Depth of understanding and excellence of practice: the question of wholeness and problem-based learning

The paper evaluates the importance of conceptions underlying practices in medicine and in medical education. It uses a study of anaesthetists' approaches to practice, and of lectures in problem-based learning, to illustrate the influence of a conception of 'applying knowledge in, or to, practice' and of its apparently serious limitations reflected in practice. A brief background to the pervasiveness of the conception is given, together with discussion of an alternative, and arguably better, conception and its realization in rigorous problem-based learning in contrast to transitional, semi-problem-based learning.