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Med Princ Pract 2009;18:1–9

Problem-Based Learning and Medical Education Forty Years On

A Review of Its Effects on Knowledge and Clinical Performance

Neville A.J.
McMaster University, Faculty of Health Sciences, Hamilton, Ont., Canada
email Corresponding Author

 goto top of outline Key Words

  • Problem-based learning
  • Medical education
  • Self-directed learning
  • Memory and cognitive architecture
  • Guided learning
  • Outcome assessment
  • Clinical competency

 goto top of outline Abstract

Problem-based learning (PBL) has swept the world of medical education since its introduction 40 years ago, leaving a trail of unanswered or partially answered questions about its benefits. The literature is replete with systematic reviews and meta-analyses, all of which have identified some common themes; however, heterogeneity in the definition of a ‘problem-based learning curriculum’ and its delivery, coupled with different outcome measurements, has produced divergent opinions. Proponents and detractors continue to dispute the merits of the cognitive foundation of a PBL approach, but, despite this, there is evidence that graduates of PBL curricula demonstrate equivalent or superior professional competencies compared with graduates of more traditional curricula.

Copyright © 2008 S. Karger AG, Basel

 goto top of outline References
  1. Barrows HS: Problem-based learning applied to medical education Springfield. Carbondale, Southern Illinois University School of Medicine, 2000.
  2. Muller S: Physicians for the 21st century: report of the project panel of the general professional education of the physician and college preparation for medicine. J Med Educ 1984;59:1–200.
  3. Walton HJ, Matthews MB: Essentials of problem-based learning. Med Educ 1989;23:542–558.
  4. Vernon DT, Blake RL: Does problem-based learning work? A meta-analysis of evaluative research. Acad Med 1993;68:550–563.
  5. Berkson L: Problem-based learning: have the expectations been met? Acad Med 1993;68:S79–S88.
  6. Albanese MA, Mitchell S: Problem-based learning: a review of literature on its outcomes and implementation issues. Acad Med 1993;68:52–81.
  7. Nandi PL, Chan JN, Chan CP, Chan P, Chan LP: Undergraduate medical education: comparison of problem-based learning and conventional teaching. Hong Kong Med J 2000;6:301–306.
  8. Smits PB, Verbeek JH, de Buisonjé CD: Problem based learning in continuing medical education: a review of controlled evaluation studies. BMJ 2002;324:153–156.
  9. Newman M: A pilot systematic review and meta-analysis on the effectiveness of problem-based learning: on behalf of the Campbell Collaboration Systematic Review Group on the Effectiveness of Problem-Based Learning. Newcastle upon Tyne, University of Newcastle upon Tyne, 2003.
  10. Koh GC, Khoo HE, Wong ML, Koh D: The effects of problem-based learning during medical school on physician competency: a systematic review. CMAJ 2008;178:34–41.
  11. Anthony WS: Learning to discover rules by discovery. J Ed Psych 1979;64:325–328.

    External Resources

  12. Rutherford FJ: The role of inquiry in science teaching. J Res Sci Teach 1964;2:80–84.

    External Resources

  13. Kolb DA, Fry R: Toward an applied theory of experiential learning; in Cooper C (ed): Studies of Group Process. New York, Wiley, 1975, pp 33–57.
  14. Steffe L, Gale J: Constructivism in education. Hillsdale, Lawrence Erlbaum Associates, 1995.
  15. Kirschner PA, Sweller J, Clark RE: Why minimal guidance during instruction does not work: an analysis of the failure of constructivist, discovery, problem-based, experiential, and inquiry-based teaching. Educ Psychol 2006;41:75–86.

    External Resources

  16. Maudsley G: Do we all mean the same thing by ‘problem-based learning’? A review of the concepts and a formulation of the ground rules. Acad Med 1999;74:178–185.
  17. Barrows HS: A taxonomy of problem-based learning methods. Med Educ 1986;20:481–486.
  18. Barrows HS: A specific, problem-based, self-directed learning method designed to teach medical problem-solving skills, self-learning skills and enhance knowledge retention and recall; in Schmidt HG, DeVolder ML (eds): Tutorials in Problem-Based Learning. Assen, Van Gorcum, 1984.
  19. Elstein AS, Schulman LS, Sprafka SA: Medical problem solving: an analysis of clinical reasoning. Cambridge, Harvard University Press, 1978.
  20. Norman GR, Schmidt HG: The psychological basis of problem based learning: a review of the evidence. Acad Med 1992;67:557–565.
  21. Martensen D, Eriksson H, Ingelman-Sundberg M: Medical chemistry: evaluation of active and problem-oriented teaching methods. Med Educ 1985;19:34–42.
  22. Schmidt HG, De Volder ML, De Grave WS, Moust JHC, Patel VL: Explanatory models in the processing of science text: the role of prior knowledge activation through small group discussion. J Educ Psychol 1989;81:610–619.

    External Resources

  23. Schulman LS: Those who understand: knowledge growth in teaching. Educ Res 1986;15:4–14.
  24. Mayer R: Should there be a three-strikes rule against pure discovery learning? The case for guided methods of instruction. Am Psychol 2004;59:14–19.
  25. Neville AJ: The problem-based learning tutor: Teacher? Facilitator? Evaluator? Med Teach 1999;21:393–401.
  26. Schmidt HG, Loyens SMM, Van Gog T, Paas F: Problem-based learning is compatible with human cognitive architecture: commentary on Kirschner, Sweller, and Clark. Educ Psychol 2007;42:91–97.
  27. Hmelo-Silver C, Duncan RG, Chinn CA: Scaffolding and achievement in problem-based and inquiry learning: a response to Kirschner, Sweller, and Clark. Educ Psychol 2007;42:99–107.
  28. Eva KW, Neville AJ, Norman SR: Exploring the etiology of content specificity: factors influencing analogical transfer and problem solving. Acad Med 1998;73:S1–S5.
  29. Schmidt HG: Problem-based learning: rationale and description. Med Educ 1983;17:11–16.
  30. Norman SR, Schmidt HG: Effectiveness of problem-based learning curricula: theory, practice and paper darts. Med Educ 2000;34:721–728.
  31. Dolmans D: The effectiveness of PBL: the debate continues. Some concerns about the BEME movement. Med Educ 2003;37:1129–1130.
  32. Newman M: Fitness for purpose evaluation in problem based learning should consider the requirements for establishing descriptive causation. Adv Health Sci Educ 2006;11:391–402.
  33. Blaikie N: Designing Social Research. London, Polity Press, 2000.
  34. Colliver JA: Effectiveness of problem-based learning curricula: research and theory. Acad Med 2000;75:259–266.
  35. Albanese M: Problem-based learning: why curricula are likely to show little effect on knowledge and clinical skills. Med Educ 2000;34:729–738.
  36. Wolf FM: Problem-based learning and meta-analysis: can we see the forest through the trees? Acad Med 1993;68:542–544.
  37. Hmelo C, Evenson D: Introduction to problem-based learning: gaining insights on learning interactions through multiple methods of enquiry; in Evenson D, Hmelo C (eds): Problem-Based Learning – a Research Perspective on Learning Interactions. Mahwah, Erlbaum, 2000.
  38. Dochy F, Segers M, Van den Bossche P, Gijbelo D: Effects of problem-based learning: a meta-analysis. Learn Instr 2003;13:533–568.

    External Resources

  39. Norman G: Problem-based learning makes a difference. But why? CMAJ 2008;178:61–62.
  40. Neville AJ, Norman GR: PBL in the undergraduate MD program at McMaster University: three iterations in three decades. Acad Med 2007;82:370–374.

 goto top of outline Author Contacts

Alan J. Neville
McMaster University, Faculty of Health Sciences
1200 Main Street West, MDCL 3110
Hamilton, ON L8N 3Z5 (Canada)
Tel. +1 905 525 9140, ext. 22141, Fax +1 905 546 0349, E-Mail

 goto top of outline Article Information

Received: May 25, 2008
Revised: July 30, 2008
Published online: December 04, 2008
Number of Print Pages : 9
Number of Figures : 0, Number of Tables : 2, Number of References : 40

 goto top of outline Publication Details

Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)

Vol. 18, No. 1, Year 2009 (Cover Date: December 2008)

Journal Editor: Owunwanne A. (Kuwait)
ISSN: 1011–7571 (Print), eISSN: 1423–0151 (Online)

For additional information:

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