Journal of Postgraduate Medicine
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Year : 2009  |  Volume : 55  |  Issue : 3  |  Page : 198-203

Patient-based not problem-based learning: An Oslerian approach to clinical skills, looking back to move forward

Department of Exercise and Sports Medicine, Centre for Health, Faculty of Medicine and Dentistry, University of Melbourne, Australia

Correspondence Address:
A D Franklyn-Miller
Department of Exercise and Sports Medicine, Centre for Health, Faculty of Medicine and Dentistry, University of Melbourne
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0022-3859.57404

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Context : There have been significant changes in the past decade in both the curriculum and its delivery, in undergraduate medical education. Many of these changes have been made simultaneously, preventing clear assessment of outcome measures. The move away from a pre-clinical science grounding, to an integrated 'problem-based learning (PBL) approach' has been widespread in many countries across the world. Purpose : One effect of these changes has been the way in which clinical skills, in particular history and examination are taught. By integrating clinical scenarios earlier in the undergraduate course, clinical skills are increasingly taught in tutorials. This approach, when used in the pre-clinical setting may have shortcomings in the development of the ability to construct a differential diagnosis. There has been little evidence that PBL improves problem-solving ability and this is critical to the differential diagnostic process. The concurrent decline in anatomical teaching and understanding contributes to this difficulty. Discussion : The authors outline a model which clinicians can re-emphasize to students and juniors based on the fundamentals of clinical practice. The apprenticeship is more important than ever in the days of small group learning. The relinquishing of the traditional model of undergraduate medicine is of concern. The effects of educational reform should be examined by further research into the competencies of graduates entering higher professional training, before it is accepted that this change has been for the better.


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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow