Problem-based learning in undergraduate medicine: Perspectives, challenges and approaches

Problem-based learning (PBL) is a learner-centred approach that was conceptualised for graduate-entry medicine to prepare students for patient encounters in clinical practice. In PBL, under the guidance of a skilled “tutor," small groups of students engage with “illstructured” problems to identify gaps in their knowledge and understanding which they then research during the week and return to discuss their findings and to address any inconsistencies. With PBL designed for graduate students in a Western context in the 1960s, it has been adapted and customised, sometimes to such an extent that the approach is no longer recognisable as PBL. This excessive adaptation has clouded measurement of its educational effectiveness. Notwithstanding, PBL has been widely implemented in many disciplines and is now firmly entrenched as a small group, collaborative and active learning approach. This Chapter focusses on the implementation of PBL in undergraduate medicine, in which it is now recognised that some customisation (e.g., scaffolding to develop self-directed learning and critical thinking skills) is required to ease students’ transition to university and to the learning required in PBL. Many of the points raised in this Chapter reflect personal experiences of PBL in three different undergraduate contexts as well as a thorough engagement with the relevant historical and current literature. Key factors contributing to the successful implementation of PBL are discussed. Some of the important factors that have impacted on successful implementation of PBL include the role and responsibilities of the PBL “tutor” or facilitator, case or “problem” quality and the costs of PBL. The Chapter continues with perspectives of PBL as we move forward in the 21st century in terms of the impact of globalisation and increasing diversity and PBL in the digital age, as well as suggestions for possible research. The Chapter concludes with the recognition that “one-size does not fit all” and that in adapting and innovating our approach, we need to remain true to the original PBL philosophy.