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CLINICAL REVIEW: Diana F Wood ABC of learning and teaching in medicine: Problem based learning BMJ 2003; 326: 328-330 [Full text]

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PBL in Medical Education is natural

Abd Hamid Mat Sain   (12 February 2003)

Overrated

Jeffrey A Katz   (9 October 2009)

PBL in Medical Education is natural 12 February 2003
Abd Hamid Mat Sain, Deputy Director IPPT Bertam, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia Send response to journal: Re: PBL in Medical Education is natural	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
Overrated 9 October 2009
Jeffrey A Katz, Associate Professor of Anesthesiology Northwestern University Feinberg School of Medicine Send response to journal: Re: 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