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      Problems of problem-based learning: Towards transformative critical pedagogy in medical education

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          Abstract

          Problem-based medical education is based in a biomedical worldview that works to entrench deterministic ways of thinking about socioculturally-influenced health disparities in the minds of medical trainees. This perspective paper considers the utility of Paolo Freire’s critical pedagogy as a means of redressing this issue, as it may enable medical learners to perceive and address the social sources of illness that shape their patients’ lives. With an eye to advancing health equity, and educating health professionals who are responsive to marginalized and vulnerable communities, this paper considers how a problem- posing medical education could redefine physicians’ relationships to knowledge, identity, and to their patients.

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          The effects of problem-based learning during medical school on physician competency: a systematic review.

          Mee Lian Wong, Gerald Koh, S. H. Khoo … (2008)
          Systematic reviews on the effects of problem-based learning have been limited to knowledge competency either during medical school or postgraduate training. We conducted a systematic review of evidence of the effects that problem-based learning during medical school had on physician competencies after graduation. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Databases, and the tables of contents of 5 major medical education journals from earliest available date through Oct. 31, 2006. We included studies in our review if they met the following criteria: problem-based learning was a teaching method in medical school, physician competencies were assessed after graduation and a control group of graduates of traditional curricula was used. We developed a scoring system to assess the quality of the studies, categorized competencies into 8 thematic dimensions and used a second system to determine the level of evidence for each competency assessed. Our search yielded 102 articles, of which 15 met inclusion criteria after full text review. Only 13 studies entered final systematic analysis because 2 studies reported their findings in 2 articles. According to self-assessments, 8 of 37 competencies had strong evidence in support of problem-based learning. Observed assessments had 7 competencies with strong evidence. In both groups, most of these competencies were in the social and cognitive dimensions. Only 4 competencies had moderate to strong levels of evidence in support of problem-based learning for both self-and observed assessments: coping with uncertainty (strong), appreciation of legal and ethical aspects of health care (strong), communication skills (moderate and strong respectively) and self-directed continuing learning (moderate). Problem-based learning during medical school has positive effects on physician competency after graduation, mainly in social and cognitive dimensions.
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            Effectiveness of problem-based learning curricula: theory, practice and paper darts.

            Ingo G. H. Schmidt-Wolf, David G. Norman (2000)
            In a recent review article, Colliver concluded that there was no convincing evidence that problem-based learning was more effective than conventional methods. He then went on to lay part of the blame on cognitive psychology, claiming that 'the theory is weak, its theoretical concepts are imprecise. the basic research is contrived and ad hoc'. This paper challenges these claims and presents evidence that (a) cognitive research is not contrived and irrelevant, (b) curriculum level interventions are doomed to fail and (c) education needs more theory-based research.
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              Problem-based learning and medical education forty years on. A review of its effects on knowledge and clinical performance.

              Helen J. Neville (2008)
              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.
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                Author and article information

                Contributors
                Alice Cavanagh: cavanaam@mcmaster.ca
                Bio :
                Alice Cavanagh

                is an MD/PhD student at McMaster University, completing her doctoral work in Health Policy on the social organization and structural implications of medical education.

                Meredith Vanstone:
                Bio :
                Meredith Vanstone

                is assistant professor in the Department of Family Medicine, and a scientist in the McMaster program for Education Research, Innovation & Theory (MERIT).

                Stacey Ritz:
                Bio :
                Stacey Ritz

                is associate professor in the Department of Pathology & Molecular Medicine, and assistant dean of the Bachelor of Health Sciences (Honours) Program.

                Journal
                Journal ID (nlm-ta): Perspect Med Educ
                Journal ID (iso-abbrev): Perspect Med Educ
                Title: Perspectives on Medical Education
                Publisher: Bohn Stafleu van Loghum (Houten )
                ISSN (Print): 2212-2761
                ISSN (Electronic): 2212-277X
                Publication date (Electronic): 10 January 2019
                Publication date PMC-release: 10 January 2019
                Publication date (Print): February 2019
                Volume: 8
                Issue: 1
                Pages: 38-42
                Affiliations
                [1 ]ISNI 0000 0004 1936 8227, GRID grid.25073.33, Health Policy PhD Program, , McMaster University, ; Hamilton, ON Canada
                [2 ]ISNI 0000 0004 1936 8227, GRID grid.25073.33, Michael G. DeGroote School of Medicine, , McMaster University, ; Hamilton, ON Canada
                [3 ]ISNI 0000 0004 1936 8227, GRID grid.25073.33, Department of Family Medicine, , McMaster University, ; Hamilton, ON Canada
                [4 ]McMaster Program for Education Research, Innovation & Theory (MERIT), Hamilton, ON Canada
                [5 ]ISNI 0000 0004 1936 8227, GRID grid.25073.33, Department of Pathology and Molecular Medicine, , McMaster University, ; Hamilton, ON Canada
                [6 ]ISNI 0000 0000 8658 0974, GRID grid.436533.4, Medical Sciences Division, , Northern Ontario School of Medicine, ; Sudbury, ON Canada
                Article
                Publisher ID: 489
                DOI: 10.1007/s40037-018-0489-7
                PMC ID: 6382617
                PubMed ID: 30632061
                SO-VID: ad647f95-6678-40ce-b120-e515527750a0
                Copyright © © The Author(s) 2019
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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                Subject: Eye-Opener
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                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Education
                Keywords: critical pedagogy,problem-based learning,undergraduate medical education
                Data availability:
                ScienceOpen disciplines: Education
                Keywords: critical pedagogy, problem-based learning, undergraduate medical education

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