Reform of undergraduate medical teaching in the United Kingdom

Editor—No clear consensus emerges on whether problem based learning is a good thing in the many responses to Williams and Lau's education and debate article.¹

Among those in favour, US based associate professor Will Beachey finds that students who have learnt with this technique are not disadvantaged and argues that many people might be jealous that these students experience less intimidating education tactics than they did themselves.

Traditional courses do not need to be protected so carefully and any nostalgia is misplaced, writes Norman Boft, a medical student from Australia, while Peter McCrorie and colleagues from London's St George's Hospital Medical School provide their own course as an example of a successful application of problem based learning. Thuli and Andrew Whitehouse, a medical student and a consultant physician, ask for the public as consumers of health care to be the judge of what kind of teaching works best.

Problem based learning may be more appropriate for postgraduate than undergraduate teaching as it provides more knowledge and fewer facts, argues Brian Rambihar, a general practitioner from Preston. For him, the main argument, which bears out the pragmatism of a primary care doctor, is what doctors do is more important than what doctors know.

Problems with appropriate assessment of new teaching methods are also brought into the debate. Kayvan Shokrollahi, a trust surgeon in Oxford, finds that the key to successful medical training is to state explicitly to students or trainees what they need to know and provide the means for them to achieve these skills and knowledge. Jorge Zimbron, medical student in London, argues that the information retained after whatever teaching has been offered depends on the quality of the teacher, not on the way the teaching is delivered.

Among the detractors, radiologist Patrick Xavier equates problem based learning with deskilling. And Richard Heatley, consultant physician in Leeds, praises Williams and Lau for pointing out that the reform of medical teaching has achieved nothing other than being different, illustrating his argument with lots of examples.

A possible solution to the teaching dilemma may be evidence based learning or evidence based teaching. But undergraduate teaching should not be used as a political pawn, argues Umesh Prabhu, consultant paediatrician in Bury, adding that tomorrow's doctors must be better than today's doctors at both clinical and non-clinical skills in the quest to be “good doctors.” Undergraduate teaching has not achieved this objective, so reform is necessary.