By Panayotis Iatridis, MD, DSc
Problem Based Learning (PBL) is a form of medical education based on active learning rather
than rote memorization of facts that might become obsolete in the future. The conventional model
of medical education, centered on teachers and on disciplines, is no longer a viable model for
undergraduate medical education due to the glut of information and to enormous advances in
basic science disciplines. The alternative then, according to Barrows and Tamblyn, is to develop
an instructional method which will place medical students from the very beginning in a context
similar to that in which they will be working as graduates. Thus in PBL, clinical problems presented
to a small group of medical students, as simulated clinical cases in the presence of a tutor, promote
contextual learning, peer interaction, active student involvement and self-motivated learning.
The goal of PBL is for medical students to develop independent and lifelong learning skills.
This form of medical education is not new. Osler in 1913 said that "the student needs more time for quiet study, fewer classes, fewer lectures, and above all, the incubus of examinations should be lifted from his soul." Hippocrates used the method of discourse (dialectici) which reinforced active learning. In the 17th and 18th centuries, the clinical type of medical schools in France and England promoted active learning in a hospital setting. More and more medical schools around the world are introducing PBL curricula which are constantly evaluated and are adjusted in order to optimize their effectiveness. PBL curricula need continuous assessment and monitoring to ensure that medical students are acquiring the minimum learning objectives set by the faculty. Simulated cases should be renewed and clinical information should be always current.
Library, computer and human resources should be available, and more time should be given to the students for self-instruction and peer interaction. The IU School of Medicine's Northwest Center for Medical Education implemented the "Regional Center Alternative Pathway" in 1990. This PBL curriculum differs from other PBL curricula in that the students not only participate in PBL tutorial sessions but also attend a few optional lectures. The Departments of Biochemistry and Physiology in Indianapolis also offer PBL tutorial sessions to reinforce the clinical importance of basic sciences in addition to the conventional curriculum. So far the students' and faculty's perceptions are very positive.
PBL is expensive, but it is a more enjoyable form of medical education for students. Improvements and adjustments, such as the addition of standardized (mock) patients, will provide a more comprehensive form of medical education, integrating the clinical and basic science disciplines.