Psychiatry benefits from problem-based learning

Skokauskas (Psychiatr Bull 2009; 33: 117) restates several arguments against the use of problem-based learning in undergraduate medical education. We feel, as current problem-based learning tutors who were ourselves students on a problem-based learning course, that we can offer a more positive view.

The author seems to imply that problem-based learning cases replace the clinical experiences that have traditionally shaped students’ learning. In our experience, cases (often meticulously refined over several years) act to support and guide clinical learning, as they can bring to the fore ideas and issues that may rarely be apparent to students on clinical placements.

Skokauskas suggests that problem-based learning courses are inefficient, since traditional curricula may cover more material over the same time. But of course including a subject in the curriculum does not guarantee that it will be understood and retained by students; in fact, Dochy et al ¹ in their systematic review find evidence that problem-based learning students retain their knowledge more effectively.

We were puzzled by Skokauskas’ assertion that problem-based learning ‘assumes that students already are good problem-solvers’; in the courses we have experienced, problem solving is explicitly modelled as a skill to be developed by students. Certainly, the good group working skills needed for most working doctors cannot develop in a traditional lecture setting. Problem-based learning offers the opportunity to work in groups early and for individuals less ‘keen’ or ‘capable’ to identify their difficulties and reflect on them.

Last, Skokauskas worries that problem-based learning students may be deprived of access ‘to a particularly inspirational or charismatic professor’; this risk, we think, is mitigated by the fact that typical problem-based learning courses entail a three- or fourfold increase in hours-per-student of faculty contact. ²

A recent systematic review of the effect of problem-based learning undergraduate courses on postgraduate competence suggests that problem-based learning trained doctors have stronger competencies in domains including coping with uncertainty, legal and ethical aspects of healthcare, communication skills, and self-directed continuing learning. ³ These domains would seem to be of particular relevance to psychiatric practice, and we would encourage psychiatrists to get involved in the design and delivery of problem-based learning.