Advances in Health Sciences Education

, Volume 5, Issue 2, pp 105–116 | Cite as

A Qualitative Analysis of the Transition from Theory to Practice in Undergraduate Training in a PBL-Medical School

  • Katinka J.A.H. PrinceEmail author
  • Margaretha van de Wiel
  • Albert J.J.A. Scherpbier
  • Cess P.M. can der Vleuten
  • Henny P.A. Boshuizen


In spite of numerous curricular innovations, the problems medical students encounter in making the transition from theoretical training to clinical training remain unresolved and the problem has received scant attention in the literature. We performed a qualitative study to explore students' perceptions and attitudes regarding this transition in undergraduate medical training. Twenty fifth-year students of the Maastricht Medical School participated in focus group discussions about the transition from the preclinical phase to the clinical phase of the curriculum. All focus group discussions were videotaped, literally transcribed and qualitatively analysed using content analysis. The results suggest that students have difficulty in bridging the gap between the theoretical and clinical phase of the curriculum. The problems they experience arise largely from professional socialisation processes. However, students also find it difficult to apply theoretical knowledge in clinical practice. Students find contacts with real patients highly motivating. In the clinical phase their learning changes from passive acquisition of knowledge to more active learning.

Since the problem-based learning approach is supposed to enhance application of basic science concepts to clinical problems, it is surprising that students experience difficulties in applying their knowledge in practice. To facilitate the transition from theory to practice in the Maastricht Medical School some curricular changes could be introduced, such as early patient contacts to motivate students and help them learn usable knowledge. Furthermore, the advantages of a problem-based preclinical curriculum to student learning should be fully exploited. Finally, the assessment system must be congruent with the educational programme, because examinations have a powerful effect on student learning.

clerkships focus group medical education preclinical training problem-based learning transition 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Boshuizen, H.P.A. (1996). The Shock of Practice: Effects on Clinical Reasoning. Paper presented at the The Annual Meeting of the American Educational Research Association, New York, 8–14 April 1996.Google Scholar
  2. Boshuizen, H.P.A. & Schmidt, H.G. (1992). On the role of biomedical knowledge in clinical reasoning by experts, intermediates and novices. Cognitive Science 16(2): 153–184.CrossRefGoogle Scholar
  3. Briggs Style, C., Maxwell, J.A. & Moore, G.T. (1990). The effects of early patient contact: the student's perspective. Academic Medicine 65(9 Suppl): S33–S34.CrossRefGoogle Scholar
  4. Busari, J.O., Scherpbier, A.J.J.A. & Boshuizen, H.P.A. (1997). Comparative study of medical education as perceived by students at three Dutch universities. Advances in Health Science Education 1(2): 141–151.CrossRefGoogle Scholar
  5. Clack, G.B. (1994). Medical graduates evaluate the effectiveness of their education. Medical Education 28(5): 418–431.Google Scholar
  6. General Medical Council (1993). Tomorrow's Doctors. London: GMC.Google Scholar
  7. Foley, R.P., Polson, A.L. & Vance, J.M. (1997). Review of the literature on PBL in the clinical setting. Teaching and Learning in Medicine 9(1): 4–9.CrossRefGoogle Scholar
  8. Hendershott, A. & Wright, S. (1993). Student focus groups and curriculum review. Teaching Sociology 21: 154–159.CrossRefGoogle Scholar
  9. Hill, J., Rolfe, I.E., Pearson, S.A. & Heathcote, A. (1998). Do junior doctors feel they are prepared for hospital practice? A study of graduates from traditional and non-traditional medical schools. Medical Education 32(1): 19–24.CrossRefGoogle Scholar
  10. Morgan, D.L. (1988). Focus Groups as Qualitative Research, Vol. 16. Newbury Park, London, New Delhi: Sage Publications.Google Scholar
  11. Muller, S. (1984). Physicians for the twenty-first century/report of the project panel on the general professional education of the physician and college preparation for medicine. Journal of Medical Education 59(11 Part 2): 1–208.Google Scholar
  12. Mutha, S., Takayama, J.I. & O'Neil, E.H. (1997). Insights into medical students’ career choices based on third-and fourth-year students’ focus-group discussions. Academic Medicine 72(7): 635–640.CrossRefGoogle Scholar
  13. Newble, D.I. & Jaeger, K. (1983). The effect of assessments and examinations on the learning of medical students. Medical Education 17(3): 165–171.Google Scholar
  14. Norman, G.R. & Schmidt, H.G. (1992). The psychological basis of problem-based learning: A review of the evidence. Academic Medicine 67(9): 557–565.CrossRefGoogle Scholar
  15. Roche, A.M., Sanson Fisher, R.W. & Cockburn, J. (1997). Training experiences immediately after medical school. Medical Education 31(1): 9–16.CrossRefGoogle Scholar
  16. Scherpbier, A.J.J.A. (1997). De Kwaliteit van Vaardigheidsonderwijs Gemeten. Dissertation, Universiteit Maastricht, Maastricht.Google Scholar
  17. Schmidt, H.G., Dauphinee, W.D. & Patel, V.L. (1987). Comparing the effects of problem-based and conventional curricula in an international sample. Journal of Medical Education 62(4): 305–315.Google Scholar
  18. Van Dalen, J., Zuidweg, J. & Collet, J. (1989). The curriculum of communication skills teaching at Maastricht medical school. Medical Education 23(1): 55–61.Google Scholar
  19. Van de Wiel, M.W.J., Schaper, N.C., Scherpbier, A.J.J.A., Van der Vleuten, C.P.M. & Boshuizen, H.P.A. (1999). Students’ experiences with real patient tutorials in a problem-based curriculum. Teaching and Learning in Medicine 11(1): 12–20.CrossRefGoogle Scholar
  20. Walton, H.J. & Matthews, M.B. (1989). Essentials of problem-based learning. Medical Education 23(6): 542–558.Google Scholar
  21. Woodward, C.A. & Ferrier, B.M. (1983). The content of the medical curriculum at McMaster University: Graduates’ evaluation of their preparation for postgraduate training. Medical Education 17(1): 54–60.Google Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • Katinka J.A.H. Prince
    • 1
    Email author
  • Margaretha van de Wiel
    • 1
  • Albert J.J.A. Scherpbier
    • 1
  • Cess P.M. can der Vleuten
    • 2
  • Henny P.A. Boshuizen
    • 2
  1. 1.SkillslabUniversity of MaastrichtThe Netherlands
  2. 2.Department of Educational Research and DevelopmentUniversity of MaastrichtThe Netherlands

Personalised recommendations