Proceedings: 7th Asian- Pacific Conference on PBL, 2008
PBL in Health Professions Education,
Why and why not:
FAIMER Fellows' Perspective
Wagdy Talaat, MD, Ph.D.; Stewart Mennin, Ph.D.; Si Mui Sim, Ph.D.; Yucel Gursel MD, Ph.D.; Naranchimeg
Sodovsuren MD, Ph.D.; Kofo Soyebi, MD, FWA,CS,FMCI; & Elena Barragnan, MD, Ph.D.
Abstract
A group of 2006 and 2007 International FAIMER (Foundation for Advancement of Medical Education
and Research) Fellows explored online issues related to the adoption of PBL in their institutions. The
theme of web discussion was focused on two questions: 1) If you are using PBL at your school, what are
the challenges and issues you and your colleagues faced as you implemented and continued to use PBL? (2)
If you are not using PBL at your school, or are contemplating using it and have not yet implemented it,
what are the issues and concerns of teachers about PBL that made it not possible at this time to be used?
About thirty percent of the fellows (n=43) responded to the first question and 69.7% responded to the
second question. Analysis of the responses revealed issues of cost, faculty development and resources are
major impediments to adoption of PBL. The attraction of more students-centered, self-directed learning
was common. Different strategies for implementing PBL among the respondents were also common.
Key words: Education, medical, Problem-Based Learning, curriculum strategy, FAIMER.
Correspondence: Wagdy Talaat, MD, PhD. Department of Medical Education, Faculty of Medicine,
University of Suez Canal, Ismailia 41111, Egypt. E-mail: watalaat@gmail.com
Introduction
The Foundation for Advancement of
International Medical Education and Research
(FAIMER) is a non-profit foundation committed
to improving world health through education. It
was established in 2000 by the Educational
Commission for Foreign Medical Graduates
(ECFMG®). In partnership with ECFMG,
FAIMER promotes excellence in international
health
professions
education
through
programmatic and research activities. FAIMER's
fellowship programs are targeted to international
health professions education faculty who have
the potential to play key roles in improving
education in their schools. These programs
develop skills that allow participants to serve as
resources for their colleagues, institutions, local
communities, and global regions. The programs
emphasize education methods, education
leadership and management, and development of
a community of educators. Participants focus on
education innovation projects of their choosing
that are supported by their home institutions1. An
integral part of distance learning program at
FAIMER is to be involved in Mentoring and
Learning Web discussions (ML Web) on monthly
basis. On January 2008, the theme of the ML
1
Web discussion was Problem-Based Learning
(PBL) in Health Professions Education: what,
why, and how. Two questions formed the basis
of the discussion. (1) If you are using PBL at your
school, what are the challenges and issues you
and your colleagues faced as you implemented
and continued to use PBL? (2) If you are not
using PBL at your school, or are contemplating
using it and have not yet implemented it, what are
the issues and concerns of teachers about PBL
that made it not possible at this time to be used?
Methods
This study was carried out on 43 International
FAIMER fellows from classes of 2007 and 2006
that represent 15 countries in Africa, Asia, and
Latin America and FAIMER international faculty.
Data were collected from the fellows through ML
Web discussions over one month that started
December 25th, 2007 and ended January 25th,
2008. To prepare for the discussion and
extraction of results, a couple of relevant articles
were posted at the beginning for awareness and
terminology definition. Upon slowing down of
discussion more provocative questions were
asked to keep the heat up and extraction of more
in depth information. All participants were
encouraged to participate either by inquiring or
answering peer inquires. The discussion leaders
were following the online discussion on daily
basis and were commenting on each point then
provided a final summary by the end of the
whole discussion.
Results
During this PBL ML Web discussion, 138
responses were received from 43 FAIMER
fellows and faculty with an average of
3.2/participant. Most of the participants reported
that they enjoyed the discussions and benefited
from the depth of information provided. Some
fellows indicated that they were more encouraged
to try PBL.
Out of the ML Web discussion, the list of topics,
in the order of interest was:

Costs of PBL and its required resources.

Concepts and rationale of PBL.

Pre-requisites for adopting PBL.

Background of students before admission to
PBL schools.

Different ways of implementing PBL.

Advantages and disadvantages of PBL.

Evaluation of students and faculty in PBL.

Comparison between graduates of PBL
versus graduates of traditional curricula.
Most of these topics will be discussed in
relevance to the main research questions that
have been addressed at the beginning of this
article.
Why we did not adopt PBL?
Thirty fellows who constituted the majority
of respondents (69.7%) reported different
reasons for not adopting PBL as an
educational strategy in their institutions. The
following points were frequently addressed
during the web discussion and listed below
according to the order of frequency:
 PBL is costly and resource demanding in
terms of finance, large number of
classrooms for small group tutorials,
human resources working as curriculum
designers, block planners, problem/case
designers, coordinators, class tutors, and
seminars moderators (80%).
 Large number of students compared to
number of faculty (66.6%).
 Lack of competent trainers both at the
local and national levels (66.6%).
 Lack of sufficiently persuasive evidence
regarding difference in educational
outcomes studied (60.0%).
2





Power struggle between change advocates
and resistant faculty who deny the need
for change and are reluctant to move out
of their comfort zone (60.0%).
Lack of maturity of entry students with
diverse backgrounds to be able to handle
their own learning (40.0%).
Lack of political will to depart from the
traditional discipline-based form of
teaching/learning (33.3%).
Lack of motivation of the staff to develop
the intellectual materials required (cases,
etc.) (26.6%).
"We followed the British Curriculum,
when there was no PBL" (a comment by
Indian and Pakistani fellows) (10.0%).
Why we adopted and implemented PBL?
Those fellows whose institutions adopted PBL,
either partially or fully constituted a minority
among the respondents (30.3%). The reasons
given why PBL was adopted were:










It promotes active and self-directed
learning (100%).
It emphasizes peer learning (100%).
Students learn to articulate their
knowledge well and are confident and
professionally fluent (100%).
It focuses on acquiring competencies
rather than the mere recall of knowledge
(100%).
It gives students direct responsibility for
their own learning (76.9%).
It reverts medical education to the natural
whole by integrating the medical sciences
away from the artificial separation
(76.9%).
It encourages students to practice critical
thinking and clinical reasoning (76.9%).
It makes the learning process more fun
(53.8%).
It brings relevance to medical education
(53.8%).
Students are better able to engage in a
clinical conversation by the time they get
to the clinical clerkship years (30.7%).


It produces competent doctors with a
holistic approach to the practice of
medicine (30.7%).
In response to the current fashion in
innovation (one response).
How we implemented PBL?
As an educational strategy, PBL was implemented
by the FAIMER fellows in their own institutes as
in the following formats:
- PBL concepts were implemented in the
pre-clinical phase and considered clinical
training to be problem-based by its very
nature (15.3%).
- A Hybrid PBL strategy was adopted in
the pre-clinical years (30.7%).
- A pure PBL strategy was adopted in the
pre-clinical phase (15.3%).
- A pure and full PBL strategy was
implemented across the whole curriculum
(23.0%).
- A pure and full PBL strategy was
implemented in conjunction with another
innovative strategy: Community-Based
Education across the whole curriculum
(15.3%).
Discussion
Issues of cost and resources dominated the
discussion of why PBL was not adopted at
fellows’ institutions. Issues of cost often
focus around the absolute amount of
resources available and it is rare to find
discussions or literature examining the
question of how existing resources could be
redistributed to support innovations such as
PBL. There remain some questions about
this in the literature2, 3 although there are only
three studies with data that show that up to a
class size of 100 students, the human,
physical, technical, and financial resources are
different but not necessarily more costly4, 5, 6.
Reasons for the different perspectives in the
literature remain to be clarified.
The discussion about sufficiently prepared
teachers to support a PBL curriculum
addresses a critical issue.
Faculty
development in most medical schools in the
3
world is not well supported or attended.
What is required in PBL are teachers with
skills and knowledge in facilitating smallgroup, self-directed learning. This requires an
initial investment of time and energy and
many institutions are either unprepared to
make such an investment or lack the skilled
personnel to undertake it.
The principal
reasons given for adopting PBL center are
the increase in relevance, activation and
stimulation of student learning. The
limitations with this study include the fact
that we did not collect data on when the PBL
programs were implemented or considered
and what was going on at the institutions and
in the regions that might have influenced
their decisions. This would be of interest to
follow up. It seems that the implementation
of pure PBL programs and parallel tracks that
marked the early years of PBL is not being
sustained in the institutions represented by
the Fellows in this study. Many assume this
approach to learning is extensively time
consuming and too expensive compared to
the traditional forms of medical education4.
An interesting result that was driven from the
discussion about the adopted strategies for
implementing PBL was the prevalence of
hybrid curricula among PBL medical schools.
On depth discussions about this point
revealed different styles of implementing
hybrid PBL. It seems that the term "hybrid"
in PBL means different things to different
people. As long as it seems to become more
popular compared to "pure" PBL, it is about
time to work on some definitions and
processes that limit the vagueness of such
strategy and possible misconceptions.
Another interesting argument about why PBL
was not adopted that says "We followed the
British Curriculum, when there was no PBL".
During the discussion, the point was made
that the British themselves have reformed
their curriculum introducing innovation,
integration, and problem-oriented learning.
Many reasons had been given to explain why
PBL was addressed. Most of these reasons
were acknowledged by researchers except a
few like the one that says “Produces more
competent doctors with a holistic approach
to the practice of medicine”. This point, like
many others, is disputed in the literature7, 8, 9,
10
.
Areas for future research

The literature on the cost of PBL
compared to that of traditional
approaches is derived from studies at
North
American,
European
and
Australian institutions. To what extent is
this true in other regions of the world?
What are the pros and cons and feasibility
of implementation of PBL, in the preclinical compared to the clinical phase?
 What are the most suitable student
assessment methods for PBL and how
can they be best integrated with other
assessment methods?
 To what extent is it possible to link
curriculum innovations and outcome
studies on physician competence and
capability?
Such areas and many others still raise a lot
unanswered questions that need further
investigations.
Acknowledgement
The authors acknowledge the support of the
FAIMER Institute for the Fellows and ML Web.
References
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Emergence of problem-based learning in
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