Problem based learning in the 3rd world context.

Problem based learning (PBL) was first introduced into the medical curriculum by the Case Western University of USA and the Mc Master University of Canada in the late sixties.This example was followed by the University of Liniber at Maastricht in Netherlands and University of Newcastle in Australia 1 .The University of Manchester introduced first PBL in 1994, after the publication of the General Medical Council's document, Tomorrow's Doctors, which recommended that medical education should foster, "learning through curiosity and exploration of knowledge and critical evaluation".The McMaster University programme, was developed by the neurologist Howard Barrows in collaboration with others, in response to poor knowledge that medical students displayed during their neurology clerkship.According to Maudsley 2 , PBL was recommended "as a(not the)" major method of undergraduate medical education, to rectify this deficiency.In PBL students are divided into small groups of 5 or 6 (upper limit 12) and given a "clinical" problem to solve.At this stage they have little if any knowledge of basic sciences, as PBL starts from the beginning of the course.They are required to acquire this knowledge, as they proceed to study the case, with no teacher intervention.The institution provides resources to accomplish this, in form of library and computer facilities, photograph displays, self-learning material, anatomical models, histopathology slides and a good pathology museum 3 .There is no doubt that this early clinical exposure is a healthy departure from the traditional programme, which students appreciate.Each group has a "facilitator" or a tutor who only acts as a guide any may even be a "non-expert".The use of a "non-expert", has however been criticized by students in one of the surveys done at the University of Manchester and they prefer an expert to be in charge 4 .It is claimed that PBL gives the students, cognitive skills for the early development of medical expertise and thus to make them eventually into better doctors 5 .Maudsley 2 states that inspite of a large amount of literature on PBL, its definitions remains "elusive" and its relationship to "problem solving" unclear.The term "case-based" learning, appears to be more appropriate, as the new learning process utilizes cases-real or simulated.The latter being trained subjects portraying features of illness or other abnormalities.Using this material the students learn to take medical histories on these "patients" and to practice physical examination.In some schools, e.g., Manchester the number of lectures have been drastically reduced, and the bulk of training is now by PBL.Generally, the anti-lecture attitude is based on the view, that lectures are "teacher-centered" and unsuitable for student needs, implying that the interest of teachers and students, for some unspecified reason, are in conflict with each other!It is also claimed that lectures lead to rote learning (memorizing without understanding) and the information given is soon forgotten.To emphaze this point, examples are often given of poor lecturers, who read from prepared texts and should not be in the teaching profession in the first place!In reality a well-planed and interactive lecture, is probably the most cost effective way of delivering information to a large audience.A good lecturer is in constant eye contact with the students and quickly responds to their needs.He explains the problem so that rote learning does not occur.In many medical schools PBL and lectures are now used in hybrid arrangement at the National University of Singapore (NUS), with which I am familiar, PBL forms 20% of the medical programme 6 .At Harvard there is one-hour lecture every day but the lecturers are asked to incorporate material that they do not think will have been covered in group sessions 7 .PBL and the traditional lecture is not a dysfunctional marriage, and there is no reason why the existing structure should be totally dismantled

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