Abstract
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.
Highlights
The globalization of health professions education has resulted in more collaboration between educational institutions and a greater flux of students and teachers across the globe (Hodges et al 2009; Martimianakis and Hafferty 2013)
Who benefits from globalization, and who does not (Hodges et al 2009)? Do those who sell medical education internationally remain critical of their product and its implications across contexts (Whitehead 2016)? How and why are education standards from countries that have a strong international presence in health professions education, often Western countries, imposed globally (Hodges 2016)? In particular, Bleakley et al (2008) argue that globalization has facilitated the global spread of Western medical education, underpinned by a “set of cultural attitudes that are rarely questioned”, which, according to the authors, carries the risk of a new wave of Western imperialism
Both discourses converge on the idea that there is expertise associated with implementing and sustaining problem-based learning (PBL), either in the form of a ‘golden standard’, or in developing culturally sensitive versions of PBL. These ideas extend to those who evaluate PBL curricula and initiatives. This enables institutions “who have historically been in a position to build capacity and experience in PBL and share their knowledge and research worldwide, such as Maastricht University, to continue being looked at for expertise (...), possibly at the expense of others who did not have such a head start or who have a different educational message that is less aligned with mainstream global discourse” (Frambach and Martimianakis 2017)
Summary
The globalization of health professions education has resulted in more collaboration between educational institutions and a greater flux of students and teachers across the globe (Hodges et al 2009; Martimianakis and Hafferty 2013). We analyze the dominant discourses currently framing the PBL literature to explore what is missed when the globalization of PBL is theorized either as a positive consequence of the standardization of health professions education, or as a problematic spread of Western educational ideals and values.
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