PROBLEM-BASED LEARNING - MEASURABLE OUTCOMES

Problem-based learning (PBL) could potentially contribute to four key objectives in the education of doctors. (1) Motivating learning. Three studies show that students studying PBL problems choose fewer topics to study than those identified by the faculty, but one study of a crit ical care rotation showed that students were motivated to learn over a wider range of basic science topics than had been included in the bas ic science curriculum. (2) Developing clinical reasoning. One study co mpared methods of solving problems in PBL and conventional track curri cula and suggested that PBL students work backwards from clinical info rmation to theory, while conventional curriculum students tend to reas on forward from theory. One study showed that computer searches provid e knowledge for helping solve some PBL problems, and another study sho wed that specific knowledge in emergency medicine correlated with test scores. (3) Structuring knowledge in clinical contexts. A few studies show that PBL students perform less well on basic science examination s but better on clinical examinations. Educational outcomes, however, have been assessed quantitatively mainly by the U.S. National Boards o f Medical Examiners Examinations or by clinical examinations with smal l samples. Only one study includes a power computation to assess type LI error. There are no studies that examine how much variance occurs b etween PBL programmes in their curricular methods and outcomes. (4) De veloping self-learning skills. PBL students use a much wider range and number of resources than conventional track students. There is only o ne study comparing the knowledge of doctors trained by PBL and convent ional curricula after the doctors have been in practice for a substant ial number of years, and no studies of patient outcomes. Patient outco mes need to be assessed with randomized controlled trials, and sample sizes should be determined by power computations to avoid Type II erro r. Four possible methods of improving PBL would be to derive national and internationally accepted PBL curricula; to organize internationall y accepted and psychometrically validated methods of evaluation; to de velop attitudes among students and tutors to facilitate co-operative P BL teamwork; and to teach group process diagnostic skills.