Table 3.

Students’ perceptions of PBL, including best and most difficult features (N = 144)

Theme	Examples of student comments	No. of similar responses
Most useful features of Problem Based Learning
Discussion oriented sessions		61/144
Students enjoyed the discussion that took place within the PBL session, and the opportunity to teach and learn from each other	PBLs are a chance to: meet and brainstorm ideas with peers, learn from peers and teach peers in a safe environment No time pressure – conducive for thorough discussion. Discussion and interaction with fellow students and being able to learn from each other
Clinical reasoning opportunity within PBL		23/144
Students liked the opportunity to discuss a clinical case with their peers, and learn from each others’ clinical experience Students found that working through detailed patient cases helped them to retain information	Being able to recreate a clinical situation, via a PBL, is a great way to learn - especially in this block - as there is more correlation with the patients I have seen at hospital on clinical days. In addition, listening to various opinions of my peers gives me an insight into the way they think about the cases and process information. I like how detailed the patient histories are. When studying later on, it allows me to actually remember “Mr D’este has low back pain because he did X, and it resulted in Y and we treated him with A, B and C”. Getting a chance to discuss and work through a case with your peers.
Most difficult features of PBL and need for improvement
Variable expertise and training of PBL tutors		78/144
Students perceive that the knowledge, engagement and experience of PBL tutors varies greatly Students felt their learning was dependent upon the PBL group allocation, which they perceived as unfair. Students felt it was necessary to have clinicians as tutors	Tutor and students unable to validate information, we got into the habit of glossing over things because it would get too tedious Our PBL tutor, like the previous block, is not able to help us learn about different clinical cases, simply because they are not a clinician. It is unfair that some groups do actually learn more in these classes simply because they have better tutors. I found that the tutors who were non clinical based didn’t have much to say and weren’t very helpful when a question was targeted to them. I think tutors need to have a more relevant background in the framework of a case. There seems to be a lack of structure given to tutors that gives a disjointed feel to the PBLs. Prepare tutors in group facilitation or the subject matter
The PBL groups were too large		61/144
Students found that having 10 students per PBL made group work difficult Some students felt the ‘louder’ students tended to dominate discussion in PBL	Group work is difficult with 10 people….means people can skip under the radar a little bit. With 10, there’s still a good 4–5 people that don’t participate strongly in discussion Too many people- I often didn’t feel comfortable talking and sometimes felt pushed over. We never really had a successful session- I actually feel I didn’t really learn much at all.
Inadequate direction and structure		59/144
Students found the PBL tutorials lacked guidance Students would like to have more direction regarding pre-readings to enable effective teamwork Students would like to have ensured they had completed tasks by the end of the PBL	Sometimes we are not sure how deep we should know about certain topic, and questions in the students guide are too general/a bit vague. The questions could be more specific Not everyone comes with the same level of preparedness. More pre-work would be beneficial to increase confidence and understanding in the session Produce a tangible document at the end which we need to submit so that I can take away and refer to in the future, rather than a vague memory of discussion.
Inefficient use of time		28/144
Students felt their time was not used efficiently, and there was too much information to cover within the PBLs	For my group, staying on time is very difficult. Some people in the group like to answer the discussion questions right down to the very last detail. Less time so there is more pressure for a concise discussion that is relevant.
Ineffective group dynamics		37/144
Students felt the group dynamic within PBL was hindered by lack of preparation, direction and feedback	Power battles between people, no experts in the room and no certain answers to questions - if anything it creates more questions as opposed to answers Lack of universal participation (2–3 students), everyone is on their computers. Lack of engagement, lack of internal thinking due to obvious nature of the case study…. some members are content to watch or are intimidated by the bigger personalities.
Lack of prior knowledge and different		20/144
preparation requirements	It was difficult to do independent research about topics that we are not familiar with. Going through a case without significant prior knowledge.