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Problem based learning better prepares students for practice
Karen Hebert, Bristol
Medical graduates who have followed a problem based
learning (PBL) course report that they have a different set of skills when
they start working than students who have followed a traditional course (Medical Education 2005;39: 394-401).
Katinka Prince and colleagues analysed responses from
1159 graduates from one PBL (239) and four non-PBL (917) medical schools in
the Netherlands. (At the time of the study there was only one PBL medical
school in the Netherlands.) Graduates answered a questionnaire 18 months
after graduating.
"We explored graduates' perceptions of how
well their training had prepared them for medical practice, particularly in
general competencies. We compared the opinions of graduates from PBL and
non-PBL schools, because PBL is supposed to enhance general
competencies," Dr Prince explained.
The PBL graduates rated their quality of training, and
in turn, their preparation for practice, significantly more highly than
their non-PBL counterparts. Non-PBL graduates (83%) ranked their own expert
medical knowledge significantly more highly than the PBL graduates (72%).
Most PBL graduates (83%) considered that they had competent communication
skills in contrast to a minority of non-PBL graduates (41%).
Dr Prince said, "This study showed that PBL
graduates gave higher ratings for the connection between school and work
and their preparation for practice. We expected this as PBL is supposed to
enhance preparation for practice. We found it interesting that the PBL
school appeared to provide better preparation with respect to several of
the competencies needed in practice—profession specific skills,
communication skills, and teamwork."
The study showed, however, that most graduates (46%
PBL and 34% non-PBL) report a lack of training in computer work, planning
and organisation skills, and leadership skills at medical school. Most
graduates (53% PBL and 58% non-PBL) agreed that although they had attained
most of their knowledge during medical school, they had learnt profession
specific skills, such as team working, while in the workplace.
Dr Prince said, "There is an apparent failure of
medical schools to provide students with adequate preparation with respect
to many general competencies that doctors need in their day to day work,
such as working independently and accurately. Using computers, planning and
organising work, and leadership skills were identified as competencies with
insufficient exposure in the curriculum.
"This study is not conclusive as to whether PBL
graduates are better or worse than non-PBL graduates. Personally, I
don't think any study can conclude that, because I don't know
what makes graduates better or worse. One can only draw conclusions on
components that can be measured."
SPENCER GEWWN/AP
studentBMJ 2005;13:177-220 May ISSN 0966-6494
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Responses published this month
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Articles
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Responses
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NEWS
Problem based learning better prepares students for practice
Karen Hebert (May 2005)
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Dr.Satheesha Nayak B
(May 08, 2005)
Read this response
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NEWS
Problem based learning better prepares students for practice
Karen Hebert (May 2005)
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Dr.CIRAJ A.M
(May 11, 2005)
Read this response
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NEWS
Problem based learning better prepares students for practice
Karen Hebert (May 2005)
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Miss S. Khan
(May 21, 2005)
Read this response
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NEWS
Problem based learning better prepares students for practice
Karen Hebert (May 2005)
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Owais Raza
(May 27, 2005)
Read this response
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NEWS
Problem based learning better prepares students for practice
Karen Hebert(May 2005)
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Talha Vaqar
(September 4th, 2007)
Aga Khan University, Karachi, Pakistan District, Karnataka State, INDIA. 576104 talhavaqar@hotmail.com
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The stereotype of conventional teacher-centred-learning has so deeply become so deeply ingrained in our mind that accepting a highly student based learning experience was quite difficult. Four years ago when I initially started my degree (being part of just the second class at our college to follow a pbl curriculum), the idea of unassisted learning made me feela bit like I had been abandoned by my potential teachers.
After four years of going through the grind, I feel that PBL which sounds so fantastic on paper, failed to implemented entirely in spirit. Since with time we realised that our previous knowledge was scant and there was always a 'correct answer' in a medical text book, the process of hypothesizing became gradually extinct.
Our cases usually gave us the diagnosis in the first session, so rather that constructing an idea with tiny bits of information, we ended up thinking backwards. Such actions are partly due to time constraints that medical institutions face to cover an ever increasing medical curriculum. But the tragedy was that already knowing the diagnosis was like letting the cat out of the box - no mystery, no fun and hence much less drive to 'explore'.
With time PBL students start to derive short cuts to studying for sessions. After an year or so of practicing PBL, students are usually following a stereotypical pattern of studying which primarily involves the pathology and a bit of other things. Needless to say that the sessions can become quite boring.
My conclusion is that pbl is a system much better suited to clinical rotations where there is relatively less content to study as compared to basic science modules. During clinical years students are actually seeing 'problems' while during basic sciences years the whole thing is behind a curtain. It would be a boon for up-coming medical students in my college and elsewhere, if they were allowed a solid grounding in basic sciences (which the conventional system does well), followed by three years of clinical training with problem based learning which gives them a chance to apply and integrate the knowledge they already have.
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NEWS
Problem based learning better prepares students for practice
Karen Hebert(May 2005)
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Dr.Satheesha Nayak B
(May 08, 2005)
Selection Grade Lecturer, Melaka Manipal Medical College (Manipal Campus), Manipal, Udupi District, Karnataka State, INDIA. 576104 nayaksathish@yahoo.com
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Editor,
Problem based learning is better than conventional curriculum in many ways and vice versa. We should not and can not compare PBL method to conventional method in terms of outcomes. They are like two paths leading to one goal. Finally you will reach the goal whichever way you take.
As the author’s last paragraph says, it is difficult to draw conclusions about the overall achievement of PBL when compared with traditional method. It is like comparing vegetarian food with non vegetarian food. Which is better? Each one has its own consumer. You can design questionnaires and get feedback from students who have completed the courses and from patients who have been treated by both doctors from PBL School and conventional school.
Previous studies, like the current one, have shown that PBL method improves profession specific skills, communication skills, and teamwork. The studies have also shown that the basic science knowledge of PBL school graduates is not as good as the graduates of conventional school. The stress in taking integrated examinations is also more for PBL graduates when compared to graduates of conventional school.
If the PBL curriculum was the best curriculum, all the schools have changed towards it by now because it is already a decade if not more, since the PBL system came to existence. There are examples of schools which changed into PBL method and then back to conventional. Some have added the components of PBL system into the existing conventional curriculum and have made a hybrid curriculum.
PBL system is like a luxurious car. It is a pride to have and it is luxurious but if you think about the money invested initially and then maintaining it in good condition it is discouraging. It is a costly affair in terms of physical facilities and man power. It needs more classrooms and teachers when compared to conventional methods.
I am not telling that conventional method is the best but then it has its own footprints in medical education. If not it would have been vanished by now. Have you heard of any school which was initially a PBL school and then changed into conventional system for some time and then again back to PBL system saying PBL is better than conventional method? There are examples for schools that initially had conventional method in their schools, then thought of innovation of curriculum and adopted PBL curriculum for a few years but then came back to their conventional system. Why did they do so?
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NEWS
Problem based learning better prepares students for practice
Karen Hebert(May 2005)
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Dr.CIRAJ A.M
(May 11, 2005)
Assistant Professor of Microbiology, Manipal Academy of Higher Education, MANIPAL, INDIA cirajam@yahoo.com
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Problem Based Learning (PBL) is believed to enhance critical thinking and problem solving abilities. The article identifies PBL as an educational strategy that helped medical students in fostering their general competencies. However one should be cautious while implementing a medical curriculum that is exclusively problem based. Based on their past learning experiences students have a tendency to see their instructor as a disseminator of knowledge. Breaking this traditional assumption is not that easy. Our experiences show that students freshly enrolled into a medical school will simply rely on subject matter expertise of their teacher and would find themselves difficult to orient to any strategies of self-directed learning. Hence medical students who express difficulties in a curriculum that is exclusively problem based are many.
We recommend that during the initial phases/semesters of a medical curriculum, multiple approaches be incorporated. This would mean blending traditional approaches like information based learning and strategic learning with innovative approaches like PBL and action based learning (ABL). While traditional methods would help students understand theory and ideas better, PBL and ABL would enhance their creativity and critical thinking.
We have seen that medical students explore greater range of learning experiences if exposed to a combination of information based learning with PBL
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NEWS
Problem based learning better prepares students for practice
Karen Hebert(May 2005)
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Miss S. Khan
(May 21, 2005)
Clinical Fellow, Plastic Surgery, Northern General Hospital, Sheffield sykhan2001@yahoo.com
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Dear Editor,
In response to your article about problem based learning.
I graduated from Manchester Medical School, UK in 2001. My medical degree was purely problem based learning, and as a new university student, fresh from A levels i did not know or have any other experience with any other way of university teaching.
I agree fully that those students who undertake problem based learning feel better prepared for their hospital duties once qualified in terms of communication and team based work.
Having worked with fellow colleagues who have undertaken non-problem based learning, this is evident and they too are in agreeance with this observation.
In response to the email sent by Dr. Satheesha Nyak, i agree that you cannot make direct comparisons between both methods of learning as at the end of the day whatever method the graduate has learnt the same syllabus and the overall degree is the same, preparing the junior doctor for work.
PBL does have its advantages as mentioned in the original article, but it also has disadvantages, which i feel is described as "student dependant". It requires student dedication to participate in a certain style of learning and committment to keep up with the work throughout the five years training.
Overall i do think that PBL does work and helps cover the ever increasing medical syllabus, but requires committment and hard work by not only the student but also by the university. It is very easy for an institution to change to PBL but i believe that there has to be a carefully thought out approach in order to obtain a sucessful working degree course that is going to fully prepare students and support them through a different style of teaching. Certainly as a Manchester graduate, I think that Manchester university has succeeded in this (and i'm sure just like other institutions running PBL) and their degree course should be scrutinised by any medical college wishing to change to PBL.
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NEWS
Problem based learning better prepares students for practice
Karen Hebert (May 2005)
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Owais Raza
(May 27, 2005)
MBBS final year, Ziauddin Medical University, Karachi, Pakistan. paperpin27@hotmail.com
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Dear Editor,
Although, I have neither experience of working as front line medical personal in managing patient, nor as intimate member of medical team around the given case, which can prove my clinical skills and professional attitude while working in a team. I am also going to be a product of Problem Based Learning (PBL) teaching strategy. I can better say that we have been taught in a blend of both PBL and conventional Lecture Based Studies, adjuvant with tutorials and assignment, I suppose not new methods, but in a appropriate mixture. It has correctly said that PBL and conventional methods are two pipeline headed to a single outlet, each having its own benefits and shortcomings. Nevertheless, the disadvantage, obviously for the person at delivering end, is that he is endlessly facing criticism geared up by the student at learning end, and the only solution to this situation is that he needs to keep himself very up-to-date – hard nut to crack for old-fashioned teachers! Our instructors, many times gave us an impression that they are not only forced to study their own specialty, but also compelled to upgrade their knowledge to give a conclusive talk at the end of PBL session.
Another pleasure we PBL students had was of integration of medical curriculum juiced into one case. I remember my first PBL case, which was on Duchene Muscular Dystrophy when we were studying the module of ‘Genetics’. I learned its pathophysiology right in my first week of medical school, immediately after going through the anatomy and physiology of muscles.
Reason why medical colleges find difficulties in running this system is that PBL has two ends to play the game; The teachers/instructors and The student. The student component finds it somewhat interesting to study in broader dimension , because of integration from very beginning. Whereas instructors have always pushed to books, journals and web to see what new have entered.
I will say that exclusion of any one system should not aimed, rather multidisciplinary approach should gain valid consideration if any medical school wants to add this PBL system in their teaching strategy.
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