The General Medical Council's influential document Tomorrow's Doctors1 recommended that medical education should foster 'learning through curiosity, and exploration of knowledge and the critical evaluation of evidence . . . '. Many medical schools in the United Kingdom hope to achieve these aims by the introduction of new educational methods, foremost amongst which is problem-based learning (PBL).2 The University of Manchester introduced PBL into medical student education in 1994, less than a year after the publication of Tomorrow's Doctors, and the first cohort to learn by this method are now in their second year of study. In this paper, we discuss our experience of helping to develop and implement an integrated pre-clinical PBL-based course.
PRINCIPLES OF PROBLEM-BASED LEARNING
PBL is an educational strategy encompassing several related teaching method^^,^ and is based on research into how adults learn most effectively.s Typically, students explore a series of problems, with little or no didactic input. The problems are chosen to be similar to the cases that students will eventually face in their professional lives, and act as challenges to stimulate learning. Students discuss the cases with each other in student groups, with a little guidance if necessary from a tutor. This promotes the gradual development of clinical reasoning skills, whilst learning the essentials of both basic biomedical and social sciences. Learning is cumulative: each case is designed so that students can begin to understand it using prior knowledge, whether from secondary school education, previous PBL cases, or other forms of learning within the medical school;6 further understanding is developed as students discuss cases with one another and consult appropriate resources such as standard textbooks, original references, and staff members. Habits of self-directed learning, it is believed, will be retained beyond q~alification.~ Careful construction of PBL cases is fundamental to success. Our cases usually represent major health issues and each covers a range of traditional disciplines;