Adoption of Problem-Based Learning in Medical Schools in Non-Western Countries: A Systematic Review

Figures & data

Table 1. Search terms and strategies used for database searching.

Database	Search strategy
PsycINFO	((“problem based learning” OR “problem-based learning” OR “problem oriented learning” OR “problem-oriented learning” OR “problem-based method” OR “problem based method” OR “problem-based methods” OR “problem based methods”) AND (“focus group” OR “focus groups” OR interview* OR qualitative OR transcript*) AND (“medical school” OR “medical schools” OR “medical education” OR “medical curriculum” OR “medical curricula” OR “medical student” OR “medical students”))
MEDLINE	((“problem based learning” OR “problem-based learning” OR “problem oriented learning” OR “problem-oriented learning” OR “problem-based method” OR “problem based method” OR “problem-based methods” OR “problem based methods”) AND (“focus group” OR “focus groups” OR interview* OR qualitative OR transcript*) AND (“medical school” OR “medical schools” OR “medical education” OR “medical curriculum” OR “medical curricula” OR “medical student” OR “medical students”))
ERIC	“problem-based learning” “medical education” “medical students” “qualitative”

Figure 1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses) flowchart.

Table 2. Selection criteria used to guide screening of articles.

Inclusion	Exclusion
Empirical study published in English	Study conducted in Northern America, Europe and Australasia
Study focused on problem-based learning as a learning method	Systematic reviews/ Conference abstracts/books
Study involved undergraduate medical students only (basic medical education/qualification)
Study adopted a qualitative study design (inclusive of mixed method papers)

Table 3. Table collating the formulated themes by researchers based on second-order constructs extracted from research articles.

	Second-order constructs	Example of first-order constructs	Article references
Students’ experiences of PBL	Participation and Engagement	“During discussion, there are one or two students who actively participate in the discussion, but the others are reluctant to participate in the discussion.”^6“In PBL, we (students) learn by searching and discussions.”^31^(p.1336)	^6^,^7^,^21^,^31–45
	Motivation for Learning	“Some students are not interested, if feels like they don’t want to be there.”^46^(p.462)	^6^,^7^,^21^,^33^,^38^,^39^,^43^,^46–48
	Acquisition of Learning Skills	“It inspired us (students) to develop imagination and creativity…We analyzed the case little by little, and it was an exercise for our logical thinking and how to use the learned knowledge.”^33	^7^,^31–33^,^35^,^38^,^39^,^42^,^43^,^45^,^47–55
	Assessment Orientated	“We (students) want to end the case and get all the answers quickly and maybe we are also more obsessed with the official version of everything. Like, we want the official answer.”^21^(p.743)	^6^,^7^,^21^,^46^,^50^,^39^,^55–57
	Working with others	“I loved PBL… I really enjoyed PBL… I had some really good people in my group. I learnt more in PBL with those students than I did probably in lectures.”^58^(p.4)“I’m quite motivated and in my team, all of them have their own strengths and weaknesses. Therefore, we compete with each other in a healthy way. That motivates me to be the best. I believe the rest feel that too.”^49^(p.766)	^6^,^7^,^31^,^33^,^41^,^43^,^46^,^48^,^49^,^51^,^53^,^54^,^57^,^58
Teachers’ experience of PBL	Knowledge of Subject Matter	“We, as [tutors], think that we should know everything. But, when we don’t have a thorough knowledge of the topic being discussed by the students during the PBL session, we feel uneasy.”^6	^6^,^34^,^39^,^59
	Facilitation Skills	“It is all about the facilitator.” “It [students knowing learning objectives/problems beforehand] will not affect the quality of the discussion as long as the facilitator can direct the discussion.”^60^(p. 3)“Tutors need to be more involved/ interactive. It requires higher level of tutor skills.”^51	^6^,^7^,^21^,^31–34^,^39–41^,^45^,^48^,^49^,^51^,^54^,^56^,^58–63
	Personal Characteristics	“Our tutor is humorous, can get along with us (students) and respect our opinion. These characteristics give us the courage to share our opinion freely with our fellow students without the fear of ridicule.”^64^(p.182)	^49^,^53^,^59^,^63^,^64
Student- teacher relationship	Student vs Teacher centered	“The main discussion should be led by the students themselves, and then the students could arrange some activities around certain topics. If the discussion misses the point, or there is a big mistake in the direction, the tutors should correct the students.”^33“If we [tutors] don’t evaluate students’ participation in discussions, they [students] won’t participate in the discussions at all.”^6“We (Students) learn more in lectures because everything is explained by the teacher.”^31^(p.1336)	^6^,^7^,^21^,^31^,^33–36^,^39^,^42^,^49–51^,^53^,^62^,^65
	Feedback	“It is great that our tutor has made a detailed record of our tutorial performance and has provided us with the feedback at the end of each tutorial. Don’t be too polite and afraid of hurting our feelings. Tell us our deficiencies so that we can improve.”^64^(p.181–182)“I need feedback on good things because I know my bad performance and this feedback on my good performance is important to stimulate me for the next session.”^31^(p.1337)	^6^,^31^,^39^,^46^,^57^,^64
	Fear of confrontation	“Tutors should create a good learning environment of us (students) in the first place so that discussion can happen. Sometimes I don’t know whether I can talk because I am not sure about the tutors’ attitudes.”^35^(p.7)“In our culture, it’s hard to point out wrong-doing to females by male facilitators.”^46^(p.463)	^35^,^36^,^46
Course structure and organization	Utilisation of authentic/ realistic cases	“The problem was related to a clinical problem; so that it strongly stimulate[d] an integrated discussion.”^66^(p. 36)	^7^,^34^,^37–39^,^47^,^49^,^50^,^54^,^55^,^65^,^66
	Knowledge level of students	“I think my knowledge in basic sciences is not enough, what I mean is that the foundation is not solid in terms of breadth and depth.”^50^(p.288)	^32^,^38^,^39^,^42^,^50^,^51^,^60
	English as language of instruction (affecting student participation)	“Our tutor is very knowledgeable about English usage, who has corrected our pronunciation and explained to us the meaning and proper usage of technical terminology.”^64^(p.181)“I really understand, but I just can’t communicate using the good language to speak to my friends. It is quite emotion for me, between myself, for the communication.”^49^(p. 769)	^32^,^36^,^45^,^49^,^64
	Interactive learning material	“Real exposure to clinical signs and symptoms helped us analyze and relate basic concepts to clinical presentation… it caught my attention… going beyond paper and books add[ed] resources that we could use later… Visual material provided an interactive environment.”^37^(p.6)	^37^,^39^,^44^,^63^,^67

Figure 2. Explanatory model of factors affecting the implementation of PBL in non-Western settings.

Red = Third Order Constructs; Black = Second Order Constructs

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