Does problem-based learning in medical education lead to more self-directed learning by physicians? A review of comparative studies, theory and analysis

This dissertation reviews available literature on self-directed learning (SDL) in problem-based learning (PBL) medical education curricula to assess whether PBL trained medical students and physicians develop more effective SDL behavior than their conventionally trained counterparts. Process/product dimensions of SDL in PBL are described and an analysis by Everson & Hmelo (2000) is provided to support the impact of PBL on SDL as defined by Candy (1991). Similarities and differences between SDL and self-regulated learning are also described.; Undergraduate research examining SDL development in PBL and conventional curriculum (CC) students appears to possess substantial methodological limitations, including undeveloped conceptual SDL definition and inadequate operational measures. Analysis of different study subsections from this research compendium is provided to support the conclusion that PBL has not yet been found to be superior to traditional medical education in developing SDL and that undergraduate SDL in PBL research does not offer strong or clear evidence to support the lasting impact of PBL on SDL.; Similarly, post-graduate research also is found to possess variable quality in SDL conceptual and operational definitions. Definitions of SDL and/or PBL were absent in many studies. The poor design of this research prohibited conducting a meaningful, quantitative meta-analysis. Rather, a qualitative, or non-statistical meta-analysis, was performed to determine the extent of the relationship between the two variables. Three of nine studies reviewed found statistically significant results favoring PBL graduates over CC graduates on SDL measures.; Recommendations for advancing SDL development in medical education and research are proposed. Additionally, a supplemental review of the continuing medical education (CME) literature reveals well-developed models of physician learning. Analysis of SDL research in CME suggests that physicians may report learning needs discrepant from actual observed learning needs, answer only a small percentage of questions generated following patient encounters, and misinterpret clinical research findings. Implications these finding may have for undergraduate medical education are discussed and SDL-enhancing curricular strategies are proposed.; In summary, a review of SDL in PBL undergraduate and post-graduate medical education research does not support the hypothesis that problem-based learners become more effective self-directed learners than those in conventional medical curricula.