Introduction of problem-based learning in an undergraduate medical education program: Challenges and opportunities in curricular reform

Many medical schools around the world follow a traditional, lecture-based curriculum. However, pedagogical approaches for undergraduate medical education are evolving and gradually replacing traditional methodologies and curricula. As reported in the literature, curricular reform, such as shifting to the right of the SPICES model, is both impeded and facilitated by a number of factors. Circumstances differ in institutions that are responding to evolving trends through curricular reform as compared to those medicals schools that from their inception have adopted innovative curricula. As a case study, we present the experience of the Medical College at Aga Khan University in Karachi, Pakistan, which adopted an integrated, spiral curriculum based on common clinical conditions in 2002. Problem-Based Learning (PBL) was introduced as one of the active learning strategies, replacing the traditional, predominantly lecturebased curriculum. The practical challenges to curricular reform, including studentcentered pedagogical approaches to replace teacher-centered approaches, are deliberated in this chapter. The strategies to overcome barriers, such as faculty and student apprehensions, limited capacity to plan and implement curricular and assessment-related changes, limited infrastructure to support small group learning/tutorials and resistance of regulatory authorities are discussed. Enabling factors facilitating curricular reform are also discussed in light of our experience. We conclude with a discussion of innovations that have been attempted in the PBL process in the decade since its introduction, as part of continuous curricular improvement in response to monitoring and evaluation.