Reform of undergraduate medical teaching in the United Kingdom

Editor—Williams and Lau debate the reform of undergraduate medical teaching.¹ The most important issue in medical education is not whether problem based learning is a weaker approach than “traditional” learning but whether medical sciences are viewed as a body of facts to be crammed in a crude fashion or as a conceptual framework for understanding human health and disease. Quality in medical education can be assured only by understanding this essential point.

The traditional strategy does have certain weaknesses. Why provide students with overwhelming lists of detail if they lack the intellectual skills necessary to apply these appropriately? No one can emerge from a medical degree having achieved a comprehensive knowledge of the basic sciences: biochemical and genetic knowledge is expanding faster than anyone can retain it. Why try to force students to achieve impossible ends?

This reality means that the material presented to students must be carefully selected—by focusing the learning on a clinical problem, problem based learning may have a role in performing this function.

Anecdotes show, however, that during group sessions students too often do not identify and learn what is needed to tackle the case presented properly. Problem based learning therefore fosters incomplete styles of learning. The authors correctly identify—crucially—that the suitability of such an approach to UK school leavers is in doubt; it probably requires a maturity that the recently reformed A levels may not provide. It is ultimately only as good as the groups who undertake it and the “scaffolding” that facilitators provide.