A model of how students link problem-based learning with clinical experience through "elaboration"

Purpose. In 1994, the medical school at the University of Manchester introduced a new integrated Course that uses problem-based learning (PBL) throughout the clinical clerkships as the major approach for delivery of the core curriculum. This study explored how students linked PBL and clinical experiences. Method. All third- and fourth-year students were asked to respond to an open-ended question on the end-of-module course evaluation. Their responses were analyzed and grouped into themes. The authors also conducted three focus groups of third-year students and a further three focus groups of fourth-year Students to explore how students viewed the links between PBL and clinical experiences. The discussions were taped and Subsequently analyzed by the researchers independently. Results. The authors found that the students used clinical experience as a means of elaborating their knowledge either at the time of encountering an appropriate patient (outside the group) or by bringing their experiences back to the PBL group for discussion (inside the group). Major facilitators of elaboration were the match between the clinical clerkship and the content of the PBL case, the role of the tutor, and the self-directedness of the student. A theoretical model of how students linked PBL with their clinical experience was derived based on a cognitive psychological approach to learning. Conclusions. The model will be of benefit as the authors try to improve the Course for those Students who were unable to use their clinical experiences to achieve the goals of their PBL discussions.