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Problem-Based Learning

What is PBL?

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In 1993, the GMC published a radical document 'Tomorrow's Doctors' calling for major change in UK undergraduate medical education. The GMC published a revised edition of ‘Tomorrow’s Doctors’ in 2009. Important themes in the MBChB at Keele University (and 'Tomorrow's Doctors') are:

- Stimulation of curiosity; learning through problem-solving and experience. Rather than learning by rote, which emphasises recall of knowledge, students are expected to demonstrate ‘understanding’ of topics, relevant to medicine as a whole, which emphasises application of knowledge. Learning opportunities are provided in the appropriate context so students can relate the knowledge they acquire to the practice of medicine. Students should develop into doctors who are scholars and scientists.

- Students take responsibility for their own learning. The Keele curriculum utilises adult learning principles, making it ‘student-led’ rather than ‘teacher-led’ as far as possible. However, the support of tutors is still a vital and significant ingredient.

- Core Curriculum. The course has a defined ‘core’ comprising the attitudes, skills and knowledge required of a graduate competently to manage, on their own or as part of a team, the clinical situations they are likely to meet in their Foundation Years training.

- Integration. Students are encouraged to develop an understanding that spans disciplinary borders. Specific understanding of individual disciplines like anatomy, physiology, medicine, pathology and so on, is acquired in the context of medicine as a whole, and throughout the course. In the early years of the course, there is more emphasis on acquiring bioscience and clinical principles. In the later years the emphasis is on the application of knowledge and patient management in the clinical environment.

- Community-orientation. Throughout their training, students are encouraged to understand and apply knowledge of personal, community and population ‘dimensions’ of illness. They will acquire experience of the behavioural and social aspects of medicine in community placements in both health and social care environments.

- Explicit development of clinical skills and competence. The 2009 edition of ‘Tomorrow’s Doctors’ specifies the core skills and competences expected of our graduates to function as newly qualified doctors. These skills are systematically taught and systematically tested. Incompetent students will not qualify, no matter how strong they are in theory. There is a strong emphasis on communication skills and encouragement to develop appropriate professional attitudes. We expect Keele graduates to be competent and professional practitioners.

- Choice. There are ‘core’ parts of the curriculum which all students study in common but there are also substantial blocks of time when students are given choice about their learning – Student Selected/Elected Components occur in every year of the programme.

Educational methods

‘Problem-based learning’ (PBL) is one major component of the Keele curriculum. Students work in small groups to study written descriptions of clinical situations. Using a specific set of study skills, students use those scenarios to guide them towards relevant theoretical and practical learning. Normally, each scenario is the focus for learning for a week, with two or three tutorials (tutor in attendance) devoted to it. This process starts at entry to the medical school. From Year 3 onwards PBL develops into Case-based Learning where the written scenarios are replaced by discussions of patients encountered by students in their clinical placements.

The problem-based learning (PBL) programme is supported by a variety of methods which include: plenary lectures, seminars, laboratory practical classes and a wide variety of placement experiences. Placements begin in Year 1 and students learn the skills needed to get the best out of placements prior to their occurrence. The emphasis throughout the course is firmly on student-led and self-directed learning. Students are expected to demonstrate knowledge and understanding in interactive group sessions.

Each teaching hospital has a clinical skills laboratory, allowing students to develop many clinical skills in the relative ‘safety’ of simulation – for example, by examining each other, performing practical procedures on manikins . Those skills are then systematically tested in OSCEs (objective structured clinical examinations).

Communication skills are taught and tested with the help of ‘standardised patients’ (volunteers who can mimic various clinical situations and give feedback to students).

Students are encouraged to think of the whole teaching hospital and its surrounding community as a huge and readily available resource for their learning; an integrated curriculum has no boundaries and barriers. The hospitals operate ‘sign-up schemes’ to match up manageable numbers of interested students with appropriate learning opportunities. Students receive conventional clinical teaching (with a strong emphasis on clinical skills/competence) from the start of the course.

Information technology, bibliographic and critical appraisal skills. Each teaching hospital has a computer network specifically for undergraduate students. Information technology skills are required, not optional. Application of the current medical literature to clinical practice is also required of students.