Perceptions versus the reality

November 7, 1997

THE IMAGES of problem-based medical curricula given in the editorial and in Liz Frayn's "Personal View" (THES, October 24) would seem to bear little, if any, relation to the reality of such curricula.

This year I have observed problem-based tutorial groups in operation in three medical faculties in Britain (including Ms Frayn's alma mater) and one in Australia; I also have had some discussion with students and staff at these universities and at one in Sweden.

In none did I find anything remotely resembling the "touchy-feely project groups" alluded to in your editorial. I would be most interested to know where I could find problem-based medical courses that did employ problem-based tutorials of this kind.

The students I met were deeply engrossed in acquiring the knowledge, skill, and attitudes needed in medical practice. Their problem-based curricula, designed to prepare excellent medical practitioners, were rigorously and systematically planned. One student, with two years experience of a traditional medical curriculum, had switched to a problem-based curriculum; she found the problem-based curriculum clearly superior.

It would be interesting, however, to see whether traditional curricula could match the quality of design in problem-based curricula - and of teaching.

While I share Ms Frayn's unease about the term "facilitation", it can be useful in marking the profound difference between teaching and didactic teaching. What is any university teacher doing if not facilitating learning by students? The real question is how best to do this. Ms Frayn assumes that didactic performance is the answer.

The assumption is extremely doubtful, as numerous reviews of traditional medical education in several countries going back at least to Flexner's (1910) Medical Education in the United States and Canada: A Report for the Carnegie Foundation for the Advancement of Teaching have shown. In any case, excellent teachers of the kind Ms Frayn rightly praises can shine equally in what is perhaps the best kind of teaching, namely, facilitating learning by students in a problem-based tutorial.

I also share her concern that science and research be given due attention in medical education. But, again, what is the best way of doing this? Problem-based learning would appear to be an excellent preparation, not only for medical practice but also for research. It is explicitly designed to foster rigorous, critical, imaginative, evidence-based thought - just the kinds of qualities so important in research as well as in practice.

The problem-based curriculum is not about denying the importance of science and research; it is about integrating them more effectively in the preparation of excellent future practitioners. And it does so because science and research are relevant to medical practice, Ms Frayn's disparagement of "relevance" notwithstanding.

Science and research are, however, very far from being all there is to caring well for patients.

Don Margetson Faculty of education Griffith University Brisbane, Australia

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