Problem-based learning in undergraduate medical education in Saudi Arabia: time has come to reflect on the experience

Problem-Based Learning in Medical Education: A Global Research Landscape of the Last Ten Years (2013-2022)

Background

Problem-based learning (PBL) constructs a curriculum that merges theory and practice by employing clinical scenarios or real-world problems. Originally designed for the pre-clinical phase of undergraduate medicine, PBL has since been integrated into diverse aspects of medical education. Therefore, this study aims to map the global scientific landscape related to PBL in medical education in the last ten years.

Methods

We combined bibliometrics and network analysis to analyze the metadata of related research articles published between 2013 and 2022 and indexed in the Web of Science Core Collection.

Results

Our results show an annual publication rate of 9.42%. The two main journals disseminating research on this subject are BMC Medical Education and Medical Teacher. Education & Educational Research and Health Care Sciences & Services are the two most frequent research areas, and also the two most central nodes of the related network. The USA and China are the most publishing countries, while the Netherlands and Canada are the most collaborative. The Maastricht University holds the position of most publishing and collaborative research organization. The University of California ranks second in publications, while the University of Toronto is the second most central research organization.

Conclusions

Our study provides an overview of the last ten years of publications related to PBL and medical education, and we hope it can be of interest to educators, researchers, and students involved with this subject.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02003-1.

Barriers to implementing problem-based learning at the school of medicine of Debre Berhan University, Ethiopia

BACKGROUND

Implementing PBL in teaching and learning can be challenging due to a variety of complex barriers. Studies on barriers to the implementation of problem-based learning in Ethiopia are scarce. This study aimed to explore the barriers to the implementation of problem-based learning at the Debre Berhan University Medical School.

METHODS

A qualitative study was conducted among faculty and medical students at the medical school. Purposive sampling was used to select participants. Semi-structured interviews were conducted with tutors and academic leaders, including the problem-based learning coordinator, the biomedical sciences coordinator, and the school dean. Data was also collected from students through focus group discussions. All interviews and discussions were recorded. The four steps of data analysis of Spradley, including domain analysis, taxonomic analysis, componential analysis, and theme analysis, were employed.

RESULTS

The study identified student-related, tutor-related, case scenario-related, and assessment-related barriers as the most significant obstacles to implementing problem-based learning. These barriers included work overload for both students and tutors, lack of training and experience among tutors, student reluctance, absence of standardized case scenarios, subjectivity of assessment methods, and on-the-spot assessment of students.

CONCLUSIONS AND RECOMMENDATIONS

Lack of both tutor and student commitment, lack of standardized cases, absence of a recognition of staff input, gap in communication skills, work overload, lack of continuous training, and at-spot evaluation of students were identified as the main barriers to the implementation of PBL.

Evaluating the Group Debate Activity as a Student-Centered Approach in Microbiology Course for PharmD Students: An Observational Study

BACKGROUND

Group debate is an educational strategy meant to equip undergraduate students with enhanced communication skills as well as the understanding of complex topics. Many controversial topics in the microbiological field pose challenges to the pharmacist's ability to attribute a specific opinion to its supported clinical evidence and to discuss these topics with confidence.

METHODS

A total of 76 second-year pharmacy students who enrolled in a PharmD program participated in the group debate as part of the student assessment in microbiology course. The students prepared selected topics on controversial issues in microbiology, which were presented as a debate. Post-debate questionnaire was distributed to the students and used to measure student perceptions.

RESULTS

The majority of the students (82.89%) demonstrated an improvement in their understanding of the topics after the debate. The highest percentage was recorded from one topic group (97.37%) which stated that they had improved understanding after the debate. About a third of the total students reported great improvement in their communication skills.

CONCLUSION

This debate group clearly provided the students with high confidence in presenting their arguments from relevant scientific information gathered from existing literature. It also enhanced their understanding of complex and controversial microbiology topics that will be needed during their pharmacy education.

Evaluation of Problem-Based Learning implementation in a College of Medicine, Kingdom of Saudi Arabia: a cross sectional comparative study

BACKGROUND

Problem-Based Learning (PBL) is an innovative student-centered learning method that has been implemented in numerous medical colleges worldwide. However, the newly adopting PBL institutes may face challenges during its implementation. This study aims to evaluate PBL implementation in the medical college of Imam Abdulrahman bin Faisal University (IAU) from the facilitators' and students' perspectives.

METHODS

This is a cross-sectional study using a quantitative self-administered online questionnaire. The questionnaire evaluated PBL implementation using the three scales: small group learning, problem case scenario, and facilitator role. A total of 52 facilitators and 1289 students (from second to sixth years) were invited to participate in the study at the end of the 2019-2020 academic year.

RESULTS

Forty-six facilitators (88.46%) and 324 students (25.13%) responded to the questionnaire. There was an overall positive evaluation of PBL implementation. However, the facilitators' rating was significantly higher than the students' rating across the three scales. Regarding the small group learning, a significant difference was found between types of facilitation status (p = 0.017) and between trained and not trained facilitators (p = 0.029). In respect to the problem case scenario, there was a significant difference based on the types of facilitation status (p = 0.017) and facilitating tutorials related to the facilitator's specialty (p = 0.004). Regarding the facilitator role, a significant difference was found between the academic year they had facilitated (p = 0.032). Female students rated the three scales significantly higher than male students (p < 0.001). Students aged between 24 and 25 years old and sixth years students also rated the three scales significantly higher than other students (P < 0.05).

CONCLUSIONS

The participants rated PBL implementation positively as measured by the three scales rating. However, specific concerns have been highlighted that are related to group dynamics, training before starting PBL, relevancy of the case scenarios, and the facilitator's role in nominating group members and providing feedback.

The case for plural PBL: an analysis of dominant and marginalized perspectives in the globalization of problem-based learning

The globalization of problem-based learning (PBL) in health professions education has been both celebrated and criticized. Using a critical narrative review approach, underpinned by our archive of global PBL literature and a targeted literature search, we analyze these dominant global discourses of PBL in health professions education. More precisely, we explore what is missed when the globalization of PBL is theorized either as a positive consequence of standardization, or a problematic spread of Western educational ideals and values around the world. We make visible how two dominant global discourses, a universalist and culturalist discourse, have emerged in the global proliferation of PBL. We also discuss the limitations of the two discourses by demonstrating how they either ignore contextual and cultural diversity or see it as problematic. We then turn to a perspective that has been marginalized in the PBL literature that emphasizes the global origins of PBL, transcending the dichotomy between West and non-West. We make a case for relating to PBL as a plural construct in order to learn from the cultural and situational nuances of educational activities labeled PBL around the world. We argue that PBL as a singular and universal concept has no global future, yet versions of PBL may continue to thrive locally. Finally, we propose avenues for future research that may help elucidate the global and local values that underpin our curricula, as well as the socio-political factors that perpetuate neo-colonialist views and practices in the uptake and implementation of PBL approaches across the globe.

The Effectiveness of Problem-based Learning in Acquisition of Knowledge, Soft Skills During Basic and Preclinical Sciences: Medical Students' Points of View

Background:

Students’ opinions about their medical curriculum is essential process for evaluating program strength and weakness. Aim: We aimed to assess the benefits and effectiveness of PBL in acquisition of knowledge and soft skills during basic (Phase I) and preclinical (Phase II) sciences.

Methods:

Across-sectional study was conducted at the University of Bisha, College of Medicine, Saudi Arabia. Students at Phase I and Phase II were involved. A validated self-administered questionnaire used for data collection. Responses to the questionnaire items regarding PBL benefits, preferences and effectiveness in acquisition of knowledge and soft skills were ordinal following a four-point Likert scale format. Independent and paired t tests were used to compare between the means and SD of each two variables. A p value ≤ 0.05 considered as statistically significant.

Results:

Most of students (86.3%) reported a positive perception on all the items assessing the benefits of PBL approach. Students’ responses on PBL relating to the acquisition of knowledge (3.27±0.46) and soft skill (3.32±0.45) were high. There were no significant differences determined in the mean score and SD of acquisition of knowledge (p=0.768) and soft skills (p=0.297) between second and third year students. PBL was preferred in Phase II comparable to Phase I modules (3.371±0.299 vs. 3.026±0.627; p=0.001).

Conclusion:

Effectiveness of PBL found to be high and increasing after taking a series of modules. Although PBL methodology has impact in acquisition of knowledge and skills, intended program outcome should be determined to assess the effects of PBL.

Learning through debate during problem-based learning: an active learning strategy

We explored medical student's views and perceptions of a series of debates conducted during problem-based learning (PBL) practiced as a part of the Spiral curriculum at the Imam Abdulrahman Bin Faisal University, Saudi Arabia. A series of debates were employed during PBL sessions for second-year female medical students, over the period 2014-2016. Each cohort of students was randomly split into 10 small PBL groups and exposed to weekly PBL activity. Within each group, the students were divided into a proposition half and an opposition half. Students were given 1 wk for debate preparation. The students' responses were recorded on a formulated questionnaire. Descriptive statistics were used to analyze quantitative data, and results are presented as percentages. The usefulness of debate in alleviating potential difficulties in communicating with patients was agreed to by 69% (n = 126) of participants. That these sessions evoked critical thinking among students was reported by 78% (n = 142). This series of debates helped 61% (n = 111) of students to learn effectively about controversial issues. Seventy-one percent (n = 130) considered that debate promoted argument generation and interpretation skills. Enhanced ability to analyze and research evidence was reported by 59% (n = 108) of students. One hundred and thirteen students (62%) agreed that debate helped them to improve clinical decision-making, and 75% of students agreed that debates encouraged tolerance toward diverse viewpoints/convincing strategies. The majority of our medical students found debating enhanced analytic decision-making, communication, and critical thinking skills.

Impact of Mode of Curriculum on Knowledge and Attitudes of Medical Students towards Health Research

INTRODUCTION

Equipping students with skills in medical research should be an integral part of medical education systems. This study is designed to gauge the difference in knowledge and attitudes towards health research between two sets of undergraduate medical students; those enrolled in the new Problem Based Learning (PBL) education system versus those of the conventional Lecture Based Learning (LBL) curricula.

MATERIALS AND METHODS

From the 4(th) and 5(th) years of medical university students, 90 participants were recruited from the Aga Khan University (PBL group) and Dow University of Health Sciences (LBL group) and were presented with structured and pre-validated questionnaire. Responses obtained for knowledge and attitudes of each group were recorded on a scale and graduated in percentages to be compared statistically for differences to identify the effectiveness of each curriculum.

RESULTS

The score on the knowledge scale for the PBL group was found to be 44.77% against the 31.55% of the LBL students (p-value<0.001). Furthermore, the mean attitude score of AKU students was 72.22% as opposed to the 56.11% of the DUHS participants (p-value<0.001).

CONCLUSION

The PBL group achieved significantly higher scores in all aspects than the LBL group, showing healthier attitudes towards health science research along with better knowledge. Hence, the apparent positive influence of PBL curricula on attitudes towards research may be helpful in improving research output of medical students in Pakistan.

Problem-based learning: Dental student's perception of their education environments at Qassim University

Aims:

The objectives of this study were to assess perceptions of the Saudi dental students of the problem-based learning (PBL) curriculum and to compare their perceptions among different sex and academic years.

Subjects and Methods:

Data was collected through a questionnaire-based survey at Qassim College of dentistry. The questionnaire consisted of 19 questions regarding the perception of PBL curriculum and was distributed to 240 students. The chi-square test was used for statistical analysis of the data.

Results:

Out of the 240 students recruited for this study, 146 returned a complete questionnaire (the response rate was 60.8%). The majority of the students perceived that PBL enhances the ability to speak in front of people (91.1%); improved the ability to find the information using the internet/library (81.5%); enhances the problem-solving skills (71.3%); increases the practice of cooperative and collaborative learning (69.2%); improves the decision-making skills (66.4%). Sixty-five percent (n = 96) noted that some students dominate whereas others are passive during PBL discussion session. Statistically, significant differences were found in the following variables according to the academic year students assuming before responsibility for their own learning (P < 0.037) and the role of facilitator in the process (P < 0.034). Moreover, according to gender; there were statistically significant differences in the following variables, assuming responsibility for own learning (P < 0.003); activating prior knowledge and learning to elaborate and organize their knowledge (P < 0.009); enhancing the ability to find the information using the Internet/library (P < 0.014); PBL is effective without having lecture of the same topic (P < 0.025); helping in identifying the areas of weakness for improvement (P < 0.031); student understanding the objectives of the PBL session better than the conventional way (P < 0.040); and enhancing the ability to speak in front of people (P < 0.040).

Conclusions:

Perceptions of Saudi dental students regarding their education environments at Qassim College of dentistry using PBL hybrid curriculum were more positive than negative. However, improvements are still required to provide students with stimulating favorable learning environment and to take the students recommendations into consideration.