PROBLEM-BASED LEARNING: A STRATEGIC

LEARNING SYSTEM DESIGN FOR THE EDUCATION

OF HEALTHCARE PROFESSIONALS IN THE
21ST CENTURY
Matthew Choon-Eng Gwee
Medical Education Unit and Department of Pharmacology,
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Problem-based learning (PBL) was first implemented by McMaster University medical school in
1969 as a radical, innovative, and alternative pathway to learning in medical education, thus setting
a new educational trend. PBL has now spread widely across the globe and beyond the healthcare
disciplines, and has prevailed for almost four decades. PBL is essentially a strategic learning system
design, which combines several complementary educational principles for the delivery of instruction.
PBL is specifically aimed at enhancing and optimizing the educational outcomes of learner-centered,
collaborative, contextual, integrated, self-directed, and reflective learning. The design and delivery of
instruction in PBL involve peer teaching and learning in small groups through the social construc-
tion of knowledge using a real-life problem case to trigger the learning process. Therefore, PBL
represents a major shift in the educational paradigm from the traditional teacher-directed (teacher-
centered) instruction to student-centered (learner-centered) learning. PBL is firmly underpinned by
several educational theories, but problems are often encountered in practice that can affect learn-
ing outcomes. Educators contemplating implementing PBL in their institutions should have a
clear understanding of its basic tenets, its practice and its philosophy, as well as the issues, chal-
lenges, and opportunities associated with its implementation. Special attention should be paid to
the training and selection of PBL tutors who have a critical role in the PBL process. Furthermore, a
significant change in the mindsets of both students and teachers are required for the successful
implementation of PBL. Thus, effective training programs for students and teachers must pre-
cede its implementation. PBL is a highly resource-intensive learning strategy and the returns on
investment (i.e. the actual versus expected learning outcomes) should be carefully and critically
appraised in the decision-making process. Implementation of PBL can be a daunting task and will
require detailed and careful planning, together with a significant commitment on the part of edu-
cators given the responsibility to implement PBL in an institution. PBL can offer a more holistic,
value-added, and quality education to energize student learning in the healthcare professions in the
21st century. Successful implementation of PBL can therefore help to nurture in students the
development of desired “habits of mind, behavior, and action” to become the competent, caring, and
ethical healthcare professionals of the 21st century. Thus, PBL can contribute to the improvement
of the healthcare of a nation by healthcare professionals, but we need to do it right.

Key Words: challenges, issues, opportunities, outcomes, problem-based learning

(Kaohsiung J Med Sci 2009;25:231–9)

Address correspondence and reprint requests to: Dr Matthew C.E. Gwee, Medical Education Unit, Yong Loo Lin School
of Medicine, 10 Medical Drive Block MD 11, National University of Singapore, Singapore 117597.
E-mail: phcmgce@nus.edu.sg

Kaohsiung J Med Sci May 2009 • Vol 25 • No 5 231

© 2009 Elsevier. All rights reserved.
M.C.E. Gwee
THE DARK AGES OF MEDICAL EDUCATION
Throughout the 19th century, and until about the last
2–3 decades of the 20th century, the design of the under-
graduate medical curriculum was highly discipline-
specific with little cross talk across disciplines. The
delivery of instruction was then highly teacher-directed
(teacher-centered) and also highly lecture-based. This
was the era of the instructional paradigm in which
the student role in the teaching/learning process was
mainly that of a passive recipient of abundant content
knowledge (or information) delivered by the teacher
(“sage-in-center stage”).
What then can we expect as the educational out-
comes from such a traditional educational environ-
ment? Several major limitations [1,2] have already
been identified, including:
• Information overload resulting from student acquisi-
tion of abundant content knowledge (“…informa-
tion that taxes the memory but not the intellect.”) [1].
• Development of rote-learning habits by students
through MRR (memorize, recall, regurgitate)—often
abetted and intensified by tests on recall of factual
content knowledge (information).
• Teaching inputs as the primary focus of instruction
with little attention to student learning outcomes.
• High dependency of students on teachers for their
learning needs, including what, how, and when to
learn.
• Inadequate attention to student acquisition of more
enduring educational process and life skills, including:
higher-order cognitive (intellectual) skills (critical think-
ing, reasoning, and problem-solving); and some
generic “soft” skills in the attitudes (affective) domain
of learning (interpersonal, communication, team-
work, and leadership).
THE MCMASTER UNIVERSITY INITIATIVE:
SETTING A NEW TREND IN MEDICAL
EDUCATION
“In the mid-1960s, an exceptional event occurred. McMaster
University gave birth to a medical school so different it
sent ripples of astonishment throughout the educational
world” [3].
In the 1960s, the Canadian government identified
a need to establish a medical school in McMaster
University in Hamilton, Ontario. At the outset, the
232
educational planners responsible for this project
declared that they intended to take a radical (“fresh
and new”) approach to the design and delivery of
their medical curriculum to “…get away from the
standard building-block structure…from shoving a lot
of content down their throats because they don’t retain
it very long anyway. Let’s try and get them actively
involved…” [3].
Indeed, in 1969, McMaster University Medical
School implemented its new medical curriculum,
which set a new, radical and innovative trend, and
offered an alternative pathway for learning in medical
education. The McMaster curriculum was imple-
mented as problem-based learning (PBL), primarily aimed
at overcoming what the educational planners per-
ceived to be the many shortcomings of the then cur-
rent (traditional) medical curriculum [1–3]. In fact,
even after almost three decades, Boud and Feletti [4]
still consider PBL as “…the most significant innovation
in education for the professions for many years. Some argue
that it is the most important development since the move of
professional training into educational institutions.”
WHAT IS PBL?
PBL is, essentially, a strategic learning system design,
which combines several complementary educational
principles for the delivery of instruction. PBL is spe-
cifically aimed at enhancing and optimizing the edu-
cational outcomes of learner-centered, collaborative,
contextual, integrated, self-directed, and reflective learn-
ing. Barrows and Tamblyn [5] provided a simple
operational definition of PBL as “…the learning that
results from the process of working toward the understand-
ing or resolution of a problem. The problem is encountered
first in the learning process.”
PBL: WHAT ARE ITS KEY FEATURES AND
ITS LEARNING STRATEGY?
An important and basic tenet of PBL is that it is problem-
first learning, i.e. students attempt to problem-solve a
medical case even before receiving any formal learn-
ing on the subject matter. Usually, a real-life medical
case (a problem) triggers the learning process for stu-
dents, i.e. the problem serves as the starting point
for learning relevant content knowledge required to
Kaohsiung J Med Sci May 2009 • Vol 25 • No 5

understand or resolve various issues related to
the problem case. Thus, regular practice in problem-
solving is another key feature of the PBL process
[6,7]. Moreover, case-writers often construct PBL
problem cases that contextualize and integrate learn-
ing across disciplines and, therefore, a problem case
usually includes issues relating to population, be-
havioral and the life sciences, as well as the clinical
sciences.
Typically, intensive small-group tutorials are used
for the delivery of instruction in the PBL process with
the teacher serving as the tutor (or facilitator) whose
role it is “to expedite the intellectual and interpersonal
process for the group” [8]. The PBL tutorials usually con-
sist of two sessions of about 2 hours, each devoted to
each problem case, with an intervening self-study period
of about 4–5 days for information searching and gath-
ering. The self-study period creates opportunities for
students to undertake self-directed learning [6,7] and,
therefore, laying a firm foundation for lifelong contin-
uing self-education.
Each tutorial session has its “specific process, goals
and outcomes” [6]. The first tutorial (tutorial session 1)
consists mainly of brainstorming as follows:
• Presentation of the problem-case by a member of the
group
• Problem analysis through reviewing the facts of the
problem case
• Hypothesis generation to develop ideas to explain
various aspects of the case
• Formulation of learning issues (learning objectives)
to guide identification of the content knowledge
hat needs to be learned in order to either refute or
confirm any hypothesis generated and, thus, to
have a better understanding of the case
• Identifying the appropriate learning resources (e.g.
textbooks, internet, or professional expertise) from
which to search for and gather information relevant
to the case
• Assigning tasks to group members to search
for information related to the learning issues
formulated
Tutorial session 1 is, therefore, primarily aimed at
identifying the facts of the case through problem analysis,
generating hypotheses (ideas) about the case, formulat-
ing learning issues to guide relevant learning that is
required to explain or resolve the case, and identify-
ing the learning resources for information search and
gathering.
Kaohsiung J Med Sci May 2009 • Vol 25 • No 5
PBL: education for healthcare professionals
In the second tutorial (session 2), the students recon-
vene in their respective groups after the self-study
period to perform the following:
• Share and evaluate the new knowledge and in-
formation (new evidence) acquired by group
members
• Reanalyze the problem in the light of new evidence
available
• Reformulate and refine the preliminary hypotheses
generated
• Integrate and apply the refined hypotheses generated
to explain the key issues related to the problem case
• Resolve the problem case
The primary purpose of tutorial session 2 is, there-
fore, to reanalyze, evaluate, integrate and then apply the
new evidence obtained to explain and/or to resolve the
problem case.
DYNAMICS OF THE PBL TUTORIAL
PROCESS
“…when the objective is critical thinking…, or problem-
solving…, and the development of qualities such as sensitiv-
ity, cooperation and zest for discovery, discussion pedagogy
offers substantial advantages” [9].
The PBL tutorial process applies the principles of
interactive teaching and learning using discussion pedagogy
[9]. The small group learning design creates opportunities
for student-centered and collaborative learning character-
ized by “…joint goals, mutual rewards, shared resources,
and complementary roles among members of a group” [10].
The process essentially consists of students engaged
in constructive conversation among themselves and
facilitated by their tutor, mainly through brainstorming
in which students critically analyze, debate and clarify
ideas and issues, and then mutually reach consensus
to explain or resolve a problem. The dynamics of the
PBL tutorial process is, therefore, specifically aimed
at actively involving students in teaching and learn-
ing from and with one another, i.e. in peer teaching and
learning in an “All teach All learn” mode.
Thus, in the PBL tutorial process, students learn
through social interaction in which they are required
to co-construct their own meaning and understanding
of knowledge that needs to be learned, “…rather than
having knowledge delivered to them in already organized
form” [11]. Peer teaching and learning is recognized as
a powerful pedagogical strategy to enhance higher-order
233
M.C.E. Gwee
cognitive processes among members of a group. This
has been clearly emphasized by Brookfield [12] in his
statement “…the peer support provided by a group of
others also trying to do this is a powerful psychological
ballast to critical thinking efforts.”
Furthermore, according to Abercrombie [13], such
discussion pedagogy promotes clinical judgment, and
he has clearly expressed that “Discussion in a group does
for thinking what testing on real objects does for seeing…
Instead of seeing our own mistakes by contrast with the state-
ments of an unquestioned authority, as in the traditional
pupil-teacher relationship, we see a variety of interpreta-
tions of the same stimulus pattern, and the usefulness of
each must be tested in its own right.”
Providing and receiving feedback
An important practice in PBL is for tutors and stu-
dents to devote about 10–15 minutes near the end of
each tutorial session to provide and receive feedback
from each other. This focusing on what factors en-
hanced or inhibited group achievements of tasks and
individual performance in tutorials, including the
perceived impact of one’s own behavior on others
and on group functioning. It is expected that such reg-
ular feedback sessions help nurture the development
of reflective learning in students and, consequently, the
development of greater self-awareness leading to self-
initiated remedial action (i.e. metacognition). Thus, stu-
dents can develop personal insights of their strengths
and limitations with respect to a given area of learn-
ing. According to Halpern [14] and Maudsley and
Strivens [15], such self-awareness (metacognition) is
an important attribute of critical thinkers.
PBL: ARE THERE ANY THEORIES
SUPPORTING ITS PRACTICE?
The Contextual Learning Theory has often been advo-
cated as the main theoretical underpinning for PBL,
which has been highlighted by Boud and Feletti [4]:
“problem-based learning is grounded in the belief that
learning is most effective when students are actively in-
volved and learn in the context in which knowledge is to
be used.” However, according to Albanese [10], there
are also other theoretical underpinnings, which pro-
vide stronger support for the PBL strategy, including:
• Information processing theory: relating to prior knowl-
edge activation, encoding specificity (i.e. learning in
234
context), and knowledge elaboration (i.e. creating
opportunities for active discussion)
• Cooperative learning theory: relating to the process
of collaborative small group learning
• Self-determination theory: relating to external and
internal motivators of learning
• Control theory (of human behavior): relating to in-
fluencing human behavior (including the desire
to learn) through satisfying one’s basic needs for
survival, including belonging, love, power, free-
dom, and fun.
PBL: SOME ISSUES, CHALLENGES,
OPPORTUNITIES
Any institution responsible for the education of health-
care professionals and contemplating implementing
PBL as a way of learning for their students must have
a clear understanding of the strengths and limitations
of PBL as a pedagogical strategy. This section will pro-
vide some insights on the issues, challenges, and op-
portunities associated with the practice of PBL. These
will hopefully guide curriculum planners and devel-
opers in their decision-making.
Curriculum options
PBL can be implemented as a full (complete or pedi-
gree) curriculum in which the entire (or almost entire)
curriculum for the education of healthcare profes-
sionals is designed and delivered through PBL, just
as in the case of the highly teacher-directed, lecture-
based and discipline-specific curriculum of the 20th
century. Armstrong has already drawn attention to
this issue, as she cautioned “replacing all lectures with
discussion groups or tutorials would merely substitute one
lop-sided system with another” [16]. It is also well recog-
nized that students have a diversity of learning styles
and offering only one way of learning through PBL
may disadvantage some students. Several institu-
tions have successfully implemented PBL as a hybrid
curriculum combined with other learning strategies
(e.g. lectures, practical classes). Armstrong has, in
fact, made the point that “hybrids usually display
strength and adaptability” [16].
Implementation of PBL
Careful and strategic planning is required in the
implementation of PBL, especially in institutions that
Kaohsiung J Med Sci May 2009 • Vol 25 • No 5

have already been deeply entrenched and entrapped
in a traditional 20th century curriculum in the educa-
tion of students. Paying attention to the following
will pay dividends:
• Have a clear understanding of the basic tenets of
PBL, including its practice and philosophy, before
attempting to design a PBL curriculum
• Ensure a deep commitment to planning and
development as implementing PBL can be a
daunting task
• Form a PBL committee consisting of members
from various disciplines, including members from
the basic sciences as well as clinicians
• Prepare students and teachers for a significant
mindset change prior to implementation; this can
be an onerous task. Moore has already cautioned
that, in the experience of Harvard Medical School,
“considerable resistance, skepticism and outright hos-
tility emerged during the planning process” [17].
Thus, specific training and faculty development
programs must be organized to prepare students
and teachers for their new roles in the PBL process.
The PBL tutor
“The problem-based learning (PBL) tutor is one of the most
important elements in PBL” [18].
The success or failure of PBL tutorials is often
determined by the commitment and tutoring skills of
the PBL tutor. It is the tutor who sets the brainwaves
in motion and, therefore, the pulse and tone of dis-
cussions. In fact, the tutor usually creates a “mirror
effect”, because the enthusiasm of students in tutori-
als often reflects the enthusiasm of the tutor in his/
her role as the facilitator of the learning process [8].
There are several important issues relating to the role
of PBL tutors, including whether tutors should be
experts or otherwise. Institutions intending to im-
plement PBL must therefore pay particular attention
to the “selection and training of tutors… a critical com-
ponent of PBL.” [18,19]. Several scholars have ad-
dressed the arguments over the role and choice of
PBL tutors and have provided much insight on the
issues [18–22].
Logistics, including manpower support
It is important to appreciate that PBL is a highly
resource-intensive educational strategy requiring a
large range of logistical support. This includes: the
availability of well-trained and committed tutors and
Kaohsiung J Med Sci May 2009 • Vol 25 • No 5
PBL: education for healthcare professionals
the support of skilful and dedicated case writers; from
the viewpoint of physical and technical support, one
needs to consider the availability of suitable tutorial
rooms (particularly when student numbers are large),
as well as the availability of appropriate technological
resources (e.g. internet facilities).
Sustaining ongoing PBL programs
Not only is it important to ensure the successful
implementation of PBL in an institution, but one also
has to ensure that an ongoing successful program can
be sustained. Thus, obtaining regular feedback from
students and their tutors is critical to identify emerg-
ing problems early, and for remedial action to be
taken when deemed necessary. Ongoing training for
new cohorts of students and teachers should also be
included to help sustain the practice of PBL.
Culture and learning
A basic tenet of PBL is the need for an open discussion
style in PBL tutorials, but this may conflict with the
more reserved Asian communication style. Although
the Asian communication style can be a barrier and,
therefore, a hindrance to learning in PBL, it is a problem
that can be overcome and, consequently, enhance stu-
dent learning in PBL, if teachers and students are
informed about and clearly understand the dynamics
of the PBL process. Another related issue is that of
language. Many higher education institutions in Asia
now prefer and expect their students to use the English
language in PBL tutorials, although many students
lack proficiency in English, as it is neither their spoken
nor national language. Gwee has already addressed
these issues in a previous publication [23].
PBL: same name but different game
“…PBL is interpreted in widely different ways. PBL in
action is currently characterized by many different strate-
gies. This variety has important consequences for evalua-
tion and research since findings from one PBL institution
may not be applicable or relevant to another also employ-
ing the problem-based approach” [24].
PBL has now spread widely across the globe, and
beyond the original confines of medicine and other
health sciences curricula into many other disciplines
[25,26]. Asian healthcare educators started adopting
and implementing PBL with much vigor in the mid-
1990s [23]. The adoption of PBL, as an active learning
strategy for students in the 21st century, by so many
235
M.C.E. Gwee
disciplines and institutions, led to its adaptation to
suit individual requirements in practice. As a conse-
quence, there are now many different versions of PBL
which may differ quite considerably from the original
McMaster model, as well as from each other. Com-
parisons of the results of outcome studies reported by
PBL practitioners in different institutions can therefore
pose serious difficulties and cause much confusion
in the interpretation of the results from such studies
[24,27,28].
PBL: the need for assessment
“[There is a need to design] …an assessment plan that
respects PBL principles, is reliable and valid, and has no
negative steering effect [on student learning]” [29].
All educators are aware of the steering effect of
assessment on student learning and the common
adage that “assessment drives learning”. It has also been
emphasized that “students don’t respect what you expect,
they respect what you inspect”! In this context then, it is
imperative to ensure that assessment must also be an
ongoing part of any PBL curriculum. First, there is a
need to assess knowledge acquisition by students (i.e.
assessing the cognitive domain of learning) for which
a clinical, scenario-based, multiple choice question type,
which incorporates testing of higher-order thinking
skills and problem-solving skills would serve the pur-
pose: “…we are unequivocally on the side of multiple-
choice questions” [30,31]. It should be noted that the
problem-solving ability is highly dependent on having
an adequate and relevant knowledge base, in the
sense that it is dependent on how factual knowledge
is constructed, contextualized and organized into a
conceptual framework to facilitate retrieval in the
problem-solving process [30].
Assessment in PBL must go beyond just testing
cognitive learning—it must also include the as-
sessment of learning outcomes in the affective (atti-
tudes) domain, a value-added outcome of the PBL
curriculum. Such assessment will need to involve,
as precisely as feasible, documentation of specified
observed behaviors and attitudes in a given situation
or context, or in the actual work environment. The
end-of-tutorial feedback session (self–peers–tutor)
serves as a useful and informal (formative) assessment
procedure, often with the need for more formal
(summative) self, peer and/or tutor ratings on specific
items relating to, for example, interpersonal, com-
munication and team-work (group) skills. A major
236
limitation of such assessment in the affective domain
of learning is that they may inherently lack psycho-
metric reliability and validity. Special attention must
therefore be paid to the design and selection of a rig-
orous assessment strategy together with the formula-
tion of relevant test items in such assessment [32].
Returns on investment
The returns on investment from PBL can be quite a
contentious issue, especially in view of PBL being a
highly resource-intensive educational strategy to imple-
ment. Perhaps it is best to review this issue through a
comparison of the actual educational outcomes (as sub-
stantiated in the literature) with the expected educa-
tional outcomes (as intended in the design principles,
i.e. the expected outcomes based on theoretical con-
siderations). Many educators have great expectations
of the educational outcomes from PBL because it is
aimed at enhancing and optimizing learner-centered,
collaborative, contextual, integrated, self-directed, and
reflective learning. Educational outcomes from PBL
are therefore expected to go beyond just knowledge
acquisition. PBL can be expected to equip students
with a more enduring educational process and life
skills, including the higher-order cognitive skills of
critical thinking and reasoning, and problem-solving, as
well as “soft” skills in the affective domain of learn-
ing such as interpersonal, communication, team-work,
and leadership.
However, a review of the literature strongly sug-
gests that there is a mismatch between the actual (as
reported in literature) and expected (based on educa-
tional strategies used) educational outcomes from
PBL. In fact, several studies in the past have con-
cluded that there is generally little or no difference in
knowledge acquisition and clinical skills between
students from traditional approaches and those from
PBL curricula, even when students are tested for
higher-order thinking [33]. In his editorial, Norman
provided a critical and excellent overview on this
issue [34], in particular drawing attention to “…what
may lie beyond PBL” with respect to “…how concepts are
learned”. Nevertheless, Norman clearly stated that “the
solution is not advocacy of return to a traditional, discipline
oriented curriculum” [34]. However, student acquisi-
tion of interpersonal skills and the joy of learning from
a PBL curriculum are well documented, as attested to in
the statement of Albanese: “Even if knowledge acquisition
and clinical skills are not improved by PBL, the enhanced
Kaohsiung J Med Sci May 2009 • Vol 25 • No 5

work environment for students and faculty that has been
consistently found with PBL is a worthwhile goal” [35].
It is noteworthy that a more recent systematic
review was undertaken by Koh et al in which they
searched for “…evidence of the effects that problem-based
learning in medical school had on physician competencies
after graduation” [36]. The authors concluded that
PBL “…during medical school has positive effects on
physician competency after graduation, mainly in social
and cognitive dimensions.” In his commentary on the
work of Koh and his colleagues, Norman expressed
that, “For years we have endured debate about the relative
merits and weaknesses of problem-based learning. Now
there is good evidence that the method delivers on some
very important issues. The next step is to determine why
the method works.” [37]. Similarly, Wood expressed
“The review confirms what most educators have come to
believe on the basis of hundreds of less rigorous reports
that, compared with traditional learning, problem-based
learning has some beneficial effects on some psychosocial
outcomes of undergraduate medical education” [38].
Challenges
Although PBL represents a strategic learning system
design which combines several learning principles
and is strongly underpinned by educational theories
and principles [10], Dolmans et al also pointed out
that “…in educational practice, problems are often en-
countered, such as tutors who are too directive, problems
that are too well structured, and dysfunctional tutorial
groups” [39]. Thus, the greatest challenge to the suc-
cessful implementation of PBL is how best to success-
fully combine the key learning principles of PBL into
a coherent practice which would result in beneficial
outcomes in the education of healthcare profession-
als in the 21st century. Important issues, which impact
on the practice of PBL (as discussed above), should
provide some guidance in this context.
Wood [38] has raised an even more fundamental
issue, pointing out that most undergraduate medical
curricula today are outcome-based [40] and incorpo-
rate small-group learning with fewer lectures in the
delivery of instruction. The challenge posed by Wood
is in her statement: “Teaching and learning in communi-
cation skills and the psychosocial domains can be achieved
in many ways, and working in small groups—coupled
with timely and constructive feedback—may be just as
effective as problem-based learning” [38]. The question
is, then, do we still need to adopt and implement
Kaohsiung J Med Sci May 2009 • Vol 25 • No 5
PBL: education for healthcare professionals
a PBL strategy to nurture student learning in the
affective domain?
Opportunities
“To build the colleges we need for the 21st century… we
must consciously reject the Instruction Paradigm and
restructure what we do on the basis of the learning para-
digm” [41].
“[Medical] Schools have yet to create a truly learner-
centered environment that makes active, self-directed learn-
ing under the close tutelage of interested faculty members
the core of the experience” [42].
There is now global consensus on the need for a
major shift in the educational paradigm, from the tra-
ditional teacher-directed instruction to more student-
centered learning. The major paradigm shift is expected
to provide better educational preparation for students
to meet the demands and challenges of a globalized
knowledge-based economy in the 21st century [41,42].
In this context then, PBL represents a highly student-
centered learning paradigm that has stood the test of
time for almost four decades now, and is still spread-
ing widely across the globe (some criticisms notwith-
standing) [22]. No other educational innovation is
known to have lasted this period of time.
Therefore, PBL offers educators of healthcare pro-
fessionals and students excellent opportunities to de-
sign and deliver instruction to their students with a
primary focus on student learning outcomes and on active
student participation in the learning process. More-
over, as a strategic learning system design, PBL is also
aimed at enhancing and optimizing collaborative, con-
textual, integrated, self-directed, and reflective learning
which add further educational value to the learning
outcomes expected from PBL.
CONCLUSION
“The central mission of medical education is to improve the
quality of health care delivered by doctors… [with] pa-
tients as the recipients of our skills… what doctors do, and
how and when they do it, depends on the quality of medical
education. We need to get it right” [43].
PBL is essentially a strategic learning system which
represents a major shift in the educational paradigm
from the traditional teacher-directed (teacher-centered)
instruction to student-centered (learner-centered) learn-
ing, a paradigm considered more appropriate for the
237
M.C.E. Gwee
educational preparation of students in the 21st cen-
tury. Implementation of PBL can be a tremendously
daunting task: not only will it require a clear under-
standing of the strengths and limitations of PBL, but
also a significant change in the mindsets of students
and teachers [7,17,44]. Implementation of PBL is
likely to cause some difficulties, including discomfort
and agitation to both teachers and students, especially
in the early phase of its implementation, and in those
institutions deeply entrenched and entrapped in the
traditional teacher-directed and highly discipline-
specific curriculum.
As educators of healthcare professionals, it is our
responsibility to design and deliver instruction to our
students which best enhances their learning and acqui-
sition of desired knowledge, skills, and attitudes for
their future professional practice. We should nurture
our students and help them develop the desired “habits
of mind, behavior and action” to become competent, car-
ing, and ethical healthcare professionals. PBL can
offer a more holistic, value-added and quality educa-
tion to energize student learning in the 21st century.
To optimize the benefits from PBL for students in the
healthcare professions and to contribute to the im-
provement of the healthcare of a nation, we need to
do it right.
If we fail to complete our responsibility well as
educators of future healthcare professionals, it will
result in dire consequences, not only for our students,
but also for our society and for ourselves, as clearly ex-
pressed by Evans: “overcoming difficulties is easier said
than done. But we must make the effort, or graduates will
leave our institutions full of knowledge, but with little com-
prehension and even less ability to apply, analyze, synthesize
or evaluate. Unless we take what steps we can to improve the
learning environment for our students, their potential will
only be partly realized, our standing in our own eyes and in
the eyes of society will be diminished and, ultimately, society
itself will be the poorer” [45].
ACKNOWLEDGMENTS
I would like to express my sincere thanks to Professor
Hsin-Su Yu, President of KMU, and to Professor
Chung-Sheng Lai, Dean, College of Medicine, KMU,
for having invited me to speak, and for the opportu-
nity to serve as a PBL tutor in the very successful
KMU International Workshop on PBL held in July 2008.
238
I am also grateful for the generous support provided
by KMU. I would like to express my deep apprecia-
tion to all my fellow speakers, tutors and all KMU
faculty and students for the fellowship and commu-
nity spirit with which we all enjoyed our learning
together.
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