Barriers to the acceptance of problem-based learning in medical schools

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Abstract
Despite a steadily increasing recognition that most medical schools in both Britain and the USA now provide inappropriate educational methods for the future needs of their students, there has been little interest or activity in curricular development in most established schools. Most of the problems identified with medical education are neither new nor unique to medicine, and resemble those found in many post-graduate professional schools where academic educational and professional training roles conflict. Included among these mutual problems are curricular overload due to a steady increase in basic scientific knowledge, overemphasis on factual memorisation and recall at the expense of scientific reasoning skills and knowledge utilisation, and a failure to secure integration of basic scientific concepts into clinical practice. A promising solution to many of these criticisms has recently emerged in the form of problem-based learning. This method, designed to encourage learning in a functional context throughout the medical course, is based on small-group tutorials which focus on defined clinical problems. Problem-based learning has now been in continuous use at McMaster University, Canada for over a decade, and has been more recently adopted as the major educational method in several newly established schools throughout the world. To date, however, very few established schools have either considered or adopted the principles of the method. Several barriers to the acceptance of problem-based learning in these established schools seem to be identifiable and include institutional complacency resulting from long standing educational tradition, together with a lack of reward for teachers who develop academic competence in education at the expense of biological research and clinical care. Individual departments may also feel threatened by the method if the integrated learning which it promotes is perceived to reduce the need for independent department-based courses. Faced with such problems, the adoption of concepts such as problem-based learning seem doomed to fail unless both universities and professional regulatory bodies demonstrate their support, and exert influence upon the schools. Administrative strategies for facilitating such change could involve the establishment of academic reward for identifiable educational scholarship in staff, financial support for establishment of educational departments to stimulate and coordinate educational innovation, and a reorientation of the examination system from one in which factual recall predominates to one which more accurately assesses the desired skills, attitudes and knowledge of future doctors. “No human arrangements are free from faults. A strenuous effort to improve and render perfect what already exists constitutes the task of life. Where can such endeavours be more justified or demanded than in dealing with the education of doctors on whose knowledge and ability the health and lives of men are so greatly dependent?˚d (Theodor Puschmann, 1891)

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