Short-term outcomes of a near-full PBL curriculum in a new Taiwan medical school.

Problem-based learning (PBL), which incorporates principles of adult learning, is an important innovation in medical education. The use of PBL in health professional curricula is becoming more widespread. The curriculum design and the ways of implementing PBL are different among schools. More evidence is needed before a full PBL curriculum can be successfully implemented in an Asian medical school. Fu Jen Medical School is the first school in Taiwan to adopt a near-full PBL approach for the 3rd and 4th year curriculum (the medical education in Taiwan is mostly a 7-year undergraduate program). Fu Jen Medical School launched the interdisciplinary case-based, small group learning and integrated curriculum in 2002. This study investigated the short-term outcomes of this PBL curriculum, evaluated from several aspects. First, the self-directed learning readiness of the medical students before and after they entered the PBL curriculum was investigated using the Self-Directed Learning Readiness Scale (SDLRS). Second, semi-structured qualitative interviews were conducted with 5th and 6th year medical students and clinical instructors to understand the impact of PBL on the learning of clinical medicine. Finally, the passing rates in the Taiwan Medical Licensure Examination were compared with those of other medical schools in Taiwan. After 1 year of PBL, medical students at Fu Jen Medical School showed significant increases in the total SDLRS score, and in the subscores for learning strategy and self-assessment. These changes persisted until the end of 2 years of PBL. Students in their clinical years claimed that they were more active in learning, and had better learning skills and confidence in self-directed learning as compared with students from lecture-based curricula. PBL helps their clinical reasoning process, self-directed learning abilities and the use of knowledge in basic science to explain the clinical problem. On the other hand, the students thought that PBL had limited breadth and depth in clinical medicine and could not give them enough confidence in facing the national licensure examination. The initial batches of medical students (students from the first three cohorts) had the highest passing rate for Part 1 (basic sciences in medicine) and students from the first two cohorts had a 100% passing rate for Part 2 (clinical medicine) of the Taiwan Medical Licensure Examination. A near-full PBL curriculum in Asian medical schools is feasible and could encourage students to improve their self-directed learning abilities, learn adequate knowledge in basic sciences, and experience positive effects on learning clinical medicine. Better preparation of students for integrated learning of basic and clinical sciences are still needed, as is an emphasis on tutor training to improve the effectiveness of tutorial discussions.