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Problem-based learning in medical education: one of many learning paradigms

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The role of problem-based learning should be weighed carefully against that of other models

In 1978, when problem-based learning (PBL) was introduced in the University of Newcastle medical faculty,1 the prevailing educational style in 6-year undergraduate medical programs in Australia was teacher-led learning (TLL), wherein students first acquired core knowledge in basic sciences, which were taught in large class lectures, tutorials and laboratory sessions during the 3 preclinical years of the course. They then progressed to a multilayered, sequential, integrated approach incorporating fundamental clinical skills in history-taking and eliciting and interpreting physical signs, leading to differential diagnoses and patient management. These skills were taught in small tutorial groups at the bedside, in the operating room, in outpatient clinics and in consulting rooms. During the clinical years students were assigned to separate blocks (medicine, surgery, obstetrics and gynaecology, paediatrics and psychiatry) where they were embedded in the daily activities of individual departments. These departments were responsible for designing and delivering separate lecture-based programs which, together with recommended textbooks and printed handouts, provided core information. The students were taught, assessed and examined by each department separately. The integration of basic sciences, pathology and clinical practice…