Problem-based learning as an efficient teaching modality: improvements proposed by UK medical students

Dear editor

We read the article by Yadav et al¹ with great interest which highlighted the positive perception of medical students toward problem-based learning (PBL). Surprisingly, however, over half of the participants deemed PBL as a time-consuming teaching method. This is supported by a study wherein 32.9% of respondents detailed PBL to be time inefficient, highlighting potential concerns regarding its ability to adequately meet learning outcomes.² As penultimate year medical students studying a curriculum utilizing PBL, we would like to use our experience to propose improvements that can be made to PBL teaching.

The paper highlighted the positive view students have of tutors in stimulating discussions. From our experience, we agree with this, but we think the tutor can also play a vital role in improving time efficiency of sessions. Some common reasons for inefficiency not discussed by the authors could be related to the quality of written cases, group cohesion, or poor timekeeping. To help tutors address such problems, we propose some improvements.

First, we suggest introducing standardized training amongst PBL tutors. This not only improves tutor competency as facilitators of productive PBL discussions but also reduces variability in the delivery of sessions. Such methods have already been shown to enhance student satisfaction with tutor performance.³ Second, inviting feedback from students would give tutors the opportunity to make relevant changes to the sessions. Third, tutors could meet regularly to share PBL experiences. As a result, case designs can be improved through discussion to ensure time efficiency. Additionally, this provides an opportunity to identify commonly occurring problems and devise solutions.⁴

Finally, standardized assessments can be utilized to maximize learning. Problem analysis, self-directed learning, and reporting phase are three distinct but interdependent stages of PBL; each stage prepares students for learning in the next step. As medical students, we believe that self-directed learning is the most important part of this process. Unfortunately, it is very common to see low levels of self-directed learning by some students in the group before the reporting phase. We believe that the introduction of a multiple choice styled assessment would help tackle this issue. This approach has been shown to improve student achievement.⁵ The quiz would ideally take place before the reporting phase consisting of questions designed by the universities based on the learning objectives of students. This will ensure that every student is on the same level or at least aware of the expectation from them.

We commend the authors for completing an insightful study exploring medical student views on PBL. We must stress, however, that the participants were exclusively first-year medical students at one institution. A multi-institutional study investigating a sample comprising medical students across all year groups would have improved the generalizability of findings. PBL is already well established, and students are receptive to its incorporation into university curricula as highlighted in this study. We, however, feel there is room for improvement in medical student perspectives on PBL particularly with regard to its time efficiency. We believe the suggested improvements can provide a possible avenue for achieving this.