Department of Paraclinical Sciences, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Lot 77, KTLD Section 22, Jalan Tun Zaidi Adruce, Kuching, Sarawak 93150, Malaysia.
BMC Med Educ. 2012 Sep 25;12:89. doi: 10.1186/1472-6920-12-89.
Problem-based learning (PBL) has become the most significant innovation in medical education of the past 40 years. In contrast to exam-centered, lecture-based conventional curricula, PBL is a comprehensive curricular strategy that fosters student-centred learning and the skills desired in physicians. The rapid spread of PBL has produced many variants. One of the most common is 'hybrid PBL' where conventional teaching methods are implemented alongside PBL. This paper contends that the mixing of these two opposing educational philosophies can undermine PBL and nullify its positive benefits. Schools using hybrid PBL and lacking medical education expertise may end up with a dysfunctional curriculum worse off than the traditional approach.
For hybrid PBL schools with a dysfunctional curriculum, standard PBL is a cost-feasible option that confers the benefits of the PBL approach. This paper describes the signs of a dysfunctional PBL curriculum to aid hybrid PBL schools in recognising curricular breakdown. Next it discusses alternative curricular strategies and costs associated with PBL. It then details the four critical factors for successful conversion to standard PBL: dealing with staff resistance, understanding the role of lectures, adequate time for preparation and support from the administrative leadership.
Hybrid PBL curricula without oversight by staff with medical education expertise can degenerate into dysfunctional curricula inferior even to the traditional approach from which PBL emerged. Such schools should inspect their curriculum periodically for signs of dysfunction to enable timely corrective action. A decision to convert fully to standard PBL is cost feasible but will require time, expertise and commitment which is only sustainable with supportive leadership.
以问题为基础的学习（PBL）是过去 40 年来医学教育中最重要的创新。与以考试为中心、以讲座为基础的传统课程相比，PBL 是一种全面的课程策略，它促进以学生为中心的学习和医生所需的技能。PBL 的迅速传播产生了许多变体。其中最常见的是“混合 PBL”，其中同时实施传统教学方法和 PBL。本文认为，将这两种对立的教育哲学混合在一起可能会破坏 PBL 并使其积极效益化为乌有。使用混合 PBL 且缺乏医学教育专业知识的学校最终可能会得到比传统方法更差的功能失调课程。
对于课程功能失调的混合 PBL 学校，标准 PBL 是一种具有成本效益的选择，可以带来 PBL 方法的好处。本文描述了功能失调的 PBL 课程的迹象，以帮助混合 PBL 学校识别课程故障。接下来，它讨论了替代课程策略和与 PBL 相关的成本。然后详细介绍了成功转换为标准 PBL 的四个关键因素：应对员工抵制、理解讲座的作用、充分的准备时间以及行政领导的支持。
没有医学教育专业知识的员工监督的混合 PBL 课程可能会退化为功能失调的课程，甚至比 PBL 所源自的传统方法还要差。这些学校应定期检查课程，以发现功能失调的迹象，以便及时采取纠正措施。完全转换为标准 PBL 的决定具有成本效益，但需要时间、专业知识和承诺，只有在得到支持性领导的情况下才能持续。
