Problem based learning
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7384.328 (Published 08 February 2003) Cite this as: BMJ 2003;326:328All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Editor--Problem-based Learning(PBL) curriculum has been actively and
enthusiastically promoted as a new and innovative curriculum for the
education of medicine in most new universities as well as the old ones. It
is indeed new only in so far as comparison to the didactic delivery
methods of scientific subjects during the early years of medical course in
the traditional system. The later years in any medical curriculum was and
still is dominated by clinical teaching. Whether it be PBL or traditional
curriculum, clinical teaching in the wards is still mandatory. Apparently,
the clinical teaching component has not been the focus of the newer PBL
curriculum in its deviation from the more traditional system.
Clinical teaching in medical schools has always been left
unstructured. Students are quite often left freely roaming in the wards
without any specific purpose or objective in their learning. This has been
one of the damning situation that demoralize many a talented medical
students who have competitively earned a prestigious place in the
university only to be let down by the system. There are at least two
reasons for this apparent snag ; I) clinical education is a learning
process of acquisition of knowledge and skills. Like any professional
education, students are perceived as adults and are supposed to know what
they should be learning and this should be the driver of their motivation
to educate themselves. Unfortunately, some students in the traditional
system might not mature in due course away from their didactic years
mentality and they expect teaching and learning to occur in the same
manner. This state of psyche is further enhanced by the fact that the
assessment modalities of the earlier years do not differ greatly from the
clinical years. They are still expected to recall many esoteric facts that
have remote relevance to the fundamental clinical skills they are supposed
to acquire as a medical student. Secondly, to a great extent, clinical
education is literally a practical vocational training of generic skills
acquisition to be able to solve all clinical problems in an intuitive
manner. Clinical problems quite often present subjectively and frequently
intertwinned with one another. Students are expected to imbibe the many
uncertainties of medicine in their approach to solve these problems. The
shift and interface from the more objective psyche to a subjective one
could be a difficult undertaking for many people.
It is very understandable indeed to appreciate the lack of innovation
in teaching the senior medical students in their later years. However, in
view of the similarity of outcomes when PBL curriculum is assessed against
the traditional system, it is perhaps worthwhile to focus any future
innovation in medical education on the methods of clinical teaching per
se.
Competing interests:
None declared
Competing interests: No competing interests
Overrated
I've notice that with the advent of PBL, medical students arriving on
their clinical rotations demonstrate less command of the knowledge needed
to function as clinical consultants. We've also seen, consistently, that
dependence on PBL correlates to poorer performance on standardized tests
(USMLE). While some would argue that that lower test scores are a
reflection of using a poor assesment method (multiple choice questions),
my position would be that we are dumbing down medicine for the sake of
creating something new and more appealing to students. This need to
pursue PBL as a core for medical student education is a fault of the
system preceding it: basic scientists with no clinical background were
lecturing on topics without putting them into a clinical context, causing
students to be bored, dissatisfied with their education, and not
remembering much of what was taught. These basic scientists were teaching
such courses because they "had to"- it was economically tied to their
salary structure. The way around this problem of nonclinicians teaching
was to shift most education to PBL, which can't be conducted by basic
scientists since most PBL are done in a clinical context. This forcibly
removes the basic scientists from the education process (raising issues
with how they will be paid) and brings in clinicians, but at the expense
of transmitting much less information per unit time to the students. The
result- the students are pleased with the clinical-context based
education, but physicians who subsequently have to deal with their lack of
basic knowledge are disappointed in the students. Still, implementation
of PBL has generated much busywork to justify the paychecks of many
professional educators, so it will likely continue to expand. So it goes.
Competing interests:
None declared
Competing interests: No competing interests