The Use of Problem-Based Learning in Medical Education

以問題為基礎的學習在醫學教育的應用

李澤生(Robert M. K. W. Lee) ； 關超然(Chiu-Yin Kwan)

《Journal of Medical Education》 1卷2期 (1997/06) Pp. 11-20

https://doi.org/10.6145/jme.199706_1(2).0003

摘要

自從加拿大的麥馬斯特大學於1969年實施了先驅性的以「問題基礎學習」為本的醫學課程模式，世界各地的醫學院校亦紛紛以適合當地需要的方式採用這種創新的醫學敎育理論與制度，本文的主要目的是介紹二位在麥馬斯特大學服務了廿餘載的華裔敎授在醫學敎育方面的經驗及報導，以及他們近年來為香港大學醫學院在籌備醫學敎育改革中引入「問題基礎」敎學的過程中所做的一些工作。
「問題基礎學習」俱備了一個主要的優點，即是提早對病患與臨床理論的接觸以及培養自發性的學習態度，藉以使醫學生感受到「學以致用」的實在性以及「學無止境」的價値觀。「問題基礎」敎學也有一些常受誤解的弱點；譬如缺乏傳統性的組織架構，缺乏為監督學習進展而設的考試以及對基礎科學全面深度的要求不足。不過，顧慮這些弱點的敎師通常都忽視了醫學知識汲取和應用的相關性與整合性，因而失去「問題基礎學習」中，學以致用的優越性。雖然「問題基礎學習」已落葉生根了卅多載，麥馬斯特大學仍然不斷地發展並改進對行為、知識與技術等多元化的學習評量工具，以密切配合與時並遷的社會保健觀念和制度。
他們最近在香港大學醫學院生理學系，實驗性地引入「問題基礎學習」的敎學概念與模式，並顯然地激發秋季將進行的醫學敎育重組，他們認為在這傳統的醫學院，若能給予學生適當的引導與鼓勵及對敎師進行積極的敎學培訓，問題基礎學習的確可以增進這些剛由中學畢業進入大學一年級學生的學習能力、態度與效率；無論是那一種敎學模式，其更新或修改都應建立在合情合理並經驗證的基礎上，雖然問題基礎學習的概念已放出顯赫的光芒，這個概念並不代表另一個墨守成規的模式，而是個隨著時代與社會的需要而能活學活用的概念。

關鍵字

問題基礎學習 ； 醫學教育 ； 小組討論學習

並列摘要

Since the introduction of a problem-based learning (PBL) curriculum at the McMaster University School of Medicine in 1969, many medical schools in different regions of the world have adopted this approach, usually with some variations to suit their local needs. The aims of this review are to report some of our experiences at McMaster, to discuss some of the concerns which are associated with the introduction of PBL in a traditional medical school, and to review our recent experience in the introduction of PBL in Physiology in a traditional medical school. Some of the advantages of PBL are: early exposure of students to clinical settings and patients; motivation to learn is self-imposed, because students can see the practical application of the knowledge they are acquiring during their studies; and the acquisition of various learning skills, which will assist them to become lifelong learners. There are also some perceived weaknesses to PBL, which include a lack of traditional structure and progression, and a lack of depth in the knowledge acquired. Teachers with these concerns do not recognize the integrative nature, and you- learn- what- you- need aspect of PBL. Specific evaluative tools have now been developed, which will provide better measures of the learning behaviour, knowledge and clinical skills. Our recent experience in the introduction of PBL in the teaching of Physiology at the University of Hong Kong shows that with appropriate training of the students and teachers, high school students entering first year university are capable of benefiting from the PBL approach. In conclusion, any modification or improvement in the curriculum needs to be based on sound reasoning and upon experimental evidence. We have gained a significant amount of knowledge about the use of PBL in medical education since 1969, but further improvements and refinements are still necessary in order to meet the needs of the students, and that of the society.

並列關鍵字

problem based learning ； medical education ； tutorial learning