The effectiveness of problem-based learning compared to traditional teaching in undergraduate psychiatry

OBJECTIVES: A change from traditional to problem-based learning (PBL) methods in a psychiatry attachment was evaluated by comparing the learning styles, attitudes to psychiatry and examination performance of 2 cohorts of students. It was hypothesised that the PBL curriculum would result in increased deep learning, decreased surface learning, more favourable attitudes to psychiatry and improved examination performance. It was predicted that students' examination success would be related to the use of deep and strategic learning and favourable attitudes. METHODS: Consecutive cohorts of Year 2 clinical students taught using a traditional psychiatry curriculum (n = 188) and a PBL curriculum (n = 191) were compared. Students completed the Study Process Questionnaire to assess their learning styles and the Attitudes to Psychiatry Scale at the beginning and end of the attachment. Students completed 2 end-of-attachment examinations, a multiple-choice paper and a viva. RESULTS: The PBL curriculum resulted in significantly better examination performance than did the traditional teaching curriculum, both for multiple-choice questions and the viva. No differences in learning styles or attitudes to psychiatry were found between the curricula. Students were significantly more successful in the examinations if they had received the PBL curriculum, were female, and used strategic learning. CONCLUSIONS: Examination performance indicated that the PBL curriculum was more successful than the previous course, but that this improvement was not due to students using more effective learning styles or having more favourable attitudes towards psychiatry. It is possible that students learned more effectively during the teaching sessions in the PBL curriculum, but did not change their preferred learning styles.     

The effect of compulsory participation of medical students in problem-based learning

Problem-based learning (PBL) is an instructional method that has attracted many advocates since its introduction in medical education almost 20 years ago. PBL features the use of student-directed tutorials, medically relevant problems to set study objectives, and independent learning. Educators have worried that not all students will do well with this method. This study compared a group of students who had chosen to be in a PBL curriculum with a group who had not, as they undertook a curriculum that contained both PBL and lecture-based courses. Academic performance was virtually identical regardless of learning method. Students slightly favoured the courses that featured the method they had originally chosen, but a significantly larger proportion of students shifted their preference from the lecture to the problem-based approach than vice versa. Students' academic performance does not appear to suffer when they are involuntarily enrolled in a PBL curriculum and many come to prefer this type of curriculum.     

Problem-based learning versus lecture-based learning in a course of basic pharmacology: a controlled, randomized study

Since its first implementation in a medical programme at McMaster University, Canada, problem-based learning (PBL) has become a well-established means of teaching and learning medicine. Extensive research has been conducted and a number of strengths of the method are well supported. Several items, however, remain unclear although there is evidence that no relevant difference exists in factual knowledge among students from PBL and traditional curricula, a controlled, randomized study has not been conducted to address this issue. The Medical Faculty of the University of Cologne is in the process of integrating elements of PBL into its curriculum. In the spring term of 1997, after seven semesters of experience with PBL supplementing the traditional course of basic pharmacology, we did for the first time use PBL instead of the lecture-based course (LBL) and conducted a controlled prospective study to determine the effects of this intervention. One-hundred and twenty-three students were randomly assigned to either PBL (n = 63), with tutorial groups of up to nine students, or to the traditional, lecture-based course (n = 60). Analysis of the results of both groups in the examination of basic pharmacology, consisting of multiple-choice and short-essay questions, revealed similar scores with a tendency favouring PBL students in the category of short-essay questions. Hence, it seems clear that PBL does not imply a disadvantage in terms of factual knowledge. Students considered PBL to be an effective learning method and favoured it over the lecture format. Furthermore, students reported positive effects of PBL in terms of use of additional learning resources, interdisciplinarity, team work and learning fun.     

Implementation of problem-based learning in Asian medical schools and students' perceptions of their experience

BACKGROUND: Since the introduction of problem-based learning (PBL) at McMaster University in 1969, many medical schools in the USA, Canada and Europe have included PBL in their curricula. In the past decade, many medical schools in Asia have also done so. However, so far no one has questioned whether the outcomes expected of the learner in a PBL setting are applicable to students from different cultural upbringings. AIM: The aim of this study was to investigate the implementation of PBL in Asian medical schools, their students' perceptions of this new mode of teaching/learning and how the problems that have arisen may be overcome. METHOD: Published reports and conference presentations were gathered on the implementation of PBL in some Asian medical schools and comparisons of the experiences in PBL of Asian and students of other ethnic backgrounds. RESULTS: Most Asian medical schools and their students appear to be positive about adapting to PBL in their curriculum. The positive and negative observations appear to be similar to those experienced in non-Asian medical schools. The problems that arose for students in Asian medical schools in the early stages of implementing PBL appear to have been overcome after a period of adjustment with the help of supportive and open-minded tutors. The reports also suggested that trigger problems should be carefully designed to make them relevant and interesting for the students. CONCLUSION: Strong support from the academic administrators (dean and other staff responsible for implementation of the curriculum) in the introduction of PBL into the curriculum and careful training of both faculty and students appear to be key factors to ensure the successful implementation of PBL in Asian medical schools.     

The influence of tutoring competencies on problems, group functioning and student achievement in problem-based learning

CONTEXT: Prominent factors in problem-based learning (PBL) are the problems to be solved, tutorial group functioning and tutors' competencies. These factors mutually affect one another and largely determine whether a powerful learning environment will be created. It is a tutor's task to stimulate active, self-directed, contextual and collaborative learning and display interpersonal behaviour that is conducive to students' learning. We investigated the effects of tutors' competencies on students' learning and on other variables, such as group functioning and student achievement. OBJECTIVES: We investigated whether tutors who stimulate active, self-directed, contextual and collaborative learning make better use of problems and meaningful contexts in PBL and also enhance group functioning. We also investigated whether the quality of problems has a positive impact on group functioning and whether group functioning advanced student achievements. METHODS: Questionnaires were used to collect data from students at the end of 11 modules in Years 1 and 2 of a PBL undergraduate medical curriculum. We used structural equation modelling to test the fit of a theoretical model representing the factors of interest and their relationships. RESULTS: Stimulation of active and constructive learning, self-directed learning and collaborative learning by tutors enhanced the quality of the problems and group functioning. The quality of the problems promoted group functioning, which was found to have a positive effect on student achievement. CONCLUSIONS: Tutors' competencies had a positive effect on the learning of students. This suggests that it would be worthwhile including these competencies in staff development.     

Integration of pharmacology into a problem–based learning curriculum for medical students

The purpose of this study is threefold: (1) to describe a method of integration of pharmacology subject matter with other disciplines, in a problem-based learning (PBL) curriculum employed at the Northwest Center for Medical Education (NWCME), Indiana University School of Medicine; (2) to present various evaluation methods employed to assess students' learning of pharmacology knowledge; and (3) to compare the academic performance of students who underwent a traditional curriculum versus the PBL curriculum in terms of class evaluations and the standard national board medical licensure examinations. The PBL curriculum is designed for the first 2 years of medical education and consists of six sequential steps: steps 1 and 2 deal with biochemistry and anatomy respectively; steps 3, 4 and 5 deal with physiology, neuroscience and general pathology/microbiology respectively; and step 6 is a multidisciplinary step, which integrates basic science subjects with clinical medicine, emphasizing the mechanism of disease in an organ-system approach. In the PBL curriculum students start learning pharmacology within 6 months of admission. The content and process of pharmacology are spread across the first and in the second year. The pharmacology content is divided into three segments, each of which is integrated with other basic science subjects that have maximum mutual relevance. The three segments are as follows: the general and systemic pharmacology (50%) was included in step 3; the neuropharmacology and toxicology (35%) part was included in step 4; the third segment consisted of antimicrobial agents, anticancer and antiinflammatory agents (15%) and was included in step 5. The class evaluation of student performance in the PBL curriculum consisted of two elements, the content examinations and the process evaluations, which include the tutorial and the triple-jump evaluations of problem-solving skills. In order to assess the overall academic performance of the PBL curriculum and traditional curriculum groups, three classes of students who took the PBLC were compared with three classes of students who underwent a TC for performance in terms of class grades and scores of National Board examinations (NBME I and/or USMLE I). The PBL curriculum students performed as well as or better than the TC students as measured by the NMBE I and/or USMLE I. The gain in pharmacology knowledge of PBL students is accompanied by the presence of a positive experience that learning pharmacology is enjoyable. Our experience suggests that the segmental integration approach of instruction coupled with a system of content (internal and external examinations) and process (tutorial and triple-jump) evaluations, as outlined in this paper is a contextualized learning method that offers an effective way of imparting pharmacology knowledge to medical students.     

From traditional to problem-based learning: a case report of complete curriculum reform

The Sherbrooke School of Medicine, Quebec, has restructured its entire curriculum to make problem-based learning (PBL) the main instructional format. This complete reform is explained both in terms of process and content. The curriculum problems were clearly identified and overcome by a major structural shift-over following the stages of a strategic planning of change. Implementation over a period of 7 years is described according to a four-stage framework: need for change; selection of the PBL solution; planning for implementation; and the full-scale adoption of the PBL method. The programme is described in relation to the congruence of goals, learning and evaluation activities. Initial impact on student learning and evaluation, attracting better quality students, academic staff roles, and on financing the operation are discussed. Changing the undergraduate programme has become an institutional project directed by the Office of the Dean.     

Problem-Based Learning and Learning Approach: Is There a Relationship?

Aim: To assess the influence of a graduate-entry PBL curriculum on individual learning style; and to investigate the relationship between learning style, academic achievement and clinical reasoning skill. Method: Subjects were first-year medical students completed the Study Process Questionnaire at the commencement, and again, at the end of the academic year when they also completed the Diagnostic Thinking Inventory, a measure of clinical reasoning skill. Subjects were classified on the basis of their predominant learning approach, and this was correlated with examination results and DTI score. Results: There was a net shift in predominant learning approach away from deep learning towards a more surface approach over the period of the study, as well as a significant decrease in deep-learning scores. There was a statistically significant association between deep learning score and clinical reasoning skill as shown by total DTI score as well as on the structure of knowledge subscale. No correlation was found between learning approach and examination results. Conclusion: Although these results suggest that a deep learning approach may be beneficial in the development of clinical reasoning skill through its potential to enhance the development of knowledge representations, the substantial shift towards a surface learning approach brings into question previous conclusions that PBL curricula foster a deep approach to learning, and suggests that other factors, such as work load may be more determinants of learning approach than curriculum type. Taken together, these findings emphasise the context-dependent nature of learning approach as well as the importance of assessment as a driver of student learning and strongly suggest that further work to determine precisely the factors which influence learning approach in medical students is urgently needed.     

Evolutionary trends of problem-based learning practices throughout a two-year preclinical program: a comparison of students’ and teachers’ perceptions

Implementation of a pedagogical approach is a continuous and evolving process. As an institution with more than 15 years problem-based learning (PBL), we studied how the learning and teaching processes are currently practiced in a 2-year preclinical basic sciences program to assess whether they still match the intended objectives. Using both students’ and tutors’ evaluations, we analyzed and compared their perceptions on the program content and its organization, on tutors’ functioning and on the duration of PBL sessions throughout 11 instructional units of the second and third-year of a 6 years medical curriculum. Whereas both tutors and students indicated that the content and problems selected for the curriculum were well adapted to the PBL process, they felt the references as well as the self-study time as moderately appropriate. Over the course of the 2-year program, tutorial sessions got linearly shorter, whereas reporting sessions got longer. While tutors knew well the PBL approach and were suitably prepared to their tutorials, they however, became less regular in providing feedback and in evaluating group functioning over the 2 years. Our results suggest that the practice of the PBL process evolves within and throughout a 2-year preclinical program and moves away from the original intentions. Possible underlying reasons and their implications are discussed within the context of tutors’ and students’ concepts of teaching and learning, the medical schools’ learning environment and teaching practices and the difficulty of developing and maintaining in the long term a deep and self-directed learning approach.     

Faculty opinions about a revised pre-clinical curriculum

INTRODUCTION: Medical schools having innovative curricula have been encouraged to ascertain the levels of satisfaction of faculty members with the curriculum. Faculty at schools that employ problem-based learning (PBL) have been shown to have positive perceptions, but not all schools are in a position to adopt PBL on a large scale. This study sought to determine faculty members' opinions about a new curriculum that is less ambitious than one utilizing true PBL. CONTEXT AND SETTING: Since 1997, the University of Otago Medical School (Dunedin, New Zealand) has had an integrated, modular pre-clinical curriculum that emphasizes clinical relevance. It has proved popular with students. This study focused on faculty members' impressions. METHODS: We surveyed faculty members' opinions with a questionnaire identical to one used in studies at PBL schools. Faculty compared the students and their own levels of satisfaction in the old and new curricula on 7 to 10 items. The overall response rate was 85.4% (152 of 178). RESULTS: Perceptions of the new curriculum were positive among teachers who taught during the pre-clinical years and those who taught the students only after they reached the clinical years. Results for individual questions were in the same direction and generally similar in magnitude to those reported on identical items for PBL. CONCLUSION: We conclude that a hybrid curriculum that is more acceptable to many traditional teachers and students than is PBL has almost as great a positive effect on faculty members' perceptions of students' abilities and of the curriculum as does PBL.     

Task-based learning: the answer to integration and problem-based learning in the clinical years

INTRODUCTION: Integrated teaching and problem-based learning (PBL) are powerful educational strategies. Difficulties arise, however, in their application in the later years of the undergraduate medical curriculum, particularly in clinical attachments. Two solutions have been proposed - the use of integrated clinical teaching teams and time allocated during the week for PBL separate from the clinical work. Both approaches have significant disadvantages. Task-based learning (TBL) is a preferred strategy. In TBL, a range of tasks undertaken by a doctor are identified, e.g. management of a patient with abdominal pain, and these are used as the focus for learning. Students have responsibility for integrating their learning round the tasks as they move through a range of clinical attachments in different disciplines. They are assisted in this process by study guides. METHOD: The implementation of TBL is described in one medical school. One hundred and thirteen tasks, arranged in 16 groups, serve to integrate the student learning as they rotate through 10 clinical attachments. RESULTS: This trans-disciplinary approach to integration, which incorporates the principles of PBL offers advantages to both teachers and students. It recognizes that clinical attachments in individual disciplines can offer rich learning opportunities and that such attachments can play a role in an integrated, as well as in a traditional, curriculum. In TBL, the contributions of the clinical attachments to the curriculum learning outcomes must be clearly defined and tasks selected which will serve as a focus for the integration of the students' learning over the range of attachments.     

Effects of a Metacognitive Intervention on Students’ Approaches to Learning and Self-Efficacy in a First Year Medical Course

Aim To determine the influence of metacognitive activities within the PBL tutorial environment on the development of deep learning approach, reduction in surface approach, and enhancement of individual learning self-efficacy. Method Participants were first-year medical students (N = 213). A pre-test, post-test design was implemented with intervention and control cohorts, with intervention students experiencing a program of metacognitive activities within their PBL tutorials of at least 20 weeks duration. All students completed the Medical Course Learning Questionnaire at the commencement, and again at the completion of, the study. The metacognitive intervention itself consisted of reflection on the learning in PBL coupled with peer- and self-assessment. Results Self-efficacy was significantly reduced for both control and intervention cohorts at the conclusion of the study. A significant reduction in the adoption of deep and strategic learning approach, matched by a corresponding increase in the use of surface learning, was demonstrated for both cohorts. There was a statistically significant association between high self-efficacy and deep learning approach, with older students over-represented in the group of efficacious deep learners. Conclusion Over the course of first-year medical studies, students lose self-efficacy and move away from deep-strategic learning approaches towards more surface approaches. The program of metacognitive activities failed to reverse this trend. The substantial swing towards surface learning raises questions about the perceived capacity of PBL curricula to promote deep approaches to learning in dense curricula, and reinforces the importance of personal and contextual factors, such as study habits, workload and assessment, in determining individual approaches and idiosyncratic responses to learning situations.     

Problem-based learning: measurable outcomes

Problem-based learning (PBL) could potentially contribute to four key objectives in the education of doctors. (1) Motivating learning. Three studies show that students studying PBL problems choose fewer topics to study than those identified by the faculty, but one study of a critical care rotation showed that students were motivated to learn over a wider range of basic science topics than had been included in the basic science curriculum. (2) Developing clinical reasoning. One study compared methods of solving problems in PBL and conventional track curricula and suggested that PBL students work backwards from clinical information to theory, while conventional curriculum students tend to reason forward from theory. One study showed that computer searches provide knowledge for helping solve some PBL problems, and another study showed that specific knowledge in emergency medicine correlated with test scores. (3) Structuring knowledge in clinical contexts. A few studies show that PBL students perform less well on basic science examinations but better on clinical examinations. Educational outcomes, however, have been assessed quantitatively mainly by the U.S. National Boards of Medical Examiners Examinations or by clinical examinations with small samples. Only one study includes a power computation to assess type II error. There are no studies that examine how much variance occurs between PBL programmes in their curricular methods and outcomes. (4) Developing self-learning skills. PBL students use a much wider range and number of resources than conventional track students. There is only one study comparing the knowledge of doctors trained by PBL and conventional curricula after the doctors have been in practice for a substantial number of years, and no studies of patient outcomes. Patient outcomes need to be assessed with randomized controlled trials, and sample sizes should be determined by power computations to avoid Type II error. Four possible methods of improving PBL would be to derive national and internationally accepted PBL curricula; to organize internationally accepted and psychometrically validated methods of evaluation; to develop attitudes among students and tutors to facilitate co-operative PBL teamwork; and to teach group process diagnostic skills.     

Problem-based learning: why curricula are likely to show little effect on knowledge and clinical skills

OBJECTIVES: A recent review of problem-based learning's effect on knowledge and clinical skills updated findings reported in 1993. The author argues that effect sizes (ES) seen with PBL have not lived up to expectations (0.8-1.0) and the theoretical basis for PBL, contextual learning theory, is weak. The purposes of this study were to analyse what constitutes reasonable ES in terms of the impacts on individuals and published reports, and to elaborate upon various theories pertaining to PBL. DESIGN: Normal theory is used to demonstrate what various ESs would mean for individual change and a large meta-analysis of over 10 000 studies is referred to in identifying typical ESs. Additional theories bearing upon PBL are presented. RESULTS: Effect sizes of 0.8-1.0 would require some students to move from the bottom quartile to the top half of the class or more. The average ES reported in the literature was 0.50 and many commonly used and accepted medical procedures and therapies are based upon studies with ESs below 0.50. CONCLUSIONS: Effect sizes of 0.8-1.0 are an unreasonable expectation from PBL because, firstly, the degree of changes that would be required of individuals would be excessive, secondly, leading up to medical school, students are groomed and selected for success in a traditional curriculum, expecting them to do better in a PBL curriculum than a traditional curriculum is an unreasonable expectation, and, thirdly, the average study reported in the literature and many commonly used and accepted medical procedures and therapies are based upon studies having lesser ESs. Information-processing theory, Cooperative learning, Self-determination theory and Control theory are suggested as providing better theoretical support for PBL than Contextual learning theory. Even if knowledge acquisition and clinical skills are not improved by PBL, the enhanced work environment for students and faculty that has been consistently found with PBL is a worthwhile goal.     

Students' Conceptions of Constructivist Learning: A Comparison between a Traditional and a Problem-based Learning Curriculum

This study investigated students' conceptions of constructivist learning activities in a problem-based learning (PBL) and a traditional curriculum. We examined whether students who have chosen for a problem-based curriculum have different conceptions of constructivist assumptions compared to students who have chosen to be enrolled in a traditional, lecture-based curriculum when they enter university. Although constructivism represents an influential view of learning, studies investigating how students conceptualize this perspective have not been conducted before. A structural equation modelling approach was adopted to test the hypothesized model in both student populations and to calculate latent means. Results suggested that students in the PBL environment agree more on constructivist assumptions of cooperative learning and the use of authentic problems, while students in the traditional curriculum acknowledge the importance of motivation to learn more. It is discussed that conceptions of constructivist learning activities can act as an important moderator of PBL effects and should be considered in examining the effects of PBL and probably in all comparative education research.     

Blended learning positively affects students’ satisfaction and the role of the tutor in the problem-based learning process: results of a mixed-method evaluation

Problem-based learning (PBL) is an established didactic approach in medical education worldwide. The impact of PBL depends on the tutors’ quality and the students’ motivation. To enhance students’ motivation and satisfaction and to overcome the problems with the changing quality of tutors, online learning and face-to-face classes were systematically combined resulting in a blended learning scenario (blended problem-based learning—bPBL). The study aims at determining whether bPBL increases the students’ motivation and supports the learning process with respect to the students’ cooperation, their orientation, and more reliable tutoring. The blended PBL was developed in a cooperation of students and teachers. The well-established Seven Jump-scheme of PBL was carefully complemented by eLearning modules. On the first training day of bPBL the students start to work together with the online program, but without a tutor, on the final training day the tutor participates in the meeting for additional help and feedback. The program was evaluated by a mixed-method study. The traditional PBL course was compared with the blended PBL by means of qualitative and quantitative questionnaires, standardized group interviews, and students’ test results. In addition log-files were analyzed. A total of 185 third-year students and 14 tutors took part in the study. Motivation, subjective learning gains and satisfaction achieved significantly higher ratings by the bPBL students compared with the students learning by traditional PBL. The tutors’ opinion and the test results showed no differences between the groups. Working with the web-based learning environment was assessed as very good by the students. According to the log-file analysis, the web-based learning module was frequently used and improved the cooperation during the self-directed learning.     

Does problem‐based learning lead to deficiencies in basic science knowledge? An empirical case on anatomy

INTRODUCTION: Problem-based learning (PBL) is supposed to enhance the integration of basic and clinical sciences. In a non-integrative curriculum, these disciplines are generally taught in separate courses. Problem-based learning students perceive deficiencies in their knowledge of basic sciences, particularly in important areas such as anatomy. Outcome studies on PBL show controversial results, sometimes indicating that medical students at PBL schools have less knowledge of basic sciences than do their colleagues at more traditional medical schools. We aimed to identify differences between PBL and non-PBL students in perceived and actual levels of knowledge of anatomy. METHODS: Samples of Year 4 students in all eight medical schools in the Netherlands completed a questionnaire on perceived knowledge and took part in a computerised anatomy test consisting of both clinically contextualised items and items without context. RESULTS: Problem-based learning students were found to have the same perceived level of anatomy knowledge as students at other medical schools. Differences in actual levels of knowledge were found between schools. No significant effects on knowledge levels were found for PBL schools versus non-PBL schools. CONCLUSION: The results of this study show that PBL does not result in a lower level of anatomy knowledge than more traditional educational approaches. It remains to be ascertained whether the levels students attain are adequate. Subjects for further study are the desired level of anatomy knowledge at the end of undergraduate medical education and the effectiveness of basic science learning within a clinical context and with repetition over the course of the curriculum.     

The effect of problem-based learning in nursing education: a meta-analysis

Problem-based learning (PBL) has been identified as an approach that improves the training of nurses by teaching them how to apply theory to clinical practice and by developing their problem-solving skills, which could be used to overcome environmental constraints within clinical practice. A consensus is emerging that there is a need for systematic reviews and meta-analyses regarding a range of selected topics in nursing education. The purpose of this study was to conduct a meta-analysis of the available literature in order to synthesize the effects of PBL in nursing education. Using a number of databases, we identified studies related to the effectiveness of PBL in nursing. An analysis was conducted on a range of outcome variables, including overall effect sizes and effects of evidence and evaluation levels, learning environment, and study characteristics. We found that the effect of PBL in nursing education is 0.70 standard deviations (medium-to-large effect size). We also found that PBL has positive effects on the outcome domains of satisfaction with training, clinical education, and skill course. These results may act as a guide for nurse educators with regard to the conditions under which PBL is more effective than traditional learning strategies.     

The process of problem-based learning: what works and why

Medical Education 2011: 45 : 792–806 Objectives In this review, we portray the process of problem‐based learning (PBL) as a cognitive endeavour whereby the learner constructs mental models relevant to problems. Two hypotheses are proposed to explain how learning is driven in PBL; an activation–elaboration hypothesis and a situational interest hypothesis. Methods Research relevant to these hypotheses is discussed. In addition, research studying the effects of various support strategies used in PBL is reviewed. Finally, we summarise a number of recent studies in which a new ‘micro‐analytical’ methodology was used to trace the process of PBL in the natural classroom setting. Conclusions We conclude that there is considerable support for the idea that PBL works because it encourages the activation of prior knowledge in the small‐group setting and provides opportunities for elaboration on that knowledge. These activities facilitate the comprehension of new information related to the problem and enhance its long‐term memorability. In addition, there is evidence that problems arouse situational interest that drives learning. Flexible scaffolding provided by cognitively and socially congruent tutors also seems to be reasonably effective, as opposed to ‘hard’ scaffolding represented by, for instance, worksheets or questions added to problems. Small‐group work protects against dropout and encourages students to study regularly. Initially, students do not study much beyond the learning issues generated; the development of personal agency in self‐study needs time to develop. The extent of learning in PBL results from neither group collaboration only (the social constructivist point of view) nor individual knowledge acquisition only; both activities contribute equally to learning in PBL.     

Influence of context and preferred learning environments: approaches to studying physiology

Summary. One hundred and twenty-eight medical students who had experienced a traditional-style preclinical curriculum completed three self-report questionnaires. Using factor analysis of students' responses this study explores interactions between study orientation, preferences for different kinds of learning environment, and evaluations of the physiology course. Such interactions can provide insight into the reasons why students fail to adopt effective learning strategies. Although many students had the intention to understand, they did not adopt a deep approach. Achievement motivation was strong, test anxiety high, and the course was perceived to be competitive. The meaning orientation merged with the achieving orientation; students were thus performance rather than task oriented. These students perceived the course to have been challenging, as did students within the reproducing orientation and who had ‘surface’ preferences. Students within the non-academic orientation had difficulty coping with the course. The findings suggest that conventional teaching and assessment methods are preventing students from developing appropriate criteria and internal standards for evaluating performance. An illusion of comprehension may prevent students from seeing the need to adopt more effective learning strategies and cause ‘good’ students with the ability to adopt a deep approach to abort the pursuit of deep understanding. Students' preferences and evaluations of teaching and assessment indicate that students within the different learning orientations have different educational needs. The implications for instruction and evaluation are discussed.