Document Type : Original Article

Authors

1 School of Medicine, Tehran University of Medical Sciences, International Campus, Tehran, Iran

2 Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

3 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

4 Research Center for Health Management in Mass Gathering, Red Crescent Society of Islamic Republic of Iran, Tehran, Iran

5 Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

6 School of Medicine, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran

Abstract

BACKGROUND: This study was designed to assess the clinical judgment of medical students in
surgery clinical decision‑making by a standard examination after lecture‑based learning (LBL) or
problem‑based learning (PBL).
MATERIALS AND METHODS: A prospective randomized trial study on 175 medical students
whom were randomly allocated to three groups was performed during November 2017 and January
2018. LBL group (n = 103), PBL group led by an attending (n = 39), and PBL group (n = 33) led by
an intern. Chi‑squared test and independent student t‑test were used to compare between the two
groups. All the analyses were performed by the two‑sided method using the Statistical Package for
the Social Sciences software (SPSS version 22; SPSS, Inc., Chicago, IL, USA), and a P < 0.05 set
as statistically significant.
RESULTS: The students in the PBL group scored significantly higher on the posttraining multiple‑choice
examination, compared to the LBL group (P = 0.048). However, there was no significant difference
between the PBL group led by an attending and the PBL group led by an intern (P = 0.892).
CONCLUSION: We concluded that PBL remarkably increased the students’ scores in the
problem‑solving examination, as compared to the conventional method. We found no significant
differences in PBL facilitated by an attending or an intern.

Keywords

1. Tayyeb R. Effectiveness of problem based learning as an
instructional tool for acquisition of content knowledge and
promotion of critical thinking among medical students. J Coll
Physicians Surg Pak 2013;23:42‑6.
2. Sahu PK, Nayak S, Rodrigues V. Medical students’ perceptions of
small group teaching effectiveness in hybrid curriculum. J Educ
Health Promot 2018;7:30.
3. Albanese MA, Mitchell S. Problem‑based learning: A review of
literature on its outcomes and implementation issues. Acad Med
1993;68:52‑81.
4. Kolahdouzan M, Mahmoudieh M, Rasti M, Omid A, Rostami A,
Yamani N. The effect of case‑based teaching and flipped classroom
methods in comparison with lecture method on learning and
satisfaction of internship students in surgery. J Educ Health
Promot 2020;9:256.
5. Savery J. Overview of problem‑based learning: Definitions and
distinctions. Interdiscip J Problem Based Learn 2006;1:5‑15.
6. Neville AJ. Problem‑based learning and medical education forty years on. A review of its effects on knowledge and clinical
performance. Med Princ Pract 2009;18:1‑9.
7. Al‑Azri H, Ratnapalan S. Problem‑based learning in continuing
medical education: Review of randomized controlled trials. Can
Fam Physician 2014;60:157‑65.
8. Dolmans DH, Schmidt HG. What do we know about cognitive
and motivational effects of small group tutorials in problem‑based
learning? Adv Health Sci Educ Theory Pract 2006;11:321‑36.
9. Athari ZS, Sharif SM, Nasr AR, Nematbakhsh M. Assessing critical
thinking in medical sciences students in two sequential semesters:
Does it improve? J Educ Health Promot 2013;2:5.
10. McLean M. What can we learn from facilitator and student
perceptions of facilitation skills and roles in the first year of a
problem‑based learning curriculum? BMC Med Educ 2003;3:9.
11. Schwartzstein RM, Roberts DH. Saying goodbye to lectures in
medical school‑Paradigm shift or passing fad? N Engl J Med
2017;377:605‑7.
12. Barrows HS. Problem‑based, self‑directed learning. JAMA
1983;250:3077‑80.
13. Bligh J. Problem‑based learning in medicine: An introduction.
Postgrad Med J 1995;71:323‑6.
14. Servant‑Miklos VF. Fifty years on: A retrospective on the world’s
first problem‑based learning programme at McMaster University
Medical School. Health Prof Educ 2019;5:3‑12.
15. Kandi V, Basireddy PR. Creating a student‑centered learning
environment: Implementation of problem‑based learning to
teach microbiology to undergraduate medical students. Cureus
2018;10:e2029.
16. Yiou R, Goodenough D. Applying problem‑based learning to the
teaching of anatomy: The example of Harvard Medical School.
Surg Radiol Anat 2006;28:189‑94.
17. Wyness L, Dalton F. The value of problem‑based learning in
learning for sustainability: Undergraduate accounting student
perspectives. J Account Educ 2018;45:1‑19.
18. Norman G. Problem‑based learning makes a difference. But why?
CMAJ 2008;178:61‑2.
19. Mumtaz S, Latif R. Learning through debate during problem‑based
learning: An active learning strategy. Adv Physiol Educ
2017;41:390‑4.
20. Karimi N, Saadat‑Gharin S, Tol A, Sadeghi R, Yaseri M,
Mohebbi B. A problem‑based learning health literacy intervention
program on improving health‑promoting behaviors among girl
students. J Educ Health Promot 2019;8:251.