650

ORIGINAL ARTICLE
Problem-based learning in comparison with lecture-based learning among
medical students
Rizwan Faisal,1 Khalil-ur-Rehman,2 Sher Bahadur,3 Laiyla Shinwari4

Abstract
Objective: To compare performance of medical students exposed to problem-based learning and lecture-based
learning.
Methods: The descriptive study was conducted at Rehman Medical College, Peshawar, Pakistan from May 20 to
September 20, 2014, and comprised 146 students of 3rd year MBBS who were randomised into two equal groups.
One group was taught by the traditional lecture based learning, while problem-based learning was conducted for
the other group on the same topic. At the end of sessions, the performance of the two groups was evaluated by one-
best type of 50 multiple choice questions. Total marks were 100, with each question carrying 2 marks. SPSS 15 was
used for statistical analysis.
Results: There were 146 students who were divided into two equal groups of 73(50%) each. The mean score in the
group exposed to problem-based learning was 3.2 ± 0.8 while those attending lecture-based learning was 2.7±0.8
(p= 0.0001).
Conclusion: Problem-based learning was more effective than lecture based learning in the academic performance
of medical students.
Keywords: Education, Problem-based learning, Lecture-based learning, Multiple choice questions, Evaluation,
Academic performance. (JPMA 66: 650; 2016)

Introduction PBL is an innovative and challenging approach to medical

Education has long focused on teaching students to give education; innovative because it is a new way of using
a correct answer. Too often the teachers ask students to learning material to help students learn, and challenging
recite, define, describe or list facts. They are less frequently because it requires the teacher to use facilitating and
asked to analyse, infer, synthesize, evaluate, think and supporting skills rather than didactic, directive ones.8,9 For
rethink. Students have become familiar with this process the student, PBL emphasises the application of
of passing knowledge, without inquiring into how this knowledge and skills to the solution of problems rather
information applies to the real world.1 than the recall of facts. It is an approach much favoured by
curriculum planners in new and more progressive
Problem-based learning (PBL) was first implemented at academic institutes.5
McMaster University Medical School in the 1960s by
Barrows and Tamblyn, and has since revolutionised the LBL was first implemented by the American Medical
field of medical education. The system was later adopted College Association and American Academy of Medicine
by Europe, the United States and the rest of the world.2-4 in 1894 and has been used by the majority of medical and
Apart from medicine, PBL can now be found in many other schools.10It traditionally consists of didactic
teaching settings, including architecture, nursing, lectures.11 LBL has been at the core of medical education
engineering and social work.5 in most of the medical colleges.12

PBL is an educational method focused on self-directed LBL focuses on factual knowledge and memorisation,
learning,6 small groups discussion with facilitators and providing little chance for application of knowledge
working through problems to acquire knowledge.7 PBL is acquired from basic science to the working situation.13
a student-centred pedagogy which can provide learners There are many other advantages of PBL over LBL,
more opportunities for application of knowledge including flexible knowledge, improved communication,
acquired from basic science to the working situations collaborative skills and self-directed learning skills, and a
than traditional lecture-based learning (LBL) method.4 more enjoyable and motivational format.4
A study carried out among 1st year students at Nelson
1-3Rehman Medical College, 4Lady Reading Hospital, Peshawar, Pakistan. Mandela School of Medicine showed that a majority of
Correspondence: Rizwan Faisal. drrizwanfaisal@hotmail.com students benefited from input of other students in PBL

Vol. 66, No. 6, June 2016

651 R. Faisal, K. Rehman, S. Bahadur, et al

tutorials as they were conducted in small groups. On the percentage were determined for further grading.
contrary, a study from Kuwait University revealed that Student's t-test was applied to see the significant
introduction of new teaching methodologies may evoke difference in performance among the two groups P<0.05
certain factors that lead students to develop adverse was considered significant.
perception of their educational environment. Another
study showed that knowledge and power of Results
interpretation was quite improved among students on The 146 students were divided into two equal groups of
reaching the 3rd year, but their interest in the process of 73(50%) each.
PBL conduction was lost and they developed short cuts to The mean score of PBL group was 3.2±0.8, while it was
solve problems.14 2.7±0.8 for the LBL group (p=0.0001) (Figure).
The uncertainty about the effectiveness of PBL and the Further comparison showed that 3(2.1%) students of PBL
heterogeneity in the published literatures provided the and 1(0.7%) of LBL scored between 90-100% marks;
drive for this study. Moreover, very limited work has been 22(15.1%) of PBL and 10(6.8%) of LBL between 80-89%
done in this regard in our country. The current study was marks, while none of them scored between 70-79%.
planned to compare the effectiveness of PBL and LBL by Besides, 39 (26.7%) of PBL and 36 (24.7%) of LBL group -
evaluation of the academic performance of the medical fell into 60-69%, while range. Nine (6.2%) students of PBL
students in order to design the curricula with much and 26 (17.8%) of the LBL group were scored in the range
benefited mode of learning. of 50-59% marks. No student was found below 50%
Subjects and Methods marks (Table).
The descriptive study was conducted at Rehman Medical
Table: Comparison of the academic performance of the students in PBL & LBL.
College (RMC), Peshawar, Pakistan, from May to
September 2014. The study comprised two study groups Percentage Marks Letter Grade PBL Group LBL Group
of 3rd year students of the bachelor of medicine and
surgery (MBBS) degree course. 90 - 100 A+(Distinction) 3 (2.1%) 1 (0.7)
80 - 89 A 22 (15.1%) 10 (6.8%)
Both the groups were already exposed to PBL multiple 70 - 79 B 0 0
times in first and second years. Students were randomly 60 - 69 C 39 (26.7%) 36 (24.7%)
divided into two groups, and informed consent was taken 50 - 59 D 9 (6.2%) 26 (17.8%)
from all the subjects. PBL was conducted for one group, Less than 50 F 0 0
while the second group was
taught by traditional LBL on the
same topic. Teachers for the two
groups remained the same and
were trained in both PBL and LBL.
At the end of PBL and LBL sessions
the performance of both groups
was evaluated by 50 multiple
choice questions (MCQs). The
MCQs and their cognitive levels
were the same for both the
groups. Six MCQs were of simple
recall, 14 were of interpretation
while the rest were problem-
solving. Grading was done as: A+
(for 90-100% marks); A (80-89%); B
(70-79%); C (60-69%); D (50-59%);
and F (less than 50% marks).15
Test result was analysed using
SPSS15.Mean and standard
deviation was applied for marks
obtained, while frequency and Figure: Mean score for students from the study groups.

J Pak Med Assoc

Problem-based learning in comparison with lecture-based learning among medical students 652
Discussion has positive effects on the student's academic
The study was designed to compare the effectiveness of performance, outcome domains of satisfaction with
PBL and LBL. The academic performance of the students training, clinical education, and skill course. The analysis
who attended the PBL session was better than those who also suggested that the PBL pedagogy is considered
attended the LBL session with a significant difference of superior to the traditional lecture-based teaching in this
p=0.001. The mean score for PBL and LBL sessions was setting. The results are similar to the current study.19,20
3.2±0.7 and 2.7±0.8, respectively. A study in the Netherlands was carried out in 2009 to
Many medical schools internationally are changing their gauge the effectiveness of PBL in comparison with LBL in
curricula and moving to PBL programmes.16 In Pakistan, a postgraduate medical training programme. The results
however, the application of PBL pedagogy in medical showed that in both groups knowledge had increased
schools is still in the initial stages. PBL is an instructional, equally after the programme and then decreased equally
learner-centred approach that empowers learners to after the follow-up. The performance indicator scores also
conduct research, integrate theory and practice, and increased in both groups, but significantly more in the
apply knowledge and skills to develop a viable solution to PBL group.21
a defined problem.17 PBL is considered to be one of the A study was performed at the psychiatry and behavioural
best described interactive learning methods, and it is sciences department of the University College of London.
advocated by many as more effective in terms of lifelong Consecutive cohorts of second year clinical students
learning skills and also as being more fun.18 taught using a traditional psychiatry curriculum and a PBL
Students on a PBL course tend to place more focus on curriculum were compared. The PBL curriculum resulted
using resources such as the library and online sources. By in significantly better examination performance than did
contrast, those who are taught in a traditional approach the traditional teaching curriculum, both for MCQs and
place more emphasis on the resources supplied by the viva.22
faculty itself. Moreover, students who learn through The sample size and single-centre nature of the study
problem-solving strategy are more likely to use this were limitations of the study. Therefore, caution should be
spontaneously to solve new problems in the future exercised while generalising the results.
compared with those taught in a traditional way.9
Conclusion
Various studies have examined the outcomes of PBL in PBL improved the academic performance of medical
medical school curricula. There is agreement on the students when compared to LBL. Our recommendation to
contribution of PBL to factors such as knowledge teachers of undergraduate and postgraduate medical
retention, student satisfaction, motivation and critical courses is to consider introducing PBL methods in their
thinking. Literature also suggests that PBL students have programmes.
as much content knowledge as their lecture-based
counterparts, and they perform better at more complex Disclaimer: This abstract has not presented or published
forms of assessment, and retain more of what they learn.4 in any conference/journal.

Galvao and his co-workers in 2014 found that PBL Conflict of Interest: We, the authors declare that we have
pharmacy students performed better in academic no conflict of interest.
examinations than the students in the traditional learning
Source of Financial Support: It is not supported
method group. Subjective evaluations of the students did
financially by any one. Authors beared all the expenses
not differ between the two groups while performance on
theirselves.
course assessments was better in PBL. Better performance
of students in PBL is in accordance with the present References
study.6 1. Tayyeb R. Effectiveness of Problem based learning as an
instructional toolfor acquisition of content knowledge and
Another study revealed that both PBL and lecture-type promotion of critical thinking among medical students. J Coll
conventional teaching were effective, but PBL was still a Physicians Surg Pak. 2013; 23:42-6.
2. Sarwar S, Saeed I, Ali S. Problem based learning: facilitators
step ahead. PBL has the potential to enhance the efficacy
perceptions. JRMC. 2014; 18:300-02.
of teaching in situations in which there are personnel and 3. Butler R, Inman D, Lobb D. Problem-based learning and the
resource constraints.8 medical school: another case of the emperor's new clothes? Adv
Physiol Educ. 2005;29:194-96.
Shin and Huang did the meta-analysis and found that PBL 4. DingX,ZhaoL,Chu H, Tong N, Ni C, Hu Z,et al. Assessing the

Vol. 66, No. 6, June 2016

653 R. Faisal, K. Rehman, S. Bahadur, et al

effectiveness of Problem-based learning of preventive medicine learning with traditional teaching as perceived by the students of
education in China. Sci Rep. 2014;4:5126. Rawalpindi Medical College. Rawal Med J. 2010;35: 249-53.
5. Bligh J. Problem-based learning in medicine: an introduction. 15. General academic rules and regulations. Riphahuniversity.
Postgrad Med J. 1995; 71:323-6. [Online] 2015 [cited 2015 April 10]. Available from URL:
6. Leary HM. [Online] Available at: Google
https://www.riphah.edu.pk/admissions/general-academic-rules
http://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=
2177 &context=etd[Accessed 27/04/2015]. Invalid URL 16. AzerA. Introducing a problem-based learning programme: 12 tips
7. Galvao TF, Silva MT, Neiva CS, Ribeiro LM, Pereira MG.Problem- for success.Med Teach: 2011; 33: 808-13.
based learning in pharmaceutical education:A systematic review 17. SaveryJ.Overview of Problem-based Learning: De?nitions and
and meta-analysis.Scientific World Journal. 2014;2014:578382. Distinctions.[Online] 2006 [2015 April 30]. Available from URL:
8. Distler J. Problem-based learning: an innovative approach to http://dx.doi.org/10.7771/1541-5015.1002.
teaching physical assessment in advanced practice nursing 18. Lin CF, Lu MS, Chung CC, Yang CM. A comparison of problem-
curriculum. Int J Nurs Educ Scholarsh. 2008; 5. based learning and conventional teaching in nursing ethics
9. Colliver JA. Effectiveness of Problem-based learning curricula:
education. Nurs Ethics. 2010; 17:373-82.
research and theory. Acad Med. 2000; 75:259-66.
19. Shin IS, Kim JH. The effect of problem-based learning in nursing
10. Buick A. Problem based learning - Friend or Foe? [Online] 2015
[cited 2015 April 20].Available from education: a meta-analysis. Adv Health Sci Educ Theory Pract.
URL:https://www.meducation.net/blog_posts/problem-based- 2013; 18:1103-20.
learning-friend-or-foe 20. Huang B, Zheng L, Li C, Li L, Yu H. Effectiveness of problem-based
11. Sandhu S, Affifi TO, Amara FM. Theories and practical steps for learning in Chinese dental education: a meta-analysis. J Dent
delivering effective lectures. J Community Med Health Educ. Educ. 2013; 77:377-83.
2012;2:1173-82. 21. Smits P, Buisonje C, Verbeek J, Dijk F, Mets J, Cate O. Problem-
12. Aleem SB, Imam KA, Hammad M. Students opinion on based learning versus lecture-based learning in post graduate
effectiveness of CBL in Army medical college, Rawalpindi,
medical education. Scand J Work Environ Health. 2003; 29:280-7.
Pakistan. Pak Armed Forces Med J. 2014;64:564-8.
13. Brame C. Flipping the classroom.[Online] 2013 [cited 2015 April 22. Shanley PF. Viewpoint: leaving the 'empty glass' of problem
27].Available from; URL: http://cft.vanderbilt.edu/guides-sub- based learning behind: new assumptions and a revised model
pages/flipping-the-classroom/ for case study in pre-clinical medical education. Acad Med. 2007;
14. Sultana A, Riaz R, Tehseen I. Comparison of problem based 82:479-85.

J Pak Med Assoc