A problem-based learning curriculum and undergraduate performance in the final psychiatry examination at the Nelson R Mandela school of Medicine

Abstract

Background. Medical education reformers must consider disease patterns, health system expectations and clearly specified outcomes to ensure that revised curricula are relevant. South Africa needs clinically competent doctors in adequate numbers to address the burden of psychiatric illnesses. Objective. To evaluate the impact of a curricular reform, this study compared undergraduate students' clinical competence in psychiatry following a change from a six-year traditional lecture-based (LB) curriculum to a five-year problem-based learning (PBL) curriculum. Method. The psychiatry examination records of 936 students enrolled in a PBL curriculum were compared with those of 771 students enrolled in a LB curriculum, covering a nine-year period from 2001 to 2009. Records covered the long case, case vignette and oral examinations. Results. Students in the PBL group performed significantly better in the problem-solving case vignette examination (p<0.02). There were no statistically significant differences in the mean marks for the long case and the oral examination. Because the revised curriculum is shorter, one additional class of 200 students graduated during the duration of the study than would have been possible under the previous curriculum. Conclusion. The new PBL curriculum produced more doctors, but there was no change in their psychiatric knowledge and skills compared with graduates from the old LB curriculum. Clinical teachers need to define outcomes prior to curriculum revision, because these are essential for evaluating the curriculum's success.