gms | German Medical Science

Objective: Introducing problem-based-learning (PBL) into an existing curriculum, or setting up a PBL-centred curriculum may result in shortage of academic staff with PBL-experience having to teach. Which combination of backgrounds and skills is most favourable for facilitating PBL sessions in a medical curriculum is still under debate. Traditionally, PBL is facilitated by physicians or scientists. However, not all of them have first-hand experience of the format. This may make it difficult to for them to develop process expertise and cognitive congruence with their students, and recognize ’the right moment’ to intervene. On the other hand, students who are enrolled in a PBL-centred curriculum have developed this experience but may lack content expertise related to the cases, an expertise that can best be developed in real-world clinical scenarios. Since the first year is the most formative for students, we set out to study students’ preferences regarding PBL-facilitation during the first year of medical school, and to test if personal experience of students can be transformed into expertise in leading groups.

Methods: We compared student-led and physician-led PBL-groups in a randomized cross-over design. During the first year of medical school, half of the groups were facilitated by a student tutor from a higher year, the other half by a physician who did not study in a PBL-centred curriculum. After one semester, groups were switched. We compared student satisfaction and academic outcome between groups and conducted guideline-based focus-group-interviews with the first year-students to explore experiences and preferences. Interviews lasted 60 minutes, were audio-taped, transcribed verbatim and analysis using grounded-theory methods.

Results: Students in the two groups were comparable in age, gender, results on A-Level exams and regarding prior experience working in paramedical professions. Student-facilitated PBL-groups were non-inferior to physician-lead groups regarding satisfaction measured during evaluation or academic outcome in end-of semester exams. 36 first-year-students (75% of the cohort) participated in the focus-groups. Student-tutors were seen as having adequate content expertise, being more conductive to creating a hierarchy-free learning atmosphere, give better orientation of current learning objectives within the longitudinal curriculum and to achieve earlier autonomy with regards to PBL-methodology with their groups.

Discussion: We found student-tutors to be non-inferior regarding satisfaction and academic outcome of their groups. Their personal experience helped them achieve cognitive congruence with the students, which is a key factor for satisfaction of students with their group leaders. Tutors were able to deliver significant additional benefits for organizing learning and integration of PBL in the curriculum.

Take home message: Students who have personal experience with PBL are non-inferior to physicians without personal PBL-erxperience, but come with additinal benefits for first-year students.