Developing Professional Competencies in Medicine: Application of the Triple Jump Model in Problem-Based Learning in Medical Education

Problem-based learning (PBL) in medical education has enjoyed widespread acceptance in recent years, particularly in the basic sciences. However, it has been used less frequently in the clinical education of medical students, and quite infrequently in medical student education on anesthesiology. Critics of PBL emphasize cost factors and a lack of evidence of superior educational outcomes. This study reports evaluation data on the use of PBL with fourth year medical students who rotated through a required clerkship in clinical anesthesiology and pharmacology over the course of three academic years. Students were asked to complete evaluation questionnaires concerning the clerkship, with particular attention to PBL and the performance of PBL preceptors. Preceptors were also asked to self-rate their performance by using identical questionnaires. Standardized items across all three years facilitated analysis of student and faculty satisfaction as one outcome of the PBL process. Results indicate that student response to PBL was mixed. Students rated PBL preceptors more favorably than the PBL process itself, and rated resident physician preceptors more favorably than attending physician preceptors. All preceptors rated their own performance lower than did their students. Significant differences between student and faculty opinion of PBL were also noted. Interpretation of results are limited by less than ideal response rates; nevertheless, valuable insight was gained into the perception of PBL in an anesthesiology clerkship. The success of this educational method may be dependent upon certain factors related to "educational context". Further study is needed of contextual and other factors related to the use of PBL in medical education.

Contents: H.S. Barrows, Foreword. Part I:The Evolution of Medical and Surgical Education. S. Abrahamson, Medical Education: The Testing of a Hypothesis. R.H. Moy, Medical Education in the 20th Century. C.E. Engel, Medical Education in Australia, Great Britain, and New Zealand in the 21st Century. A. Tekian, Teaching and Learning in Medicine and Surgery in the 21st Century: Challenges to the Developing World. Part II:The Art and Science of Medical Education. G. Regehr, K. Rajaratanam, Models of Learning: Implications for Teaching Students and Residents. D.A. DaRosa, A. Derossis, Applying Instructional Principles to the Design of Curriculum. G.L. Dunnington, Adapting Teaching to the Learning Environment. A.K. Sachdeva, Large Group Teaching. R.G. Tiberius, Small Group Teaching. E.E. Reynolds, J. Ende, Feedback for Medical Education. K.B. Williamson, Instructional Technology in Medical Education. L. Wilkerson, Curriculum Evaluation and Curriculum Change. D.E. Simpson, Medical Faculty as Teachers: Implications for Faculty Development. J.R. Folse, Medical Education as a Continuum. R.G. Bing-You, J.C. Edwards, Residents as Teachers. N. Bennett, Muddy Problems, Compassionate Care: Continuing Medical Education in the 21st Century. Part III:Major Curriculum Movements. Q. Mast-Cheney, Major Curriculum Movements. L. Arnold, K. Roberts, U.S. Medical Schools' Combined Degree Programs Leading to the MD and a Baccalaureate, Master's, or Other Doctoral Degree. L.C. Perkowski, Standardized Patients. J.A. Colliver, M.H. Swartz, Reliability and Validity Issues in Standardized Patient Assessment. R.K. Reznick, K. Rajaratanam, Performance-Based Assessment. L.J. Morrison, Clinical Practice Examinations. H.S. Barrows, Authentic Problem-Based Assessment. E.L. Loschen, Implementing Problem-Based Learning in Medical Education. Part IV:Challenges for Medical Education. M.E. Whitcomb, Effects of Changing Health Care Environment on Medical Education. G. D'Elia, E.J. Constance, Medical Education and the Physician Workforce. J.H. Shatzer, M.B. Anderson, Supporting Medical Education. W.A. Anderson, Funding and Financial Support for Research and Development in Medical Education.

Research on Problem-Based Learning in medical education has undergone an evolutionary process from initial proof of concept studies through critiques of the original methods and beyond. Initial studies focused on whether or not the instructional method was effective for medical students and the goals of medical education. Despite much movement back and forth between results demonstrating effectiveness and ineffectiveness, not much forward progress was made in reaching a decisive conclusion. Recently, however, the adoption of different theoretical perspectives, research methods, research targets and technological supports has begun to move the studies along. Current research in the area is focusing not on whether the students learn, but rather what goes on during learning that helps or hinders their learning. As such the group process and its cognitive components has become a more fruitful target of researchers.

Introduction: Scientometrics is one of the most effective ways of investigating and quantifying research in academic databases. It can help examine the scientific output of various countries, and the authors’ and articles’ impacts on different subject areas can be determined. The main objective of this study was to analyze global scientific productions of problem-based learning (PBL) found in scientific productions indexed in the Web of Science (WoS) and PubMed databases from 2003-2013. Methods: PubMed and WoS were searched for PBL-related articles with the keywords Problem Based Learning AND Medical Education, excluding the keyword problem solving. The analysis was done based on scientometric indicators, like number of publications, citation count and Journals Impact Factor. Results: Among the countries publishing research in PubMed and WoS, the USA was the most prominent producer, was identified as a leading and active contributor among others in the field of medicl education. A statistically significant relationship was found between geographical distribution of continents and PBL application in the specific field, authors’ articles and the continents of authors’ affiliations.Conclusion: Attention should be paid to the importance of problem-based learning in medical education, especially in developed countries, because a growing body of research suggests that it is necessary to train students who are researchers and can meet the needs of society.

Problem-based learning (PBL) is a student-centered educational methodology that has been shown to promote clinical skills, critical thinking, and self-directed learning in medical education. This study aims to analyze the global scientific output on PBL in medical education through a bibliometric approach. This is a descriptive and nonexperimental study with a bibliometric analysis of the articles published between 2019 and 2025 in the Scopus database. A search strategy using MeSH terms related to PBL and medical education was applied, retrieving 608 documents. Original research articles focused on PBL in medical schools were included. VOSviewer, SciVal, and Bibliometrix in RStudio were used for the analysis. Abdalla Mohamed Elhassan was identified as the most productive author, while Sibbald Matt Gary stood out for his highest relative impact. Maastricht University and Harvard University led in institutional productivity. The most relevant journals were BMC Medical Education and Medical Science Educator. National collaboration was predominant (40.5%), although international collaboration showed a higher weighted impact. Thematic clusters were identified, relating to students, curriculum, clinical competencies, and COVID-19. Journals ranked in Q1-Q2 showed sustained growth in publications. PBL is an active and consolidating field in the medical literature, with a strong institutional and editorial concentration. The findings highlight a need for greater global collaboration and geographical diversification in the scientific output.

Situation creating is the prerequisite and foundation for problem-based learning(PBL) in medical education which runs through the whole course of curriculum design and implementation. Deeply comprehending the relationship between problem and situation as well as two transform, mastering the effect of disciplinarity, emotion nurturing and ill-structured problem in teaching situation creating, developing new teaching resources suitable for PBL continuously is beneficial to improve teaching case design quality, enhance guiding function in thinking training and intellectual psychological activity, thus improved implementation efficiency of PBL teaching mode in medical education, realized the aim of developing self-cultivate ability, thinking ability, creative ability and team working consciousness. Key words: Problem-based learning; Teaching situation; Learning theory; Medical education

While the use of problem-based learning (PBL) methods continues to increase in medical education, three literature reviews of PBL have appeared in the past several years which come to different opinions about their merits. This analysis summarizes the research evidence regarding PBL by examining how well it has met its originators' goals, what we know about how PBL works, and how PBL fares in a goal-free comparison with conventional curricula. A research agenda is suggested to refine our understanding of well-documented effects of PBL, to probe for other possible longer term PBL outcomes, and to examine if and how PBL affects knowledge acquisition and retention. Consistency of evidence from a variety of PBL implementations can help decide whether the effects seen can be attributed to PBL or are the results of other curricular features unique to one setting.

Problem-based learning (PBL) has been defined as ‘an educational method which uses carefully constructed clinical problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences’ (Albanese & Mitchell 1993). The emergence of PBL and its rise to prominence stem from attempts to bring modern concepts of adult learning into the medical education arena. This implies that ‘traditional’ medical curricula that emphasize didactic teaching and rote learning are passe, a concept that will be explored further in this paper. From its tentative beginnings some 30 years ago as an experimental teaching strategy in a few pioneering medical schools, PBL has become relatively mainstream. For example, five of Australia’s 11 medical schools now have PBL-based curricula while others use PBL to some extent. Such diverse bodies as the World Federation of Medical Education (Walton & Matthews 1989) and the World Health Organisation (Fulop 1984) are long-time supporters of PBL. Numerous medical schools in the USA (Jonas et al. 1991), Europe, the Middle East, and the Far East have embraced PBL (Bligh 1995). In the UK, several schools are in the process of adopting PBL (Bligh & Wilkinson 1997). This paper aims to provide those with little or no prior knowledge of PBL with an explanation of the origins of PBL, its compatibility with educational theory and its potential advantages and disadvantages. It describes the PBL process and outlines a typical PBL case. Finally, it provides perceptions on some common problems experienced with PBLbased curricula.

PurposeConstructive feedback is key to successful teaching and learning. The unique characteristics of problem-based learning (PBL) tutorials require a unique feedback intervention. Based on the review of existing literature, we developed a feedback model for PBL tutorials, as an extension of the feedback facilitator guide of Mubuuke and his colleagues. This study was aimed to examine the perceptions of students and tutors on the feedback model that was piloted in PBL tutorials.MethodsThis study employed a qualitative research design. The model was tested in nine online PBL sessions, selected using the maximum variation sampling strategy based on tutors’ characteristics. All sessions were observed by the researcher. Afterwards, tutors and students in the PBL sessions were interviewed to explore their perceptions of the model.ResultsThree themes were identified based on the perceptions of the tutors and students: cognitive changes, behavioral changes, and challenges of the use of the feedback model. Both tutors and students benefited from improved cognition and behavior. However, the use of the feedback model still encountered some challenges, such as limited sources of feedback data, flexibility and adaptability of the model, content of feedback delivered, students’ characteristics and performance, tutors’ characteristics and self-perceptions, and supportive infrastructure.ConclusionThe model can be used as a reference for tutors to deliver constructive feedback during PBL tutorials. The challenges identified in using the constructive feedback model include the need for synchronized guidelines, ample time to adapt to the model, and skills training for tutors.

1. Introduction sustainability of PBL and innovation in medical education at Maastricht University 2. History of problem-based learning in medical education 3. The problem-based learning process 4. Designing a problem-based learning medical curriculum 5. Designing problems 6. The role of a tutor 7. Basic sciences in problem-based learning 8. The introduction of real (ambulatory) patients early in the curriculum 9. Simulated patients 10. Skills training 11. Communication skills 12. Learning how to learn, teaching how to teach 13. E-learning 14. Alternative instructional problem-based learning formats 15. How to organize the transition from a traditional curriculum to a PBL curriculum 16. Curriculum governance 17. Quality assurance 18. Faculty development 19. The institutialization of student participation in the evaluation: From passionate volunteers to skilled students delegates 20. Hybrid learning spaces learning resources and facilities 21. Assessment 22. Progress testing 23. Research in education 24. A review of the evidence: effects of problem-based learning on students and graduates of Maastricht Medical School 25. Internationalization 26. A role for problem-based learning in higher education in the developing world

PurposeThis study aims to identify how problem-based learning (PBL) has been implemented in Korean medical education, and how it is evaluated by each medical school.MethodsFor this study, a total of 40 medical schools in Korea were surveyed via e-mail. The survey tool was a questionnaire consisting of 22 questions which was developed independently by the researchers.ResultsOf the 40 medical schools, 35 schools were implementing PBL programs in their medical curriculum, while five were found not currently to be running the program. A large number of the schools which introduced PBL (30 schools, 85.7%) used a hybrid PBL model. In over 70% of the medical schools surveyed, professors evaluated the effects of PBL as positive. Most medical schools (85.7%) stated they would maintain or expand their use of PBL. However, the lack of understanding and skeptical attitude of the faculty on PBL, the lack of self-study time and passive attitude of students, insufficiency of good PBL cases, and the perfunctory PBL introduction for school accreditation interfere with the successful PBL.ConclusionPBL has been incorporated in Korean medical curriculum as hybrid PBL type. It is analyzed that intensive tutor training and good PBL case development are necessary for the success and effective operation of PBL.

Problem-based learning (PBL) is an innovative educational approach to enhance student-centered and integrated learning through small group tutorials. In 1998, PBL tutorial was introduced to the medical curriculum of Kinki University. The purpose of this study is to examine the effect of PBL on learning outcome, in comparison with the traditional lecture-based education. Students’ view on PBL was surveyed on a yearly basis. Generally students felt that PBL results in an improvement of self-directed learning skills and has a positive effect on their learning attitude. A more detailed comparative study (PBL versus lecture-based) on the learning outcome of the locomotion system block was also undertaken. The PBL students performed significantly better in the test than the lecture-based students. One year later, the PBL students performed better in the pre-and post-clinical clerkship tests on the Locomotion System. It therefore appears that the knowledge acquired through PBL is better retained after one year, in comparison with the lecture-based students. This preliminary study suggests that PBL promotes long-term memory and has beneficial effects on learning attitude.

Student-centered problem-based learning (PBL) has been implemented as an alternative curriculum by several medical schools in the United States and elsewhere. Recently, attempts to integrate PBL with lecture-based curricula have created "hybrid" curricula with varying amounts of the philosophical underpinnings of student-centered PBL. Greater clinical and research demands on faculty time threaten to diminish the use of PBL in existing curricula, whereas opportunities for expansion of PBL in medical education are being created by community-based and interdisciplinary education programs.

Problem-based learning (PBL) is increasingly being used in medical education globally, but its effectiveness in teaching remains controversial. A randomized controlled trial (RCT) is the method of choice for evaluating its effectiveness. The quality of an RCT has a significant effect on this evaluation, but to date we have not seen an assessment of the quality of RCTs for PBL. Two researchers searched MEDLINE and EMBASE for RCTs addressing PBL in medical education. The overall quality of each report was measured on a 28-point overall quality score (OQS) based on the 2010 revised Comprehensive Standards for Reporting and Testing (CONSORT) Statement. Furthermore, to study the key factors affecting OQS more effectively, a linear regression model of those factors was established using SPSS. After literature screening, 30 RCTs were eventually included and analyzed. The median OQS was 15 (range, 7-20), which meant that half of the items in the revised 2010 CONSORT statement were poorly reported in at least 40% of the RCTs analyzed. The regression model showed that the year of publication of RCTs and the impact factors of the journals in which they were published were the main factors affecting OQS. The overall quality of reporting of RCTs on PBL teaching in medical education was not satisfactory. Some RCTs were subjectively selective in reporting certain items, leading to heterogeneity in quality. It is expected that statisticians will develop new standards more suitable for evaluating RCTs related to teaching research and that editors and peer reviewers will be required to review the relevant RCTs more strictly.

Problem-based learning (PBL) is a unique form of pedagogy dedicated to developing students' self-learning and clinical practice skills. After several decades of development, although applications vary, PBL has been recognized all over the world and implemented by many medical schools. This review summarizes and updates the application and study of PBL in medical education through the literature published between 1993 and early 2017. It focuses on understanding real medical PBL courses and ways to improve PBL to achieve better learning outcomes. PBL aims to develop lifelong skills to solve practical problems rather than limiting learning to theoretical knowledge. To achieve this goal, strict and reasonable procedures need to be designed and implemented. Rigorous monitoring and timely feedback and evaluation are indispensable to constant improvements and perfecting of the process. © 2017 by The International Union of Biochemistry and Molecular Biology, 46(2):186-194, 2018.