Tutorless PBL Groups in a Medical School

Abstract Problem-based learning (PBL) has become a popular teaching method in medical schools because of its emphasis on developing problem solving skills as well as delivering course content. Typically PBL depends on the availability of significant numbers of faculty to function as small group and is therefore very resource intensive. This study compared achievement of content knowledge and student satisfaction in tutorless and physician facilitated small groups in a 2nd year medical school course, and found no significant difference in these areas between the two groups. The one significant difference found was that students in groups with tutors worked longer than those without tutors. Introduction Problem-based learning (PBL) was introduced into medical education in the 1960's at McMaster Medical School in Ontario, Canada. For years, there had been concerns by medical school professors about the overuse of lectures. It was believed that students were too passive and that the lecture method was ineffective. Studies have shown that medical students forget much of what they have memorized from lectures before they reach their clinical years (Woods, 1993). Woods also found another complaint to be that medical students were not being trained as critical thinkers or problem solvers and that they were unable to apply their knowledge in a clinical setting. Proponents of PBL theorize that students learn best when learning in context (Schmidt, 1983). PBL provides students with an opportunity to experience the process of patient care and decision making without putting any actual patients at risk. PBL is also believed to promote life-long learning and to mirror real-life use of resources (Schmidt, 1983). Studies done comparing problem-based learning with traditional lecture curricula have found several positive trends with PBL. For example, in one study PBL graduates had similar, and sometimes better, performance on clinical examinations and faculty evaluations. They also were found to have board scores similar to those of traditional lecture students (Albanese & Mitchell, 1993; Norman & Schmidt, 2000). Learning appears to be better retained by PBL students as judged by faculty (Albanese & Mitchell, 1993) and PBL students have better problem-solving and information recall in clinical years (Norman & Schmidt, 2000; Vernon & Blake, 1993). Compared with lecture based instruction, students tend to report increased satisfaction with PBL. For instance, students considered the problem-based learning method to be more nurturing and enjoyable (Albanese & Mitchell, 1993; Norman & Schmidt, 2000; Vernon & Blake, 1993). Oklahoma State University Center for Health Sciences (OSU-CHS) Tulsa, Oklahoma has used this method of instruction in the Clinical Problem Solving course for 2nd year medical students since the early 1990's. Specifically, the students take a hybrid course with four hours of traditional lecture per week combined with four hours of small group work. The groups are composed of 6-9 students and one physician/tutor, also referred to as a facilitator. The groups work through carefully structured pre-designed cases to learn content while also developing problem-solving skills. Although this has been an effective format that is very popular with the students, there are several problems with the tutored groups: * Difficulty recruiting faculty due to time constraints. Theoretically, a non-physician tutor could be used, but studies have shown that there is less student satisfaction with this arrangement (Dolmans, Gijselaers, Moust, deGrave, Wolfhagen, & van der Vleuten, 2002). * Difficulty recruiting physician tutors from the community (non-faculty members), due to time and financial considerations. Small groups meet two mornings a week during prime office hours for most physicians. * Expense to Family Medicine Department to hire non-faculty tutors. …

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