Canadian Medical Education Journal

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Canadian Medical Education Journal 2011, 2(1)

Canadian Medical Education Journal


Brief Report

Student Perception of the Integrated PBL MBCHB-III


Program Curriculum in a Medical University
Mirta Garcia-Jardon,1 Vivek G Bhat,2 Ernesto Blanco-Blanco1 and Enoch Kwizera1
1Walter

Sisulu University, South Africa and 2ACTREC, Mumbai, India2

Published: 31 March, 2011


CMEJ 2011, 2(1):e28-e31

Available at http://www.cmej.ca

2011 Garcia-Jardon, Bhat, Blanco Blanco and Kwizera; licensee Synergies Partners

This is an Open Journal Systems article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/2.0) which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited.

Abstract

Background: Integrated problem-based learning (PBL) is now an accepted method of teaching the medical
curriculum. The objective of this study was to determine perceptions of PBL from third year students in the MBChB
(Bachelor of Medicine and Bachelor of Surgery/Chirurgery) program at Walter Sisulu University, South Africa.
Methods: Year three students in the MBChB program at Walter Sisulu University were administered a
questionnaire. The 11-item questionnaire measured students perceptions of the integrated PBL curriculum.
Questions addressed course content, objectives, and application, as well as impact on learner stress.
Results: More than half of the students reported that the curriculum enhanced analytical skills, and was reasoning
and learning centered. Almost 70% of the students thought that the desired goals and objectives were clearly
defined and about 90% stated that they could recognize discipline interrelations. While 61.7% of students reported
that the curriculum facilitated active learning opportunities, more than 70% stated that it increased the workload
and stress levels. About half of the students expressed overall satisfaction with the level of content integration.
Conclusion: Students generally presented favorable perceptions of the integrated MBChB-III PBL curriculum. There
were concerns about the associated heavy workload and stress. Student counseling with respect to time and stress
management coupled with improvements in curriculum design would be helpful in addressing this issue.

Correspondence: Dr Vivek G Bhat, Dept. of Medical Microbiology, Advanced Center for Treatment, Research and
Education in Cancer (ACTREC), Kharghar, Navi Mumbai-410210, India. E-mail: vivekbhat2005@yahoo.com

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Canadian Medical Education Journal 2011, 2(1)

Introduction

Methods

Problem based learning (PBL) is now a widely accepted


method of education adopted by many medical
1
universities around the world. PBL facilitates an
integrated core curriculum encouraging students
towards independent, self-directed study, which
enables them to learn to apply underlying scientific
2
knowledge and principles in clinical practice. The
Walter Sisulu University adopts an integrated PBL
approach towards the MBChB (Bachelor of Medicine
and Bachelor of Surgery/Chirurgery year 3 course.
Integration is both horizontal and vertical. In the
former, various disciplines are taught in the same phase
(year/semester). These courses include the basic
sciences in the early years, followed by clinical subjects
in the later years of the course. The vertical integration
facilitates bridging of the basic with the clinical
sciences, thereby introducing the students to clinical
aspects in the initial years. This approach is intended to
promote integration of basic science concepts and facts
with their clinical relevance. However, the integration of
disciplines in the medical curriculum is not without its
setbacks. Horizontal and vertical integration may
sometimes be sub-optimal3, not only because of the
complexity of the exercise per se but also because of
other factors like shortage or underutilization of staff
and resources, and the challenging task of coordinating
the program.

A questionnaire was administered to 88 student


volunteers out of a total 96 students, thereby
representing 91.6% of those who had enrolled for the
MBChB year 3 course at the Walter Sisulu University.
Items
addressed
the
objectives,
content,
implementation and outcomes of the PBL program (see
Figure 1). Responses were indicated on a scale of 1 to 5
(1 = strongly disagree, 2 = disagree, 3 = neutral, 4 =
agree, 5 = strongly agree). Student names were not
disclosed and all information was made available only to
members of the research team.

Effectiveness of course programs and curricula need to


be determined on a regular basis. The most important
evidence of quality and effectiveness is performance;
and in educational programs, this is reflected in the
4
achievement of optimal student learning outcomes.
This, in turn, is strongly influenced by students learning
5
approach. Some studies have examined different
aspects of students perception relating to motivating
factors, effectiveness of faculty-led versus student led
tutorials, enhancement and flexibility of learning and
6-9
practical relevance of the PBL education system.
Others have focused on students perceptions of
10
integrated curricula within the PBL context. The
integrated medical PBL curriculum, albeit a promising
innovation, warrants further studies to better
understand and define its effectiveness. The objective
of this study was to determine MBChB-III students
perceptions of the integrated PBL curriculum.

Results
The percentage of students who endorsed each
question is shown in Figure 1. Responses of strongly
agreed and agreed were categorized as agreed; and
responses of strongly disagreed and disagreed were
grouped together as disagreed.

Discussion
This study determined that students at Walter Sisulu
University MBChB-III consider the PBL program an
innovative and useful model for learning in medicine.
Integrated curricula have been defined or described in
various ways; most of these include aspects like
combination of subjects, relationships among concepts,
sources that extend learning beyond textbooks like
journals and the internet, emphasis on projects, and
2
flexible student schedules. The intended goal of PBL in
the MBChB course is to produce a well trained, qualified
medical professional who can render health services in
real life situations. For this, the course content must
foster a healthy development of concerned skills and
competencies. In our study we found that most
students considered the curriculum useful in several
areas. They reported that it improved their analytical
skills, addressed reasoning and problem solving, and
encouraged initiative in their learning. We believe we
achieved these outcomes by conceptualizing and
designing our case simulations to challenge students
with real life situations, followed by the presentation of
facts and clues that encourage them to think logically,
formulate new hypotheses, ideas and concepts and
consider logical conclusions. Indeed, students stated
that they needed to logically consider the information in
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Canadian Medical Education Journal 2011, 2(1)


the cases and felt encouraged to seek library resources.
Most students in our study agreed that the course
content did not promote memorization or reproduction
of content. The results from our study also showed that
students were not only happy with the integrated
discussion based tutorials, but also appreciated the
supplementation of the tutorials with practical
demonstrations and didactic resource lectures.
Although many of our students were satisfied with the
clarity of the desired goals and objectives, some
reported that they needed to be defined more clearly.
Students
perceptions
about
multidisciplinary
integration generally tended to coincide with their
intended objectives, and most of them thought that the
cases were designed to encourage them to relate the
concerned topics across disciplines.
A majority of our students also were of the view that
the integrated PBL curriculum facilitated active and
interactive learning, which also helped students
improve their communication skills and develop self
confidence. Another important aspect of an effective
medical PBL curriculum would be the advantage it
provides in developing generic skills and attitudes in the
students desirable in their future practice.11
Despite the positive results of the study, almost three
quarters reported that the course levied an increased
workload, thereby increasing levels of stress. Curriculum
designers must take this point into consideration when
designing the curriculum, and students may need to
learn stress reduction strategies to manage the
program. Finally, although many of the students were
satisfied with the level of content integration, a need for
more strategic integration was identified by some
students.
Curriculum integration is a time consuming process
because teachers need to select learning themes based
on the syllabus while keeping student learning styles
and needs in mind; in addition to exploring resources,
and coordinating teaching schedules and assessments
across disciplines.11 During the process of designing the
curriculum, the faculty tries to balance various issues
that go towards formulating an effective curriculum,
and at the same time not making it too taxing for
students. While this study shed some light on students
perceptions on the integrated PBL medical course

curriculum of our university, which is generally


favorable, it gives us an opportunity to address relevant
concerns of students in our constant endeavor to
improve upon our teaching and assessment tools for
the MBChB-III program.

Conclusions and Recommendations


Students generally presented favorable perceptions of
our integrated PBL curriculum although some concerns
were raised about the associated heavy workload and
stress, and the need for defining the goals and
objectives more clearly. Recommendations include
instituting remedial measures in this respect with our
ongoing efforts to improve upon case and resource
development, curriculum design and counseling
students about stress management. Also, the faculty
could review the curriculum content, assessment
strategies and the timetable to provide better time
management for the students.

Acknowledgement
The authors would like to thank the Faculty of Health
Sciences, Walter Sisulu University and the medical
students who volunteered to participate in the study.

References
1. Bligh J. Problem-based, small group learning. BMJ.
1995;311:342-343.

2. Wood DF. ABC of learning and teaching in medicine:


Problem based learning. BMJ. 2003;326:328-330.

3. Abdul-Ghaffar TA, Lukowiak K, Nayar U. Challenges of


teaching physiology in a PBL school. Am J Physiol. 1999
Dec;S140-147.

4. Schray V. Assuring Quality in Higher Education: Key issues


and questions for changing accreditation in the United
States. Available at
www.ed.gov/about/bdscomm/list/hiedfuture/reports/sch
ray.pdf

5. Chin C, Brown DE. Learning in science: A comparison of


deep and surface approaches, J Research in Science
Teaching. 2000;37(2):109-138.

6.

Kassab S, Abu-Hijleh M, Al-Shboul Q, Hamdy H. Studentled tutorials in problem based learning: Educational
outcomes and students perceptions. Med. Teacher.
2005;27:521526.

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Canadian Medical Education Journal 2011, 2(1)


7.

Chikotas NE. Problem-based learning and clinical


practice: The nurse practitioners' perspective. Nurse Educ
Pract. 2009 Nov;9(6):393-397.

8.

Bengtsson M, Ohlsson B. The nursing and medical


students motivation to attain knowledge. Nurse Educ
Today. 2010 Feb;30(2):150-156.

9.

Segers M, Martens R, Van den Bossche P. Understanding


how a case-based assessment instrument influences
student teachers learning approaches. Teaching and
Teacher Educ. 2008;24:17511764.

coursework: A pilot investigation. Mountain Rise, the


Intern J. of 9th Scholarship of Teaching and Learning
2007;4(1). Available at
http://www.wcu.edu/facctr/mountainrise/archive/vol4n
o1/issue.html

11. Lake K. Integrated curriculum. School Improvement


Research Series (SIRS). North West Regional Educ Lab.
Available at
http://www.curriculumassociates.com/professionaldevelopment/topics/IntegratedCurriculum/extras/lesson1/Reading-Lesson1.pdf

10. Shelden DL, OBrian M, Appel KS. Student Perceptions of


the integration of early clinical experiences and

Figure 1. Students perception of the PBL program

Figure 1:Students perception of the PBL program


100
90
80

Percentage

70
60
50

agree

40

neutral

30

disagree

20
10
0

Enhanced
analytical
skills

Reasoning & Encouraged


learning
to reflect on
centred
my learning

Clear goals Exam matched Encouraged


and
goals and
me to relate
objectives
objectives
disciplines

Helped me
Facilitated Increased my
Showed
Overall
recognize active learning stress load
future
satisfaction
discipline opportunities
relevance of with the level
interrelations
what was
of content
learnt
integration

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