Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"

Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Important Notice

Year : 2010 | Month : October | Volume : 4 | Issue : 5 | Page : 3249 - 3254

Problem-based learning: A Review


*MD, Department of Medical Education, KIST Medical College, Lalitpur, Nepal.

Correspondence Address :
Dr. P. Ravi Shankar
KIST Medical College
P. O. Box 14142
Phone: 00977-1-5201680
Fax: 00977-1-5201496.


Problem-based learning (PBL) uses patient problems as a context for students to learn problem-solving skills and acquire knowledge about basic and clinical sciences. PBL is based on the principles of adult learning.

PBL takes place in small groups and learning depends on the effectiveness of the small group process. There is lack of agreement on what constitutes PBL. PBL is active, adult-oriented, problem-centred, student centred, collaborative, integrated and interdisciplinary and it operates in a clinical context.

There are a number of advantages of PBL. However, PBL is demanding in terms of time, teaching materials and physical resources. A PBL facilitator should be comfortable with relinquishing authority and exerting indirect control.

According to some authors, Asian cultures have an authoritarian student-teacher relationship. There is a high degree of acceptance of authority and knowledge is seen as something which is transmitted by the teacher. However, most Asian schools and students seem to be positive about adapting to PBL.

The effectiveness of PBL is being seriously studied. Newer learning approaches are also under development.


Adult learning, Asia, facilitator, problem-based learning,

Problem-based learning (PBL) is becoming increasingly popular and more acceptable and it has been found to be effective in a variety of disciplines in the field of higher education.(1),(2)

What is PBL?
PBL has been defined as ‘an educational method which is characterized by the use of patient problems as a context for students to learn problem-solving skills and to acquire knowledge about the basic and clinical sciences’.(1),(3) The ‘Teacher’s guide to good prescribing’ states that facilitators should define a single objective for the teaching session and formulate the objective clearly to the students.(4)

Characteristics of PBL:
PBL is based on the principles of adult learning. Knowles, the father of adult learning theory, proposed that a learning environment which is characterized by physical comfort, mutual respect and freedom of expression is conducive for adult learning.(5) Differences are accepted, the learners perceive learning goals as their own and accept partial responsibility for planning and conducting the learning sessions and their active participation in the learning process is encouraged.

PBL is usually carried out in small groups of 5 to 10 students each, who meet two or three times a week for PBL tutorials.(6) The groups are presented with a clinical problem and in a series of steps, they discuss the possible mechanisms and causes, develop hypotheses and methods to test them, are presented with further information, use this new information to refine their hypotheses and finally, reach a conclusion.(6)

Skills required for PBL:
PBL is based on a foundation of collaboration and integration within a small group context.(7) The small groups are guided by a tutor or a facilitator. At the beginning of the PBL sessions, tutor effectiveness is a crucial item in the learning process, but by the end, learning is dependent on the effectiveness of the small group process.(8)

To take advantage of PBL, the facilitators and the students should be familiar with the skills which are necessary to work effectively in small groups. These are consensual decision making skills, dialogue and discussion skills, team maintenance skills, conflict management skills and team leadership skills.(9) Consensual decision making requires that every student participates in the team process, has an equal opportunity to be heard and that their ideas are incorporated into the team’s database.(10)

To minimize conflict, ground rules should be elicited from the team members and they must be implemented. Conflict can be minimized by defining the roles, space and behaviour of each team member through a structured process. The role of leadership should be shared among the members (role-sharing). A recent article states that the small group provides more than a cognitive learning experience.(11) The group provides a conducive and collaborative learning experience, facilitates the students’ adaptation to a new and unfamiliar learning environment, fosters integration and socialization and promotes individual development.

The role of the facilitator:
The facilitator should define clear objectives for the learning session and inform the students about them. Before starting the session, s/he should define the problem. H/she should not interfere with the group process during the first ten minutes when the group is settling down and its roles and responsibilities are getting delineated. This time can be used by the facilitator to define the roles which are being played by the different group members. Interventions should be directed only at the group process and should not influence the content. The facilitator should address the group in general and not pick on specific individuals, unless it is really necessary. All group members should be encouraged to participate. When planning to intervene on the content of the discussion, the facilitator should wait and count slowly to ten. Most of the times, s/he may not need to intervene.(4) A recent article looks at the principles of successful interaction in PBL groups.(12) These are applicable to both the students and the facilitators. Some of these are, creating a group environment which encourages everyone to participate, ground rules being continuously enforced by members, tutors being well trained in facilitating PBLs, the group always having a scribe at the whiteboard, the PBL cases being authentic and well written, students using the tutor’s feedback to improve group function, students reflecting on their performances in the tutorials and their proficiency in English, among others.

Advantages of PBL:
PBL is compatible with the modern theories of adult learning. Students enjoy active participation and consider the process to be relevant, stimulating and fun.(3),(13) The teachers tend to enjoy the increased student contact and the traditional barriers between the teachers and the taught are lowered.(14)

Preliminary evidence shows that PBL students may be better able to transfer concepts to new problems.(15) PBL fosters self-directed learning skills which are becoming increasingly important in today’s competitive world.(16) PBL activities bring together faculties from different disciplines and promote greater interaction between basic scientists and clinicians, thus leading to important benefits. PBL students score higher in clinically oriented examinations (17) and they do better in long-term retention as compared to students from conventional curricula.

A recent study conducted by Katinka Prince and coworkers at the University of Maastricht in the Netherlands had shown that more PBL graduates indicated that profession-specific skills, communication skills and the ability to work in a team had been learned at medical school.(18) In South Africa, PBL has been shown to reduce attrition rates and to improve course completion rates among students from an economically disadvantaged background.(19) PBL learners feel that they are treated as mature professionals who are developing effective and clinically relevant study skills, as well as skills which will be important for their future careers.(20)

Disadvantages of PBL:
PBL is demanding in terms of time, teaching materials and other physical resources. Compared to lecture-based curricula, the costs of PBL-based curricula increase with increasing class size.(7) PBL can be relatively inefficient and research has suggested that PBL curricula cover only about 80% of what might be covered in a conventional curriculum in a corresponding time period.(3)

PBL can be stressful to both the students and the faculty unless they are familiar with the process.(21) Some teachers may find that PBL is unduly demanding of their time and they may be uncomfortable in their role as facilitators. A recent study in England found that PBL tutoring was a frustrating drain on time for some teachers, did not suit their educational style and distracted them from clinical learning.(22) The author of a recent review has stated that PBL could worsen the problems of information management.(23) PBL can create an impression that defined core knowledge is enough for clinical competence despite an ongoing knowledge expansion, which can discourage the teachers from refining didactic modalities. This can also reduce faculty time which is required for developing newer teaching modalities and resources which can more efficiently deliver factual knowledge.

Why do teachers have problems with PBL?
A good PBL teacher must be comfortable with giving up the authority which is traditionally associated with a teacher and should exert indirect control. H/she should observe closely and skillfully and attend to both social and intellectual interactions. The facilitator should sit among the students or in a corner of the classroom, but not in front of the class.(24) PBL is application oriented and the stress on the practical goes against the grain of academia.(24) In general studies, certain subjects and disciplines have more power and authority than others. This is true even for various medical disciplines, with certain disciplines having more power and prestige. PBL implies respect for the particular and the concrete and stresses on the application of knowledge, rather than just the theory. Its goal is to help the students grasp the theoretical better. The PBL teacher must mute or even give up his/her authority. The faculty metamorphoses from being experts in their specialty to being facilitators of a small group of students. Handling group dynamics may be a new and unfamiliar area for the teachers, thus leading to high anxiety levels.(1) Teachers favour didactic teaching because they need to justify being paid for their lectures as teachers.

PBL is interdisciplinary and student-centred. However, most medical specialists are in love with their disciplines and may have devoted years of study to their particular discipline. They have a depth of passion for what they are studying and will find it very difficult to be student-centred, rather than content-centred.(24)

PBL in Asian medical schools:
In Asia the student-teacher relationship is stiff and formal and teachers are seen as authority figures.(25) The Asian culture values loyalty and deference toward the teacher. Teachers may be authoritarian and expect the students to have a quiescent attitude.
In Southeast Asia, medical schools are undergoing changes, adopting educational innovations and realigning curricula with national priorities and needs. A curricular survey had shown that 50% of the responding schools reported the presence of PBL in their curricula.(26) The study carried out by Zubair Amin and coworkers from the National University of Singapore (NUS), Singapore, surveyed 30 medical schools in the Southeast Asia region. The ten countries which were studied were Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam. PBL was commonly a part of a hybrid curriculum and constituted 20-40% of the curricular time.(27) Most Asian medical schools and their students appeared to be positive about adapting to PBL in their curricula.

In Karachi, Pakistani students supported PBL as an effective method of learning.(28) The students were of the opinion that PBL helped in developing communication skills and interpersonal relationships and improved their problem-solving capacity. In China, the undergraduate medical education system is being streamlined and innovations including PBL are being encouraged and supported.(29)

The Arabian Gulf University College of Medicine and Medical Sciences in Bahrain have adopted the educational philosophy of PBL and self-directed, student-centred education.(30) At MCOMS, Pokhara, Nepal, the Department of Pharmacology uses a mixture of didactic lectures and problem-stimulated learning (PSL) sessions to teach pharmacology.(31) PSL in small groups, has been carried out by the department for over six years.

In Karamsad, India, an integrated learning program for the central nervous system was developed and implemented.(32) The basic science faculty participated actively in case based learning and hospital visits, along with the clinical experts. Students rated the program positively. PBL was first introduced into the Kaohsiung Medical University in 1997.(33) A PBL curriculum with 14 blocks was developed and conducted. Certain problems were noted, which are being addressed. A near full PBL curriculum has been adopted in a new Taiwanese medical school from 2002.(34) The students claimed that they were more active in learning and had better learning skills as compared to the students under traditional curricula. They also however, thought that PBL had limited breadth and depth in clinical medicine and they were not confident of facing the national licensure examination.

Future perspectives:
Interdisciplinary learning teams consisting of nursing students, medical students, pharmacy students and others could be another possibility. Virtual groups consisting of geographically separated students who are linked through the internet can be considered.

A review done in Australia in 1998 predicted that resource limitations and other constraints may force some medical schools with PBL-based curricula to revert to traditional learning approaches.(6) Advances in technology have the potential to lessen the resource demand for PBL. Technology never-the-less may have a negative side as well. A recent study has raised the possibility that obtaining immediate answers to case scenarios via internet searches may circumvent the hypothesis generation process.(35) Data gathering can occur within the tutorial and this may interrupt the potential and stimulus for student-directed learning.

A recent editorial by Ferguson states that PBL has fallen short of the initial expectations.(36) PBL can be incorporated in a traditional curriculum and students might benefit from some of the best elements of PBL. Team learning, a promising new strategy, incorporates student-led small group learning within a lecture environment and requires that the learners rely on each other for a component of the course grade. The approach has the potential to achieve the benefits of PBL with the use of fewer resources.(37) Other learning approaches are also under development. TBL resembles PBL by providing a small group experience with faculty guidance. Paul Koles and colleagues have used TBL in a year 2 pathology curriculum at the Wright State University School of Medicine in the United States.(38)

Peer assisted learning (PAL) has been used in the United Kingdom (UK) to encourage students to develop their teaching, learning and assessment skills and to help them engage in cooperative learning.(39)

Recommendations regarding PBL:
PBL can initially be started in individual subjects and then can be extended across subjects. PBL does not require expensive resources and the latest technology. In many medical schools, problem-based pharmacotherapy teaching can lead to a full fledged PBL curriculum later.

Training sessions for faculty members to act as facilitators during PBLs are required. Postgraduate students can be trained to act as facilitators. Each medical school has to work out an individual approach to PBL, keeping in mind the number of students, the nature of the student body and the curricular and assessment requirements.


PBL is a new learning strategy in some parts of the world, while it has been used for over two decades in others. PBL employs adult learning strategies and emphasizes self-directed learning by the students. The students are expected to assume greater responsibility for their own learning. PBL has advantages and disadvantages.

Asian students are hard working and work well in a group, but also tend to be shy and regard the teacher as a figure of authority. PBL has been successfully implemented in many Asian medical schools. Modifications of PBL have been used in different schools. Other learning approaches are also under development.


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Albanese MA, Mitchell S. Problem-based learning: a review of literature on its outcomes and implementation issues. Acad Med 1993; 68: 52-81.
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McLean M, van Wyk JM, Peters-Futre EM, Higgins-Opitz SB. The small group in problem-based learning: more than a cognitive ‘learning’ experience for first-year medical students in a diverse population. Med Teach 2006;28:e94-e103.
Azer SA. Interactions between students and tutor in problem-based learning: The significance of deep learning. Kaohsiung J Med Sci 2009;25:240-9.
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