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Problems with problem-based learning in psychiatry

  • Norbert Skokauskas (a1)
  • Please note a correction has been issued for this article.
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Albanese, M. A. & Mitchell, S. (1993) Problem-based learning: a review of literature on its outcomes and implementation issues. Academic Medicine, 68, 5281.
Norman, G. R. & Schmidt, H. G. (2000) Effectiveness of problem-based learning curricula: theory, practice and paper darts. Medical Education, 34, 721728.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Problems with problem-based learning in psychiatry

  • Norbert Skokauskas (a1)
  • Please note a correction has been issued for this article.
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eLetters

There aren't just problems with problem based learning

Daniel M Bennett, Specialty Registrar 3 in Psychiatry
11 March 2009

There aren’t just problems with problem-based learning

Dear Sir,

I write with reference to Dr Skokauskas’ letter “Problems with problem-based learning in psychiatry,” Psychiatric Bulletin, March 2009.

Problem based learning (PBL) is used in “new” curricula since the publication of “Tomorrow’s Doctors” by the GMC in 1993. It allows students to solve problems and can integrate teaching across specialties and between clinical and basic science elements (horizontal and vertical integration). This promotes ‘deep learning’ and students using this learning style perform better in clinical examinations (McParland 2004). This style will not suit all students but allowing the opportunity to adopt alternative learning styles is important. It also facilitates adultlearning which is required in clinical practice.

McParland and colleagues (2004) showed using PBL compared to traditional methods for teaching psychiatry led to an improvement in both written and viva examinations, consistent with previous studies. The PBL approach also had greater student satisfaction ratings.

In view of these factors PBL, and other newer methods, are used as part of an integrated curriculum in most medical schools (Wilson and Eagles 2008). This ensures students develop the skills fostered by PBL and those of a traditional curriculum.

Although ‘psychiatry changes rapidly’ advances are not restricted to this specialty, it is thus difficult to use this as an argument against using PBL in psychiatry. This would lead to less rather than more integration as intended by “Tomorrow’s Doctors” to the detriment of the specialty.

It is also contradictory to argue for traditional lecture methods whilst criticising PBL as problems may be set by one person, which is likely to be the case with lectures. It has been shown that PBL deliveredby non-experts leads to a reduction in examination performance (Hay and Katsikitis 2001) thus experts such as Dr Skokauskas’ ‘charismatic professors’ should be encouraged to facilitate PBL sessions. The lack of exposure to a ‘charismatic’ figure, postulated to reduce student’s enthusiasm for pursuing psychiatry as a career, can be addressed using an integrated approach. An alternative way of attracting students to psychiatry is for teachers to encourage them to join the Royal College of Psychiatrists as Student Associates (http://www.rcpsych.ac.uk/training/students.aspx).

Dr Daniel M Bennett, Specialty Registrar 3 in Psychiatry, Block A, Clerkseat Building, Royal Cornhill Hospital, Aberdeen, AB25 2ZH, (T) 01224557245, (F) 01224 557443

ReferencesMcParland M., Noble L.M., Livingston G., (2004), The effectiveness of problem-based learning compared to traditional teaching in undergraduate psychiatry, Med Education, 38, 859-867

Wilson S., Eagles J.M., (2008) Changes in Undergraduate Clinical Psychiatry in Scotland since “Tomorrow’s Doctors”, SMJ, 53(4), 22-25

Hay P.J., Katisikitis M., (2001) The ‘expert’ in problem-based and case-based learning: necessary or not?, Med Education, 35, 22-26

Declaration of InterestNil
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Conflict of interest: None Declared

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Psychiatry benefits from problem based learning

Sheraz Ahmad, SpR Psychiatry/ London Deanery Fellow in Management & Leadership of Education in Psychiatry
11 March 2009

Skokauskas (2009) restates several arguments against the use of problem-based learning (PBL) in undergraduate medical education. We feel, as current PBL tutors who were ourselves students on a PBL course, that wecan offer a more positive view.

Skokauskas seems to imply that PBL cases replace the clinical experiences that have traditionally shaped students’ learning. In our experience cases (often meticulously refined over several years) act to support and guide clinical learning, as they can bring to the fore ideas and issues that may rarely be apparent to students on clinical placements.

Skokauskas suggests that PBL courses are inefficient, since traditional curricula may cover more material in the same time. But of course the presence of a subject in the curriculum does not guarantee thatit will be understood and retained by students; Dochy et al (2003) in their systematic review find evidence that PBL students retain their knowledge more effectively.

We were puzzled by Skokauskas’ assertion that PBL “assumes that students already are good problem-solvers”; in the courses we have experienced, problem solving is explicitly modelled as a skill to be developed by students. Certainly, the good group working skills needed formost working doctors cannot develop in a traditional lecture setting. PBL offers the opportunity to work in groups early and for individuals less “keen” or “capable” to identify their difficulties and reflect on them.

Skokauskas lastly worries that PBL students may be deprived of access“to a particularly inspirational or charismatic professor”; this risk, we think, is mitigated by the fact that typical PBL courses entail a three- or fourfold increase in hours-per-student of faculty contact (Donner &Bickley, 1990).

A recent systematic review (Koh et al, 2008) of the effect of PBL undergraduate courses on postgraduate competence suggests that PBL-traineddoctors have stronger competencies in domains including coping with uncertainty; legal and ethical aspects of health care; communication skills; and self-directed continuing learning. These domains would seem tobe of particular relevance to psychiatric practice, and we would encouragepsychiatrists to involve themselves in the design and delivery of problem-based learning.

ReferencesDOCHY, F., SEGERS, M., VAN DEN BOSSCHE, P. & GIJBELS, D. (2003) Effects of problem-based learning: a meta-analysis. Learning and Instruction, 5, 533-568DONNER, R. S. & BICKLEY, H. (1990) Problem-Based Learning: an Assessment of its Feasibility and Cost. Human Pathology, 21, 881-885KOH, G. C. H., KHOO, H. E., WONG, M. L. & KOH, D. (2008) The effects of problem-based learning during medical school on physician competency: asystematic review. CMAJ, 178, 34-41SKOKAUSKAS, N. (2009) Problems with problem based learning in psychiatry. Psychiatric Bulletin, 33(3), 117
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Conflict of interest: None Declared

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