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Every teacher has seen it: the student who sits quietly through an entire tutorial, nods when asked if everything is clear, and then, weeks later, reveals in an examination that a fundamental concept was never understood. The question was there all along. It was simply never asked. This book grew from that observation, and from a second one. In teaching, in examining and in professional practice, I have seen again and again that the quality of what a person learns depends on the precision of the question that person asks. A vague question produces a flood of information that no one can reasonably manage; a precise question leads directly to what is needed. A learner with a precise question is ready to learn; a learner with only a vague sense of confusion is not. Problem-based learning, which transformed medical education in the late twentieth century, taught us the power of placing a problem at the centre of learning. I have great respect for PBL and for the many educators who have developed it. Yet in my experience as a facilitator, I have seen how easily PBL tutorials can be dominated by fast learners, how slow learners can remain silent, and how learning issues can be left unresolved. It is difficult, in a group of eight or ten, to know whether every student has reached the objectives of the session.
Question-Based Learning is my attempt to address these difficulties. It shifts the focus from the group's problem to each learner's question. It uses a single small group meeting, the Socratic method, a structured search for answers and the sharing of those answers, and it insists that every question be answered, in a debriefing lecture, before the learning cycle closes. Because this book is written for medical and health professions educators, I have called its application in that field Question-Based Medical Education (QBME). I believe it offers particular benefits to slow learners, who become resourceful because they have more questions than answers, and to fast learners, who are motivated by helping to answer them.
I have tried to write this book in a way that is both practical and scholarly. The early chapters review the theory and evidence on which QBL rests. The central chapters describe the model and its seven steps in detail. Later chapters address assessment, applications across the medical curriculum, the single question driven small group meeting, the debriefing lecture, and institutional implementation. Appendices provide templates that teachers can use immediately.
I have also tried to be honest. QBL is a proposal, not a proven method. Its components are well supported by research, but the model as a whole must be tested. I have therefore set out its disadvantages alongside its advantages, and I have proposed a research agenda. I would be delighted to hear from colleagues who implement, adapt and evaluate QBL in their own settings.
It is my hope that this book will help teachers hear the questions of all their learners, and help every learner find the courage to ask.
