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The effects of problem-based learning during medical school on physician competency: a systematic review
Gerald Choon-Huat Koh, Hoon Eng Khoo, Mee Lian Wong and David Koh CMAJ • January 1, 2008; 178 (1).
Quote:
Background: Systematic reviews on the effects of problem-based learning have been limited to knowledge competency either during medical school or postgraduate training. We conducted a systematic review of evidence of the effects that problem-based learning during medical school had on physician competencies after graduation.
Methods: We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Databases, and the tables of contents of 5 major medical education journals from earliest available date through Oct. 31, 2006. We included studies in our review if they met the following criteria: problem-based learning was a teaching method in medical school, physician competencies were assessed after graduation and a control group of graduates of traditional curricula was used. We developed a scoring system to assess the quality of the studies, categorized competencies into 8 thematic dimensions and used a second system to determine the level of evidence for each competency assessed.
Results: Our search yielded 102 articles, of which 15 met inclusion criteria after full text review. Only 13 studies entered final systematic analysis because 2 studies reported their findings in 2 articles. According to self-assessments, 8 of 37 competencies had strong evidence in support of problem-based learning. Observed assessments had 7 competencies with strong evidence. In both groups, most of these competencies were in the social and cognitive dimensions. Only 4 competencies had moderate to strong levels of evidence in support of problem-based learning for both self-and observed assessments: coping with uncertainty (strong), appreciation of legal and ethical aspects of health care (strong), communication skills (moderate and strong respectively) and self-directed continuing learning (moderate).
Interpretation: Problem-based learning during medical school has positive effects on physician competency after graduation, mainly in social and cognitive dimensions.
A serious look at how educational innovations are disseminated may give the thoughtful observer cause to question the pervasiveness of the "scientific method." Sometimes it seems that education moves from one fad to the next. In my now longish career, I have seen many educational methods come and go: patient-management problems, modified essay questions, behavioural objectives, learning styles and more. This decade's "flavours of the month" — reflective practice, e-learning and high-fidelity simulations — appear to be no more evidence-based than all those that have come (and gone) before. Sadly, although good evidence in support of a particular educational innovation may exist, it is rarely instrumental in decisions to adopt that innovation.
Nowhere is this pattern more evident than with the locally grown phenomenon, problem-based learning. In this radically different approach to medical education, learning is driven by challenging, open-ended problems; students work in small groups; learning is facilitated by a tutor; courses do not exist; and lectures are minimal. Problem-based learning originated at McMaster University in Hamilton, Ontario, in the late 1960s. The method's "founding fathers" were an iconoclastic group of physicians and basic scientists from the Toronto–Hamilton area who were recruited by the school of medicine's first dean, John Evans. They all shared a negative view of their undergraduate experiences and thought they could do better. Their goals were straightforward: in the words of Bill Walsh, the first associate dean of education, "All we want is for them to get an MD and have some fun doing it." Within a very few years, we had evidence that this was true.
In the meantime, to everyone's surprise, the method caught on like wildfire. Within a few years there were problem-based learning curricula in the Netherlands, Australia, Israel and the United States. And the method has continued to spread: now, several hundred schools profess to offer some form of problem-based learning. ......
I kinda grew up with concept of problem based learning and was introduced to the work of McMaser as a student teacher in the early 70s. I also had the chance to spend a year at the Centre of Medical Education, University of Dundee where I read competence based learning in clinical education models of medicine, dentistry and nursing and allied health. By good fortune I met several professionals who had trained at McMaster and was able to gain insights from their subjective accounts of their primal education experience. I have also had the pleasure of visiting many centres of podiatric education within the commonwealth whilst teaching, and I am not aware of any examples of a problem based learning curriculum in podiatry.
The only works I know of where the learning characteristics of podiatry students were compared with medical students was written by Prof Rob Ashford in the late 80s. Whilst he did see some similarities he was also guarded about considering the groups as homogenous. I would therefore take caution in drawing hard and fast conclusions from studies from the medical education community and relating them directly to podiatry. Here, definatley conditions apply and more direct research is indicated.
Problem based learning and competency
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