tan University in Central Vietnam and they had gone through the trouble of translating Barrows's book into Vietnamese before I came.’

The Maastricht touch

In the 80s, both Schmidt and Barrows offered PBL courses and lectures all over the world. Schmidt: ‘When I'm at a university in a faraway country and come across a sign for “Skillslab” combined into one word, as we use it in Dutch and English, I immediately recognise the influence of Maastricht.’ The skillslab, where students practise medical procedures in situations that simulate professional practice as closely as possible, was perfected in Maastricht after the idea came about in America. Also, the seven-step approach was added to PBL in Maastricht by Schmidt personally in 1976. ‘As a young psychologist, I was often a tutor in tutorial groups and it didn’t seem clear to me exactly what was expected of the students. On the whole, it was a bit muddled and the seven-step approach was meant to organise the learning process.’ The progress test, an idea of ​​Wijnand Wijnen, was also developed in Maastricht and later even adopted by McMaster. ‘Maastricht has contributed at least as much to changes in medical education as McMaster’, Servant also concludes, a conclusion that Schmidt is happy for her to make. ‘But it was obvious that we could not just thoughtlessly copy the approach of McMaster in Maastricht, if only because theirs was a three-year programme for medical students who already had some sort of basic medical training behind them, while we offered a six-year programme for students who are sometimes 18 years old.’ Servant: ‘Obviously, they had to do things differently. And I have the impression that the Dutch like to have things a bit more structured and a bit less free flowing than the Canadians. Schmidt and Bouhuijs, for example, also developed training programmes for tutors and students early on.’


Speaking of the tutor: that was basically the role assumed by the professor in the counseling of his PhD candidate. Servant: ‘He knew exactly what to say to challenge me to find the things that needed to be found. He was the perfect example of a guide rather than a teacher.’ For Schmidt, this was ‘one of the most enjoyable PhDs to supervise. She can write well and worked very independently and systematically. In addition, we had very nice, heated discussions about politics and science.’ Servant: ‘We actually talked about that more than the thesis itself. I think he liked that I'm easy to provoke into a political rant.’ Schmidt confirms this while laughing.

One intensive discussion which was indeed regarding the thesis, was about the inclusion of the Danish Aalborg University in the thesis, which also claims to apply PBL. Schmidt did not think it was legitimate to include them because students there follow lectures half the time. Schmidt: ‘One of the foundational principles of PBL is self-directed learning, and lectures are intended to support independent learning, while in Denmark they see them as knowledge transfer. They have not experienced the radical approach of Maastricht, in which students from their first year work in small groups, focusing on issues that can be resolved within the timeframe of a few days, with few classes and a lot of time for self-study. To me, that's PBL.’ Servant is somewhat ambivalent on the debate about ‘pure PBL’ and eventually did put the Danish situation in her thesis. ‘I have no evidence that such a thing as “pure PBL” ever existed. Practitioners are still split on what the definition of PBL is. I'd rather focus on purpose. If it works in accordance with the five golden rules of learning, it's fine by me. As long as education activates prior knowledge, leads to elaboration, is motivating, enables students to restructure and is contextualised, you're fine. But I did see PBL being instrumentalised: every university that uses PBL picks the things they like out of the big PBL box and calls their selection PBL.’

The red book

Is there still a need for a 'red book about PBL’? Schmidt is clear: ‘I base my work on the vision of the inventors of PBL: small groups, problems, self-study and a tutor—that's PBL. I have studied it in theory and put it into practice with my colleagues; we have written a whole series of books and scientific articles about it and I have done research on its effects, based on the cognitive psychology of learning and teaching. There’s not much more one can do.’

Schmidt left Maastricht in 2001 to go to Rotterdam. ‘I could set up a new psychology degree according to the PBL principles and develop something new, which is also what I’ve always enjoyed the most in Maastricht. I was a professor at three faculties, first with medicine and when my work there was partly finished, I went to health sciences and then together with colleagues in 1995 I helped set up the psychology programme, all with PBL.’ Now he is formally professor emeritus, but his biggest hobby, supervising PhD candidates around the world in PBL-related research, he continues cheerfully.

Servant holds a position as a lecturer at Erasmus University College, where she teaches a wide array of Liberal Arts & Sciences courses using Problem-Based Learning. She also has her own NGO, ‘FairFight’, a charity dedicated to empowering young women in underprivileged socio-economic situations through martial arts. ‘I came together with Henk for this epic project, but from here on my heart lies in philosophy and history.’

More information

  Full text of Virginie Servant's thesis  

By: Femke Kools

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