banner



Home  ›  Is Problem Based Learning Causing A Decline In Medical Students' Knowledge

Is Problem Based Learning Causing A Decline In Medical Students' Knowledge

Written By Wednesday, June 8, 2022 Add Comment Edit
  • Debate
  • Open Access
  • Published:

Learning from the bug of problem-based learning

BMC Medical Education volume 4, Commodity number:1 (2004) Cite this article

  • 7025 Accesses

  • 32 Citations

  • 1 Altmetric

  • Metrics details

Abstract

Groundwork

The last decade has witnessed a rapid expansion of biomedical cognition. Despite this, fashions in medical educational activity over the same period take shifted away from factual (didactic) teaching and towards contextual, or problem-based, learning (PBL). This paradigm shift has been justified by studies showing that PBL improves reasoning and communication while being associated with few if any detectable cognition deficits.

Discussion

Analysis of the literature indicates that the recent rapid rise of PBL has closely paralleled the timing of the information explosion. The growing dominance of PBL could thus worsen the problems of information management in medical didactics via several mechanisms: beginning, by creating the impression that a defined spectrum of core factual noesis suffices for clinical competence despite ongoing cognition expansion (quality price); second, by dissuading teachers from refining the educational utility of didactic modalities (improvement price); and third, by reducing kinesthesia time for developing reusable resources to impart factual knowledge more than efficiently (opportunity price).

Summary

These costs of PBL imply a demand for strengthening the knowledge base of 21st-century medical graduates. New initiatives towards this end could include the development of more integrated cognitive techniques for facilitating the comprehension of complex data; the blueprint of differentiated medical curricula for producing graduates with defined high-priority skill sets; and the encouragement of more cost-constructive faculty educational activity activities focused on the prototyping and testing of innovative commercializable educational tools.

Peer Review reports

Groundwork

Many doctors have commented that their medical educational activity began in hostage on the outset day that they entered the hospital wards as a easily-on practitioner. Claims of this kind support the view that the apprenticeship model of professional learning – which has been the backbone of training in the healing arts for thousands of years [1] – remains every bit central to medical career development today every bit e'er [2]. A perennial complaint of the medical apprentice-in-training is that there are too few structured teaching activities within the busy world of postgraduate work [3], a concern which many institutions have addressed by developing formalised standing education initiatives reminiscent of medical schoolhouse courses [4–6]. Predictably, different complaints prevail at the pre-licensure phase of the training spectrum, where students ofttimes feel more than motivated to acquire the (implicit) competence of the practising doctor [7, 8] than to absorb large volumes of (explicit) scientific and/or humanistic theory [nine, 10].

Such feelings underlie an unresolved argue over the optimal balance betwixt factual ('educational activity', or content-based) and practical ('training', or operation-based) components of professional evolution [eleven] and, as such, could explain a contempo migrate away from the didactic emphasis of older biomedical educative approaches [12] and towards quasi-experiential, or problem-based, learning [thirteen, fourteen] (PBL; Figure 1A). This hypothesis cannot fully account for the PBL-led transformation of medical didactics in the 1990s, however, overlooking equally information technology does a powerful contrary trend: the explosive proliferation of biomedical knowledge [15, 16] as epitomized by the completion of the Man Genome Project [17]. Although at start sight contradictory, this reciprocal human relationship between knowledge growth and didactic instruction invites a unifying explanation: namely, that the switch of educational philosophy to non-didactic methods represents a strategy for teachers and students to cope with the expansile information environment [18, xix].

Effigy one
figure 1

Comparison of growth rates of PBL and biomedical knowledge. (A), Relative growth of interest in PBL versus lecture-based teaching based on PubMed keyword frequencies between 1975 and 2000. The Title fields of the journal database were searched each year for the strings "problem-based learning" (open squares) or "lecture" (open diamonds); the retrieved items were and so scrutinized to determine those dealing with the subject of teaching way (e.one thousand., eponymous "lectures" were excluded). (B), Growth rates of periodical articles dealing with subject matter relating to science, medicine and education. The strings "gene" (solid diamonds), "clinical" (open squares) and "medical education" (solid triangles) are shown here, illustrative of the frequencies of many other keywords searched.

Total size image

There are many things which a fresh medical pupil, unburdened by factual knowledge, can begin to acquire: bones surgical methods, resuscitation interventions, generic reasoning skills, and counselling techniques, to proper noun a few. The pivotal question, and so, is not whether such context-dependent (but sequence-independent) learning will show effective [xx]; rather, information technology is why this reorientation of teaching philosophy has occurred at all, and at this time. Or to put the consequence some other way: what is the hard evidence indicating that the original educational arrangement was broken and that the new system is likely to fix it?

A secondary issue, which has been a prime concern of PBL critics [21], is whether there may prove to be long-term hidden costs payable for the clear brusk-term benefits afforded by the PBL education philosophy. Since there are major differences in the way that PBL is implemented between schools, show to confirm or refute such hypotheses may be impossible to gather. Past the same token, it is an oversimplification to view all PBL every bit having depression fact-based content, just equally it is to equate all older educational activity methods with rote learning. Still, since PBL veers more than to the agile/contextual, and didactic teaching to the passive/factual, it is plausible that ane bias occurs at the expense of the other.

Give-and-take

What is knowledge – anyone know?

The traditional educational sequence involves theory preceding application, an accelerated model of which has long been satirized in clinical circles as "lookout man one, do 1, teach 1". Every bit noted above, however, some applications may be learned in the absenteeism of theoretical noesis, just every bit some subsets of theoretical knowledge may exist unassociated with whatsoever obvious application. Is it possible, then, to define a minimum essential "core knowledge" spectrum for the student of biomedicine? If so, should such knowledge expand in parallel with other biomedical information, or should whatsoever such expansion exist restricted by its relevance to changes in clinical performance (the 'barefoot dr.' model)? In the latter case, how long tin can healthcare competence and credibility be maintained in the face of ascension constraints on scientific core knowledge [22]?

If core knowledge is indeed expanding at a charge per unit similar to that of non-core knowledge, then the strategy of solving the broad problem of knowledge expansion by defining a narrower core can only be a temporizing mensurate. On the other hand, if the quantum of core knowledge is accounted non-expansile – arbitrarily defined, for case, to correspond the amount of knowledge capable of being instilled in an average student past ten teaching hours per calendar week spread over y years – then any expansion of non-cadre knowledge will cause the core to compress every bit a proportion of total noesis. In 1984, for case, a listing of 2 hundred drugs was hailed as a solution to information overload in the field of pharmacology [23]; but by 2000 the overload problem in this discipline was perceived to have deteriorated despite both the embracement of PBL and relentless efforts to re-define a core curriculum [24].

A key difficulty in addressing this problem is that expansion of biomedical information is asymmetric – dissimilar areas of knowledge grow at different rates which in turn vary (and are ascribed differing priorities) during different periods (Fig. 1B). In exercise, most curricula cope with differential knowledge growth by adding new core modules to embrace areas of rapid growth [25]; the problem with this approach is that the notion of "core" becomes fluid, invalidating the concept. Moreover, it is difficult to discard ageing core knowledge at the same rate as calculation new information, since the credibility of newer data tends by its nature to exist weaker than that of older content. Rigid conservation of the core leaves trainees selectively deficient in new cognition areas, on the other hand, making them less competitive in the market. Discrepancies emerging between planned (taught) and bodily (learned) medical curricula [26] further weaken the practicability of paradigms based on core knowledge.

The concept of core knowledge every bit a stand-solitary solution to the problem of information inflation thus appears flawed [27]. Although at any ane fourth dimension certain knowledge subsets may be accounted disposable for learning purposes, a continuous expansion of knowledge must imply a comparable expansion of knowledge essential for maintenance of professional competence [28]. Moreover, practicality should not be the sole criterion past which core noesis is judged; a medical training system cannot succeed by simply cloning service-based doctors, but must also produce academics, researchers, visionaries and leaders able to develop the service infrastructure [29]. It is against the background of these diverse challenges that the recent growth of PBL should exist appraised.

The lure of the non-expert

A traditional authoritative doctor who dares challenge the information explosion faces the same risk equally the immovable object confronting the irresistible strength. The outcome has been to shatter the image of the omniscient doctor, as well as to dent the plausibility of experts in all fields. This slide from grace of the specialist – formerly a dominant effigy in the medical educational pantheon, and a revered colleague in the battle confronting information overload [thirty] – has paralleled the reject of the lecture every bit a pedagogy medium. These linked trends suggest that the internet-empowered medical client of the 21st century (whether patient or student) now questions data promulgated by mere individuals, thus threatening clinical and educational activity paradigms formerly assumed unassailable.

This problem has created a niche for PBL, rejecting as it has the sometime curriculum's reliance upon experts and specialists [31]. The reported disadvantages of non-expert biomedical instruction with respect to knowledge manual [32] and illness understanding [33] have been parried by numerous studies showing no detectable data deficits in PBL-trained (compared to lecture-taught) students [34–38]. Such negative data may be of express reassurance, however, given the insensitivity of the endpoints used to measure what is in practice a rather limited curricular deviation [39]. It is likewise arguable that endpoints such every bit cognition acquisition and clinical skills are surrogates, and that the nigh critical deliverable of medical training – namely, the quality of patient outcomes – has not been measured in any controlled trial of PBL [40]. These points lend credence to criticisms that the present-day popularity of PBL has and then far been driven more by individual enthusiasm and conjecture than by objective scientific evidence [41].

Who, and so, stands to gain from PBL? Medical teachers are perhaps the most immediate beneficiaries [42]. Reduced self-perceptions of fallibility may exist one attraction for teachers, as new PBL supervisors notice that their educational contributions are no longer falsifiable by their pupils. In addition, responsibleness for providing a sufficient knowledge base can be passed from teacher to pupil under the PBL auspices of 'self-directed learning' [43]. Yet another benefit relates to the lack of formal grooming required to initiate a PBL session [44] – an advantage which suggests a proceeds in efficiency. But does this bear scrutiny [45]?

Things have changed

Efficiency can be calculated past dividing (productivity) by (time and attempt). What do we mean in this context past productivity? A one-half-century ago, the only responsibleness of a medical school was to produce clinicians to serve the local community; today, however, instruction activities incorporate postgraduate specialist education, continuing medical education, professional and career evolution, public and patient awareness programmes, teaching-related enquiry, conference and workshop organization, national and international collaborative initiatives, professional accreditation and inspect activities, development of electronic educational activity resources, and then on. Hence, a modern faculty's teaching productivity is not able to be gauged exclusively (or even predominantly) by the number and quality of its outgoing medical graduates, but rather must be judged by the sum total of its useful educational output.

This raises curt- and long-term problems as to the near efficient ways to utilize faculty fourth dimension and effort: traditional teaching service activities (e.g., tutorials, mentoring) must compete with more ambitious developmental activities (e.chiliad., production of journal articles, books, software or spider web resources). Small-grouping tutorials are a time-honoured pedagogy modality, but the opportunity toll is loftier; while at that place must surely remain a place for personalized teaching, information technology seems doubtful whether the modern bookish system tin tolerate the luxury of an accelerating tendency in this management [46]. In contrast, the traditional apprenticeship training approach seems toll-constructive, relying every bit it does upon the learner assisting a professional person in the execution of his/her paid duties.

In this context information technology is worth noting that the development of PBL – growth of which during the 1990s coincided with similar trends favouring noncognitive-based medical school admissions [47–49] and humanities-rich preclinical experience [50–52] – was spawned a quarter of a century agone in a regional medical school in Canada [53]. 1 demand scarcely point out that the 1975 academic environs responsible for this educational breakthrough bears little resemblance to the market-driven imperatives that preoccupy nearly medical kinesthesia members today, both in Canada [54–56] and elsewhere [57–62]. A changing environment not only justifies, simply mandates, accommodation; if the 1990s trends exercise indeed represent a retreat from an data-dominated world, and so the substitution of a PBL-dominated philosophy could be fraught with pregnant longterm perils.

From words to deportment

Solutions prevarication in compromise. Such change is painful because it involves the abandonment of ideals formerly accessible; the vision of a 1-size-fits-all medical school becomes no longer practical, and ever more difficult decisions will exist needed equally to what style(southward) of graduate is about urgent for a faculty to produce. This process of curricular differentiation has started, just the pace is prepare to quicken as medical markets emerge and diverge, and as competition for faculty survival sharpens. To what extent, though, should these divisive educational decisions be made past markets, faculties, students, patients or governments?

Contrary to popular idea, at that place volition remain a strong need – and mayhap an enlarging one – for a subset of highly-trained medical graduates from a knowledge-intensive learning environment who are capable of assimilating the complexities of scientific discipline, computer science, humanities and logistics that contain modern medicine. Since the proportion of individuals and faculties suitable for this leadership mission looks set to decline, notwithstanding, a larger number will need to accept the every bit daunting compromise of skills prioritization.

Teachers cannot teach without students, only students tin can larn without teachers. This belated insight has transformed the office of teachers into that of learning facilitators, akin to a culture of "thinking apprenticeship". Paradoxically, in an age when even complex skills such every bit landing aircraft are learned using robotic simulators, the trend in medical education has switched back to labor-intensive minor-group teaching under the guise of PBL. This at get-go seems all the more curious given the unprecedented availability of alternative technologies for didactics clinical reasoning, the increasing importance of an acceptable knowledge base of operations in an ever more sophisticated professional surround, the growing pressures on faculties to apply limited fiscal resources in the near cost-effective mode, and the novel opportunities for commercializing educational activities and products via the development of software and web-based resources.

The rise in PBL popularity over the 1990s thus suggests a retreat from the fallout of the biomedical information explosion. Although this response seems rational plenty as a short-term adaptive measure, it should not be regarded as a solution to the trouble of knowledge expansion. Merely as PBL was originally pioneered as a reaction against complacency in traditional pedagogy, so must today's medical schools reject expediency and confront the unresolved information-direction challenges of 21st-century medical instruction. The conception of more efficient techniques for imparting factual cognition, a greater accent on directing limited resources to the product of reusable didactics tools [63], and a willingness to experiment with differentiated medical curricula that prioritise graduate skill subsets, can all play a role in driving educational reform every bit a positive and ongoing adaptive process.

Summary

The noesis explosion of the last two decades has been accompanied by a decreasing reliance on didactic teaching. This educational prototype shift has been led by widespread embracement of PBL, the original rationale of which was to improve students' power to reason and communicate. In contempo years, however, PBL has grown more rapidly in apparent response to information overload in medical school curricula, and may thus exist viewed every bit a symptom of the problem of biomedical knowledge expansion.

The challenge of defining the right balance betwixt what is taught, what is learned, and what remains unlearned volition non disappear. Although few knowledge deficits accept been detected in today's PBL-educated students, a decreasing business concern with the adequacy of the professional knowledge base of operations could yet erode the future credibility of the medical profession. By continuing to rely on popular PBL escape clauses such as 'self-directed learning' and 'information management', today'south medical educators risk losing sight of this longterm threat.

The era of active learning began thousands of years agone with the get-go apprentice. We at present live in a new era with new challenges, ane of which is exponential data expansion. PBL provides one way for kinesthesia and students to cope with this claiming, but sidesteps deeper problems relating to the widening core of essential professional noesis. Innovative curricular experiments using educational strategies complementary to PBL would therefore appear timely.

Abbreviations

PBL:

problem-based learning

References

  1. Kreisman JJ: The curandero's amateur: a therapeutic integration of folk and medical healing. Am J Psychiatry. 1975, 132: 81-83.

    Article  Google Scholar

  2. Bleakley A: Pre-registration business firm officers and ward-based learning: a 'new apprenticeship' model. Med Educ. 2002, 36: 9-15. 10.1046/j.1365-2923.2002.01128.x.

    Article  Google Scholar

  3. Britto JA: Residency experienced – in pursuit of structured apprenticeship. Ann Roy Coll Surg. 1995, 77 (supp two): 64-66.

    Google Scholar

  4. Taylor KL, Chudley AE: Meeting the needs of hereafter physicians: a cadre curriculum initiative for postgraduate medical education at a Canadian university. Med Educ. 2001, 35: 973-82. x.1046/j.1365-2923.2001.01021.10.

    Article  Google Scholar

  5. Markova T, Roth LM: E-conferencing for delivery of residency didactics. Acad Med. 2002, 77: 748-49.

    Article  Google Scholar

  6. Minor S, Poenaru D: The in-business firm education of clinical clerks in surgery and the role of housestaff. Am J Surg. 2002, 184: 471-v. ten.1016/S0002-9610(02)01001-2.

    Article  Google Scholar

  7. Rosenberg WM, Sackett DL: On the need for evidence-based medicine. Therapie. 1996, 51: 212-7.

    Google Scholar

  8. Phinney AO, Hager WD: Pedagogy senior medical students in an part setting: the apprentice system revisited. Conn Med. 1998, 62: 337-41.

    Google Scholar

  9. Turner TH, Collinson SR, Fry HS: Doctor in the business firm: the medical student as academic, bellboy and apprentice. Med Teach. 2001, 23: 514-16. ten.1080/01421590126489.

    Article  Google Scholar

  10. Rolfe IE, Sanson-Fisher RW: Translating learning skills into practice: a new strategy for learning clinical skills. Med Educ. 2002, 36: 345-52. x.1046/j.1365-2923.2002.01170.x.

    Article  Google Scholar

  11. Marckmann G: Teaching science vs. the apprentice model – do we really have the option?. Med Health Care Philos. 2001, 4: 85-89. ten.1023/A:1009956310614.

    Commodity  Google Scholar

  12. Wallace AG: Educating tomorrow's doctors: the thing that really matters is that we care. Acad Med. 1997, 72: 253-58.

    Article  Google Scholar

  13. Norman GR, Schmidt HG: Effectiveness of problem-based learning curricula: theory, practice and paper darts. Med Educ. 2000, 34: 721-8. x.1046/j.1365-2923.2000.00749.ten.

    Article  Google Scholar

  14. Finucane PM, Johnson SM, Prideaux DJ: Problem-based learning: its rationale and efficacy. Med J Aust. 1998, 168: 429-thirty.

    Google Scholar

  15. Hunt RE, Newman RG: Medical knowledge overload: a disturbing tendency for physicians. Health Care Manage Rev. 1997, 22: lxx-75.

    Google Scholar

  16. Laine C, Weinberg DS: How can physicians keep up-to-date?. Annu Rev Med. 1999, l: 99-110. 10.1146/annurev.med.50.1.99.

    Article  Google Scholar

  17. Collins FS, Morgan Yard, Patrinos A: The human genome project: lessons from big-calibration biology. Science. 2003, 300: 286-90. 10.1126/science.1084564.

    Article  Google Scholar

  18. Carlile S, Barnet S, Sefton A, Uther J: Medical problem based learning supported by intranet technology: a natural pupil centred arroyo. Int J Med Inf. 1998, 50: 225-33. x.1016/S1386-5056(98)00073-2.

    Article  Google Scholar

  19. Smith HC: A grade director's perspectives on problem-based learning curricula in biochemistry. Acad Med. 2002, 77: 1189-98.

    Article  Google Scholar

  20. Webster C, McLinden Due south, Begler Thousand: Why Johnny tin't reengineer health care processes with information technology. Medinfo. 1995, 8: 1283-7.

    Google Scholar

  21. Monkhouse WS, Farrell TB: Tomorrow'south doctors: today's mistakes?. Clin Anat. 1999, 12: 131-4. ten.1002/(SICI)1098-2353(1999)12:two<131::AID-CA9>iii.0.CO;ii-L.

    Article  Google Scholar

  22. Maudsley G, Strivens J: 'Science', 'critical thinking' and 'competence' for tomorrow's doctors: a review of terms and concepts. Med Educ. 2000, 34: 53-60. 10.1046/j.1365-2923.2000.00428.x.

    Commodity  Google Scholar

  23. Riley MW: Reducing 'information overload' in the instruction of pharmacology: the '200 Drug List'. J Med Educ. 1984, 59: 508-11.

    Google Scholar

  24. Achike FI, Ogle CW: Information overload in the teaching of pharmacology. J Clin Pharmacol. 2000, 40: 177-83. 10.1177/00912700022008838.

    Article  Google Scholar

  25. Vidic B, Weitlauf HM: Horizontal and vertical integration of bookish disciplines in the medical school curriculum. Clin Anat. 2002, 15: 233-5. 10.1002/ca.10019.

    Article  Google Scholar

  26. Verhoeven BH, Verwijnen GM, Scherpbier AJ, van der Vleuten CP: Growth of medical cognition. Med Educ. 2002, 36: 711-17. ten.1046/j.1365-2923.2002.01268.ten.

    Article  Google Scholar

  27. Simpson JG, Furnace J, Crosby J, et al: The Scottish doctor – learning outcomes for the medical undergraduate in Scotland – a foundation for competent and reflexive practitioners. Med Teach. 2002, 24: 136-43. x.1080/01421590220120713.

    Article  Google Scholar

  28. Whipp JL, Ferguson DJ, Wells LM, Iacopino AM: Rethinking noesis and pedagogy in dental education. J Paring Educ. 2000, 64: 860-66.

    Google Scholar

  29. Hammel J, Royeen CH, Bagatell N, Chandler B, Jensen G, Loveland R, Rock One thousand: Pupil perspectives on trouble-based learning in an occupational therapy curriculum: a multiyear qualitative evaluation. Am J Occup Ther. 1999, 53: 199-206.

    Article  Google Scholar

  30. Cullen R: The medical specialist: data gateway or gatekeeper for the family practitioner. Bull Med Lib Assoc. 1997, 85: 348-55.

    Google Scholar

  31. Maudsley One thousand: Making sense of trying not to teach: an interview study of tutors' ideas of trouble-based learning. Acad Med. 2002, 77: 162-72.

    Article  Google Scholar

  32. Hay PJ, Katsikitis M: The 'expert' in problem-based and case-based learning: necessary or not?. Med Educ. 2001, 35: 22-26. ten.1046/j.1365-2923.2001.00679.x.

    Article  Google Scholar

  33. Jones A, McArdle PJ, O'Neill PA: Perceptions of how well graduates are prepared for the part of pre-registration house officer: a comparing of outcomes from a traditional and an integrated PBL curriculum. Med Educ. 2002, 36: 16-25. ten.1046/j.1365-2923.2002.01105.10.

    Article  Google Scholar

  34. Kaufman DM, Isle of mann KV: Comparing accomplishment on the Medical Council of Canada Qualifying Examination Part I of students in conventional and trouble-based learning curricula. Acad Med. 1998, 73: 852-3.

    Article  Google Scholar

  35. Antepohl West, Herzig Southward: Trouble-based learning versus lecture-based learning in a course of basic pharmacology: a controlled randomized study. Med Educ. 1999, 33: 106-13. ten.1046/j.1365-2923.1999.00289.x.

    Article  Google Scholar

  36. Alleyne T, Shirley A, Bennett C, et al: Trouble-based compared with traditional methods at the Faculty of Medical Sciences, University of the West Indies: a model study. Med Teach. 2002, 24: 273-9. x.1080/01421590220125286.

    Article  Google Scholar

  37. Whitfield CF, Mauger EA, Zwicker J, Lehman EB: Differences between students in problem-based and lecture-based curricula measured by clerkship performance ratings at the beginning of the tertiary year. Teach Learn Med. 2002, 14: 211-17. 10.1207/S15328015TLM1404_2.

    Article  Google Scholar

  38. Prince KJ, van Mameren H, Hylkema N, Drukker J, Scherpbier AJ, van der Vleuten CP: Does problem-based learning lead to deficiencies in basic science knowledge?. Med Educ. 2003, 37: 15-21. 10.1046/j.1365-2923.2003.01402.10.

    Commodity  Google Scholar

  39. Albanese One thousand: Problem-based learning: why curricula are likely to show little event on knowledge and clinical skills. Med Educ. 2000, 34: 729-38. 10.1046/j.1365-2923.2000.00753.x.

    Commodity  Google Scholar

  40. Thomas RE: Problem-based learning: measurable outcomes. Med Educ. 1997, 31: 320-29. 10.1046/j.1365-2923.1997.00671.x.

    Article  Google Scholar

  41. Colliver JA: Educational theory and medical education practise: a cautionary note for medical school faculty. Acad Med. 2002, 77: 1217-20.

    Article  Google Scholar

  42. Hsu SC, Ong GH: Evaluation of problem-based learning: a lecturer'due south perspective. Ann Acad Med Singapore. 2001, 30: 524-vii.

    Google Scholar

  43. Miflin BM, Campbell CB, Price DA: A conceptual framework to guide the evolution of self-directed, lifelong learning in problem-based medical curricula. Med Educ. 2000, 34: 299-306. 10.1046/j.1365-2923.2000.00564.x.

    Article  Google Scholar

  44. Mennin SP, Martinez-Burrola North: The toll of problem-based vs. traditional medical teaching. Med Educ. 1986, xx: 187-94.

    Article  Google Scholar

  45. Doucet Doc, Purdy RA, Kaufman DM, Langille DB: Comparison of trouble-based learning and lecture format in continuing medical didactics based on headache diagnosis and management. Med Educ. 1998, 32: 590-96. 10.1046/j.1365-2923.1998.00277.10.

    Article  Google Scholar

  46. Jonas HS, Etzel SI, Barzansky B: Educational programs in US medical schools. JAMA. 1991, 266: 913-xx. 10.1001/jama.266.7.913.

    Article  Google Scholar

  47. Nowacek GA, Bailey BA, Sturgill BC: Influence of the interview on the evaluation of applicants to medical schoolhouse. Acad Med. 1996, 71: 1093-95.

    Article  Google Scholar

  48. Carrothers RM, Gregory SW, Gallagher TJ: Measuring emotional intelligence of medical schoolhouse applicants. Acad Med. 2000, 75: 456-63.

    Article  Google Scholar

  49. Edwards JC, Elam CL, Wagoner NE: An admission model for medical schools. Acad Med. 2001, 76: 1207-12.

    Article  Google Scholar

  50. Barnard D, Quill T, Hafferty FW, Arnold R, Plumb J, Bulger R, Field Thou: Preparing the footing: contributions of the preclinical years to medical education for intendance well-nigh the cease of life. Acad Med. 1999, 74: 499-505.

    Article  Google Scholar

  51. Weiss SC: Humanities in medical didactics: revisiting the doctor-patient relationship. Med Law. 2000, nineteen: 559-67.

    Google Scholar

  52. Kirklin D: Responding to the implications of the genetics revolution for the education and training of doctors: a medical humanities approach. Med Educ. 2003, 37: 168-73. 10.1046/j.1365-2923.2003.01433.x.

    Commodity  Google Scholar

  53. Walsh WJ: The McMaster programme of medical education, Hamilton, Ontario, Canada: developing trouble-solving activities. Public Wellness Pap. 1978, 70: 69-77.

    Google Scholar

  54. Thorne South: Medical school tuition fees reach record levels every bit MD incomes shrink. Tin can Med Assoc J. 1996, 155: 979-81.

    Google Scholar

  55. Godwin M, Seguin R, Wilson R: Queen'due south University alternative funding plan: effect on patients, staff and faculty in the Department of Family Medicine. Can Fam Phys. 2000, 46: 1438-44.

    Google Scholar

  56. Kwong JC, Dhalla IA, Streiner DL, Baddour RE, Waddell AE, Johnson IL: Effects of rising tuition fees on medical school course composition and financial outlook. Tin can Med Assoc J. 2002, 166: 1023-28.

    Google Scholar

  57. Robins LS, White CB, Fantone JC: The difficulty of sustaining curricular reforms: a report of "drift" at i schoolhouse. Acad Med. 2000, 75: 801-05.

    Article  Google Scholar

  58. Kenny AJ, Kendall S: Serving two masters: quality teaching and learning versus economic rationalism. Nurs Educ Today. 2001, 21: 648-55. 10.1054/nedt.2001.0601.

    Article  Google Scholar

  59. Woolliscroft JO, Van Harrison R, Anderson MB: Faculty views of reimbursement changes and clinical training: a survey of award-winning clinical teachers. Teach Larn Med. 2002, 14: 77-86. ten.1207/S15328015TLM1402_03.

    Commodity  Google Scholar

  60. Gelijns Air conditioning, Thier So: Medical innovation and institutional interdependence: rethinking university-industry connections. JAMA. 2002, 287: 72-77. 10.1001/jama.287.one.72.

    Commodity  Google Scholar

  61. Harden RM, Hart IR: An international virtual medical school (IVIMEDS): the time to come for medical teaching?. Med Teach. 2002, 24: 261-67. 10.1080/01421590220141008.

    Commodity  Google Scholar

  62. Cohen JR, Play tricks Due south: Developing a new faculty exercise plan with a model for funding flow between the hospital and the plan. Acad Med. 2003, 78: 119-ii.

    Commodity  Google Scholar

  63. Adler Doc, Johnson KB: Quantifying the literature of calculator-aided pedagogy in medical education. Acad Med. 2000, 75: 1025-8.

    Article  Google Scholar

Pre-publication history

  • The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6920/4/i/prepub

Download references

Acknowledgements

The author thank you Professor Joe Muller, as well every bit two named journal reviewers, for constructive feedback on the manuscript.

Writer information

Authors and Affiliations

  1. Department of Medicine, University of Hong Kong, Queen Mary Infirmary, Pokfulam, Hong Kong

    Richard J Epstein

Corresponding author

Correspondence to Richard J Epstein.

Additional information

Competing interests

None declared.

Authors' original submitted files for images

Rights and permissions

About this article

Cite this article

Epstein, R.J. Learning from the problems of problem-based learning. BMC Med Educ 4, 1 (2004). https://doi.org/x.1186/1472-6920-four-one

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI : https://doi.org/10.1186/1472-6920-four-1

Keywords

  • knowledge management, medical didactics

Is Problem Based Learning Causing A Decline In Medical Students' Knowledge,

Source: https://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-4-1

Posted by: keysloger1987.blogspot.com

0 Response to "Is Problem Based Learning Causing A Decline In Medical Students' Knowledge"

Post a Comment

Subscribe to: Post Comments (Atom)

Iklan Atas Artikel

Iklan Tengah Artikel 1

Iklan Tengah Artikel 2

Iklan Bawah Artikel