- Gillian Maudsley, senior lecturer
- Department of Public Health, University of Liverpool, Liverpool L69 3GB
- Accepted 3 December 1998
Over recent decades, many countries have recognised that traditional undergraduate medical education must change substantially in order to match the changing healthcare needs of the population and become more centred on the students. 1 2 This changes the role of medical educators. Problem based learning is one approach to reform that has international credibility. Numerous undergraduate medical curriculums have incorporated problem based learning; in 1992-3, 27 North American medical curriculums were using this approach, 14 of them across the board.3
In 1993, three systematic reviews of problem based learning in undergraduate medical education were published. These reviews, spanning 20 years, were cautiously optimistic about the short term and long term outcomes of problem based learning compared with traditional approaches.4–6 They found that the results for students' evaluation of the programme; students' attendance, mood, and clinical performance; and faculty attitudes were better for problem based learning—even allowing for different definitions, curricular context and costs, and study design in the evidence base. Evidence about the coverage of basic science and curricular costs is conflicting,5 but Berkson believed that the students' enjoyment4 of the adult learning route to competence6 countered these concerns or unrealistic expectations.
Traditional medical schools face many difficulties—from the resistance of staff7 to underresourcing6—in converting comprehensively to problem based learning. These pitfalls were illustrated in the unsuccessful attempt to convert Otago Medical School, New Zealand.8 The pioneering problem based undergraduate medical curriculums originated in new medical schools—McMaster, Canada; Maastricht, Holland; and Newcastle, Australia. Nevertheless, large scale conversion continues, and includes (since the mid-1990s) the first British medical schools—Manchester, Liverpool, and Glasgow. This reflects the recommendations of the General Medical Council2 and worldwide imperatives to incorporate theories of adult and problem focused education.
Problem based learning is characterised by …