John R. Savery
mane way to prepare students, given the explosion in medical information and new technology and the rapidly changing demands of future practice. Medical faculty at McMaster University in Canada introduced the tutorial process, not only as a specic instructional method (Barrows & Tamblyn, 1980) but also as central to their philosophy for structuring an entire curriculum promoting student-centered, multidisciplinary education, and lifelong learning in profes- sional practice. (p. 2)
Barrows (1994; 1996) recognized that the process of patient diagnosis (doctors’ work) relied on a combination of a hypothetical-deductive reasoning process and expert knowledge in multiple domains. Teaching discipline specic content (anatomy, neurol- ogy, pharmacology, psychology, etc.) separately, using a “traditional” lecture approach, did little to provide learners with a context for the content or for its clinical application. Further confounding this traditional approach was the rapidly changing knowledge base in science and medicine, which was driving changes in both theory and practice.
During the 1980s and 1990s the PBL approach was adopted in other medical schools and became an accepted instructional approach across North America and in Europe. There were some who questioned whether or not a physician trained using PBL was as well pre- pared for professional practice as a physician trained using traditional approaches. This was a fair question, and extensive research was conducted to answer it. A meta-analysis of 20 years of PBL evaluation studies was conducted by Albanese and Mitchell (1993), and also by Vernon and Blake (1993), and concluded that a problem-based approach to instruction was equal to traditional approaches in terms of conventional tests of knowledge (i.e., scores on medical board examinations), and that students who studied using PBL exhibited better clinical problem-solving skills. A smaller study of graduates of a physical therapy program that utilized PBL (Denton, Adams, Blatt, & Lorish, 2000) showed that graduates of the program performed equally well with PBL or traditional approaches but students reported a prefer- ence for the problem-centered approach. Anecdotal reports from PBL practitioners suggest that students are more engaged in learning the expected content (Torp & Sage, 2002).
However, a recent report on a systematic review and meta-analysis on the eec- tiveness of PBL used in higher education programs for health professionals (Newman, 2003) stated that “existing overviews of the eld do not provide high quality evidence with which to provide robust answers to questions about the eectiveness of PBL” (p. 5). Specically this analysis of research studies attempted to compare PBL with traditional approaches to discover if PBL increased performance in adapting to and participating in change; dealing with problems and making reasoned decisions in unfamiliar situations; reasoning critically and creatively; adopting a more universal or holistic approach; practic- ing empathy, appreciating the other person’s point of view; collaborating productively in groups or teams; and identifying one’s own strengths and weaknesses and undertaking