Medical Students' Perceptions of a Curricular Shift at a South African University: from problem-based learning to modified case-based learning

Introduction: Problem-based learning (PBL) and case-based learning (CBL) are two widely used pedagogical approaches to small-group learning (SGL) in medical education. They offer comparable learner benefits; however, the implementation of these approaches vary considerably, resulting in institution-specific educational outcomes and learner experiences. The aim of this study was to evaluate the delivery of these two teaching methods at a single university in South Africa in the context of a curriculum shift in response to local pedagogical needs and resource constraints.

Method: Medical Students at the University of the Witwatersrand were surveyed in their final year of the curriculum (MBBCh Year 6) regarding their experiences of both PBL and modified-CBL (mCBL) during their preclinical years (MBBCh Year 3 and Year 4 respectively). A total of 322 students were invited to complete a questionnaire designed to identify their educational background (whether graduate entry or high-school leaver) and their perceptions of PBL in comparison to mCBL as well as potential improvements to both pedagogies.

Results: There was no significant difference between students who preferred PBL (n=63, 34.1%), mCBL (n=64, 34.6%), or ‘neither’ (n=58, 31.4%) mode of study (P = 0.449). Where students found that the respective learning method prepared them for clinical practice, they were more than twice as likely to select that method over neither option (PBL OR 3.3; 95% CI 1.6-6.8 P=0.001) (mCBL OR 2.3; 95% CI 1.2-4.5 P=0.014). Furthermore, the majority of the students agreed that the background and expertise of facilitators were important to their learning experiences. For both PBL and mCBL, 79% of students preferred clinician facilitators and facilitators who were content experts (PBL - 77% and mCBL - 81%).

Conclusions: Medical students who experienced a curricular transition between two SGL methods did not prefer either teaching method over the other. This study highlights the need for institutions to explore and address context-specific challenges and expectations around SGL implementation both before and after adopting any curricular change.