Successful Use of Problem-Based Learning in a Third-Year Pediatric Clerkship

Abstract

To determine the effect of changing from lectures to a problem-based learning (PBL) curriculum on student knowledge accrual and satisfaction with the didactic portion of a clerkship. Study of cohorts before and after PBL introduction and in comparison with unchanged medicine clerkship. Third-year pediatric clerkship at 5 clinical sites. The PBL curriculum was introduced in the 1996 academic year. The 2 classes before the intervention served as historic controls (n = 319), whereas the 2 classes after PBL served as the intervention group (n = 320). Small groups of students worked through 6 PBL cases representing common pediatric illnesses. Knowledge was assessed with the pediatric and internal medicine subject examination of the National Board of Medical Examiners (NBME); student satisfaction was assessed by an anonymous end-of-rotation questionnaire. Scores on the pediatric subject examination improved significantly from means of 69.2 and 70.0 in the historic control group to 73.6 and 74.2 in the PBL cohort (P <.01). Scores on the internal medicine subject exam during the same time periods remained unchanged until the second year after the change (69.1 and 70.2, respectively, before the change; 70.1 and 72.4, respectively, after the change). Analysis of variance results indicated a significant increase in pediatric subject examination scores associated with the introduction of PBL (P <.01). Overall student satisfaction with the pre-PBL lecture series was 3.3, whereas PBL sessions received a score of 4.3. Use of PBL in a clinical clerkship was associated with higher scores on the NBME subject examination and increased student satisfaction. These results should encourage the use of PBL during the clinical years.