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Problem-Based Learning Curriculum a Success for Medical School

Knowledge in the medical field changes so rapidly that by the time students graduate, many are already behind in the latest medical knowledge. //In an effort to address this issue, the University of Missouri-Columbia School of Medicine adjusted its curriculum 13 years ago, and a recent study has shown that the adjustment was a success.

"At that time there were national voices calling for accountability and looking for skills beyond the medical licensing exam," said Kimberly Hoffman, assistant dean for education evaluation and improvement for the medical school.

MU's medical school was among the first to turn to an educational strategy called Problem-Based Learning (PBL). The pioneering curriculum cuts lecture time by 60 percent, decreases rote memorization, teaches the science of medicine in the context of clinical cases, and, according to a recent study at MU, achieves outstanding academic results.

The power of PBL was examined in a recent MU study and published in the Journal of the Association of American Medical Colleges. The study has shown that not only did MU student scores on the medical licensing exam dramatically increase after PBL was introduced, but evaluations of graduates' performance at the end of their first year of residency also improved.

"Problem-Based Learning does a great job at teaching things like collaboration and communication, in addition to the traditional skills," said Michael Hosokawa, associate dean for curriculum. "With our traditional curriculum, students took classes that had a format similar to their undergraduate courses. These lecture-based classes were discipline specific and usually tied to a certain department. It was as if students were empty vessels being filled."

PBL-based curriculum is very different depending on the school. Eighty percent of the 125 U.S. medical schools report that they use PBL, but only about 25 of those schools use the same type of PBL as MU. The MU study, which was conducted by Hoffman, Hosokawa and others from the medical school, found that beginning with the first class with a PBL curriculum, students' scores on both portions of the United States Medical Licensing Examination increased dramatically.

With the introduction of PBL, the student average on the basic sciences and clinical portions of the exams rose above the national mean. The scores steadily increased and, 10 years after the program was implemented, students' scores continue to be significantly above the national means on both portions of the exam.

Researchers also reviewed graduates' performance during their first year of residency. They compared supervisors' evaluations before and after the implementation of the PBL curriculum in 17 separate categories. In every comparison, students who completed the PBL curriculum received higher scores from the program directors than did students from the traditional curriculum.

There are two years of PBL curriculum, each consisting of four 10-week blocks. Each block includes eight weeks for learning, one week for assessment and a one-week break. A block has two major components: Basic Science/PBL and Introduction to Patient Care. In basic science, students work in groups of eight with a faculty tutor, and learn by studying cases. Students work through one PBL case each week and cover 64 cases by the completion of the second year. The purpose is to learn the basic science of medicine and problem solving, not simply to obtain a diagnosis.

Lectures and lab introduce basic concepts that correlate with the cases. Lectures are designed to provide overviews rather than detailed presentations of the basic sciences. First-year students are in PBL groups for up to 10 hours per week, with about 10 hours of supplemental lectures and labs. Second-year students spend up to 10 hours in PBL groups and 10 hours in traditional learning activities. "Introduction to Patient Care" courses focus on building students' clinical skills, increasing their understanding of health care and introducing psychosocial issues.

After they complete these two years, students participate in a restructured third and fourth year. The third-year students complete seven required clerkships including child health, internal medicine, family medicine, surgery, neurology and psychiatry. The fourth and final year consists of required an elective rotations.

Some researchers have suggested that increases in students' performance in PBL style curriculums are because students spend an increased amount of time in formal learning activities and with faculty. However, at MU the amount of time spent in these activities decreased with PBL. These results also can not be explained by the selection of students with academically superior science knowledge or aptitude for taking multiple-choice examples. The differences in the Medical College Admission Test (MCAT) verbal scores are not sufficient to account for the differences in medical licensing exam scores.

"Before, students were highly successful and did just fine," Hosokawa said. "But having a medical practice is fun, so learning how to be a doctor should also be fun. For decades it was drudgery; now we have a found a more enjoyable way for students to learn the material."


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