PBL in Undergraduate Medical Education: A Qualitative Study of the Views of Canadian Residents
Background and Objectives: At McMaster University, the birthplace of problem-based learning (PBL), administrators and curriculum planners have begun the process of renewing the undergraduate MD curriculum. One step has been to conduct an environmental scan that includes input from medical residents. Methods: Individual interviews with 17 medical residents and fellows currently enrolled at McMaster University and are graduates of six Canadian medical schools. Results: PBL appears to be well known even by graduates of non-PBL Canadian medical schools. Tutors are key to a successful PBL program, should be knowledgeable about the content area under study and able to effectively facilitate groups. Tutorial problems should be realistic, up-to-date, and challenge students to investigate more than the medical aspects of the case in question. Students need to be prepared, willing to participate in peer teaching, and supportive of the group learning process. PBL programs can be improved if they incorporate elements of traditional medical programs (e.g., mini-lectures, clear learning objectives, and unbiased evaluation of student progress) while retaining the essence of student-generated learning. Conclusions: Medical residents are an underutilized source of information about undergraduate medical programs. According to our participants, more emphasis on faculty development and upgrading health care problems will improve PBL-based undergraduate medical education.
Key wordsin-depth interviews medical residents PBL problem-based learning qualitative research undergraduate medical education
Abouleish, A.E., Golden, A., O’Donell, A.A., Beach, P.S., Calhoun, K.A., Blackwell, T.A., Gallaway, P.J., Teske, L., Wilson, S.M., Koleng, E.M., Leblanc, A.L. 2003Problem-based learning in a managed care seminar for all new residents at an academic medical centerTexas Medicine995457Google Scholar Addison, R.B. 1999A grounded hermeneutic editing approachCrabtree, B.F.Miller, W.L. eds. Doing Qualitative Research2ndSage PublicationsThousand Oaks, CA145161Google Scholar Albanese, M.A., Mitchell, S. 1993Problem-based learning: a review of literature on its outcomes and implementation issuesAcademic Medicine685281PubMedGoogle Scholar Anderson, S., Camp, M.G., Phillip, J.R 1990Library utilization by medical students in a traditional or problem-based curriculumBender, W.Hioemstra, R.J.Scherpbier, A.Zwierstra, R. eds. Teaching and Assessing Clinical CompetenceBoekwerk PublicationsGroningen, The Netherlands7780Google Scholar Antepohl, W., Herzig, S. 1999Problem-based learning versus lecture-based learning in a course of basic pharmacology: a controlled, randomized studyMedical Education33106113CrossRefPubMedGoogle Scholar Applegate, M.S. 2003Preventive medicine teaching cases for preventive medicine residentsAmerican Journal of Preventive Medicine24S111S115CrossRefGoogle Scholar Berkson, L. 1993“Problem-based learning”: have the expectations been met?Academic Medicine68S79S88Google Scholar Bligh, J., Lloyd-Jones, G., Smith, G. 2000Early effects of a new problem-based clinically oriented curriculum on students’ perceptions of teachingMedical Education34487489CrossRefPubMedGoogle Scholar Chang, G., Cook, D., Maguire, T., Skakun, E., Yakimets, W.W., Warnock, G.l. 1995Problem-based learning: Its role in undergraduate surgical educationCanadian Journal of Surgery381321Google Scholar Colenda, C.C., Wadland, W., Hayes, O., Anderson, W., Priester, F., Pearson, R., Keefe, C., Fleck, L. 2000Training tomorrow’s clinicians today – managed care essentials: a process for curriculum developmentThe American Journal of Managed Care6561572PubMedGoogle Scholar Colliver, J.A. 2000Effectiveness of problem-based learning curricula: research and theoryAcademic Medicine75259266PubMedGoogle Scholar Das Carlo, M., Swadi, H., Mpofu, D. 2003Medical student perceptions of factors affecting productivity of problem-based learning tutorial groups: does culture influence the outcome?Teaching and Learning in Medicine155964CrossRefPubMedGoogle Scholar Des Marchais, J.E. 1999A Delphi technique to identify and evaluate criteria for construction of PBL problemsMedical Education33504508CrossRefPubMedGoogle Scholar Dolmans, D.H., Gijselaers, W.H., Moust, J.H., Grave, W.S., Wolfhagen, I.H., Vleuten, C.P. 2002Trends in research on the tutor in problem-based learning: conclusions and implications for educational practice and researchMedical Teacher24173180CrossRefPubMedGoogle Scholar Eagle, C.J., Harasym, P.H., Mandin, H. 1992Effects of tutors with case expertise on problem-based learning issuesAcademic Medicine: The Journal of the Association of American Medical Colleges67465469Google Scholar Eshach, H., Bitterman, H. 2003From case-based reasoning to problem-based learningAcademic Medicine78491496PubMedGoogle Scholar Finch, P.M. 1999The effect of problem-based learning on the academic performance of students studying podiatric medicine in OntarioMedical Education33411417CrossRefPubMedGoogle Scholar Gilkison, A. 2003Techniques used by “expert” and “non-expert” tutors to facilitate problem-based learning tutorials in an undergraduate medical curriculumMedical Education37614CrossRefGoogle Scholar Gomez, A.G., Grimm, C.T., Yee, E.F., Skootsky, S.A. 1997Preparing residents for managed care practice using an experience-based curriculumAcademic Medicine: The Journal of the Association of American Medical Colleges72959965Google Scholar Jacobs, A.E., Dolmans, D.H., Wolfhagen, I.H., Scherpbier, A.J. 2003Validation of a short questionnaire to assess the degree of complexity and structuredness of PBL problemsMedical Education3710011007CrossRefPubMedGoogle Scholar Jones, A., McArdle, P.J., O’Neill, P.A. 2002Perceptions of how well graduates are prepared for the role of pre-registration house officer: a comparison of outcomes from a traditional and an integrated PBL curriculumMedical Education361625CrossRefPubMedGoogle Scholar Kaufman, D.M., Holmes, D.B. 1998The relationship of tutors’ content expertise to interventions and perceptions in a PBL medical curriculumMedical Education32255261CrossRefPubMedGoogle Scholar Krueger, R.A 1998Focus Group KitSage PublicationsThousand Oaks, CAGoogle Scholar Lloyd-Jones, G., Hak, T. 2004Self-directed learning and student pragmatismAdvances in Health Sciences Education: Theory and Practice96173CrossRefGoogle Scholar MacPherson, R., Jones, A., Whitehouse, C.R., O’Neill, P.A. 2001Small group learning in the final year of a medical degree: a quantitative and qualitative evaluationMedical Teacher23494502CrossRefPubMedGoogle Scholar Maudsley, G. 1999Do we all mean the same thing by ‘problem-based learning’? A review of the concepts and a formulation of the ground rulesAcademic Medicine74178185PubMedGoogle Scholar Maudsley, G. 2002Making sense of trying not to teach: an interview study of tutors’ ideas of problem-based learningAcademic Medicine: The Journal of the Association of American Medical Colleges77162172Google Scholar Maudsley, G. 2003The limits of tutors’ comfort zones with four integrated knowledge themes in a problem-based undergraduate medical curriculum (Interview study)Medical Education37417423CrossRefPubMedGoogle Scholar McLean, M., Henson, Q., Hiles, L. 2003The possible contribution of student drawings to evaluation in a new problem-based learning medical programme: a pilot studyMedical Education37895906CrossRefPubMedGoogle Scholar Morris, J. 2003How strong is the case for the adoption of problem-based learning in physiotherapy education in the United Kingdom?Medical Teacher252431CrossRefPubMedGoogle Scholar O’Hanlon, A., Winefield, H., Hejka, E., Chur-Hansen, A. 1995Initial responses of first-year medical students to problem-based learning in a behavioural science course: role of language background and course contentMedical Education29198204PubMedGoogle Scholar O’Neill, P.A., Jones, A., Willis, S.C., McArdle, P.J. 2003Does a new undergraduate curriculum based on Tomorrow’s Doctors prepare house officers better for their first post? A qualitative study of the views of pre-registration house officers using critical incidentsMedical Education3711001108CrossRefPubMedGoogle Scholar Patel, V.L., Groen, G.J., Norman, G.R. 1993Reasoning and instruction in medical curriculaCognition and Instruction10335378Google Scholar Prince, K.J., Wiel, M., Scherpbier, A.J., Can Der Vleuten, C.P., Boshuizen, H.P. 2000A qualitative analysis of the transition from theory to practice in undergraduate training in a PBL medical schoolAdvances in Health Sciences Education: Theory and Practice5105116CrossRefGoogle Scholar Ravens, U., Nitsche, I., Haag, C., Dobrev, D. 2002What is a good tutorial from the student’s point of view? Evaluation of tutorials in a newly established PBL block course “Basics of Drug Therapy”Naunys-Schmiedeberg’s Archives of Pharmacology3666976CrossRefGoogle Scholar Rolfe, I.E., Andren, J.M., Pearson, S., Hensley, M.J., Gordon, J.J. 1995Clinical competence of interns. Programme Evaluation Committee (PEC)Medical Education29225230PubMedGoogle Scholar Sandelowski, M. 1986The problem of rigor in qualitative researchAdvanced Nursing Science82737Google Scholar Schmidt, H.G. 1983Problem-based learning: rationale and descriptionMedical Education171116PubMedGoogle Scholar Schmidt, H.G., Moust, J.H. 1995What makes a tutor effective? A structural-equations modeling approach to learning in problem-based curriculaAcademic Medicine70708714PubMedGoogle Scholar Schwartz, R.W., Donnelly, M.B., Sloan, D.A., Strodel, W.E. 1997Residents’ evaluation of a problem-based learning curriculum in a general surgery residency programAmerican Journal of Surgery173338341CrossRefPubMedGoogle Scholar Shin, J.H., Haynes, R.B., Johnston, M. 1991The effect of a problem-based self-directed undergraduate education on life-long learningClinical Investigative Medicine14A82Google Scholar Silver, M., Wilkerson, L.A. 1991Effects of tutors with subject expertise on the problem-based tutorial processAcademic Medicine66298300PubMedGoogle Scholar Tolnai, S. 1991Continuing medical education and career choice among graduates of problem-based and traditional curriculaMedical Education25414420PubMedGoogle Scholar Tipping, J., Freeman, R.F., Rachlis, A.R. 1995Using faculty and student perceptions of group dynamics to develop recommendations fro PBL trainingAcademic Medicine: The Journal of the Association of American Medical Colleges7010501052Google Scholar Vernon, D.T.A., Blake, R.L. 1993Does problem-based learning work? A meta-analysis of evaluative researchAcademic Medicine68950963Google Scholar Walton, H.J., Matthews, M.B. 1989Essentials of problem-based learningMedical Education23542558PubMedGoogle Scholar Wilkerson, L., Irby, D.M. 1998Strategies for improving teaching practices: a comprehensive approach to faculty developmentAcademic Medicine73387396PubMedGoogle Scholar Willis, S.C., Jones, A., Bundty, C., Burdett, K., Whitehouse, C.R., O’Neill, P.A. 2002Small-group work and assessment in a PBL curriculum: a qualitative and quantitative evaluation of student perceptions of the process of working in small groups and its assessmentMedical Teacher24495501CrossRefPubMedGoogle Scholar Willis, S.C., Jones, A., O’Neill, P.A. 2003Can undergraduate education have an effect on the ways in which pre-registration house officers conceptualise communicationMedical Education37603608CrossRefPubMedGoogle Scholar Woodward, C.A. 1996Problem-based learning in medical education: developing a research agendaAdvances in Health Sciences Education: Theory and Practice18394CrossRefGoogle Scholar Woodward, C.A., McAuley, R.G. 1983Can the academic background of medical graduates be detected during internship?Canadian Medical Association Journal129567569PubMedGoogle Scholar