Introducing problem-based learning to Malawi

Dear Sir

Problem-based learning (PBL) is widespread in medical education throughout the world although its use is limited in Africa, where the majority of examples occur in South Africa. We used PBL to teach the six week psychiatry block to medical undergraduate students at the College of Medicine, University of Malawi, because of its benefits in promoting skills such as teamwork, listening to others and cooperation (Wood 2003). The aim of our study was to assess the impact of introducing PBL in Malawi in terms of student attitudes and experiences.

Relevant scenarios were written and tutors were educated in PBL theory. Ethical approval was granted and all MBBS fourth-year students (n = 41) received an introductory lecture on PBL and participated in two PBL sessions per week, in addition to supplementary lectures and clinical bedside teaching. A questionnaire was completed at the start of the block and again at the end. It consisted of 10 statements assessing attitudes to PBL with a Likert scale response and open questions for qualitative responses. The questionnaire was anonymous but numbered, so responses from individual students could be matched.

93% of students responded. Quantitative responses to all 10 statements became more positive after PBL, with six of the changes being statistically significant. The biggest changes were in statements about PBL being too time consuming and causing knowledge gaps, suggesting much of the pre-PBL anxiety about these had been allayed. Students agreed most strongly with statements about PBL being enjoyable, being more effective than traditional methods for improving team work and communication skills, and improving ability to find information themselves. This was reflected in the qualitative responses which revealed four main positive themes: the benefits of group work, being able to discuss/debate answers, learning independently and improved information retention. Negative themes were less prevalent but included PBL being time consuming and uncertainty over defining learning objectives. 100% of responders felt PBL should continue to be part of the psychiatry course.

This is the first study that measures student attitudes to PBL in Africa, out with South Africa. Results were positive and students found PBL enjoyable and beneficial. Our study demonstrated it is possible, where resources allow, to introduce a novel teaching method to a medical school in Africa and have it fully accepted by students.