Revolutionizing Doctor Training Through Innovative Educational Approaches
In lecture halls across Nepal, a quiet revolution is taking place in medical education. For decades, the approach to training doctors remained largely unchanged: expert physicians delivered knowledge to rows of students through lectures. Today, this traditional model is being challenged by problem-based learning (PBL), an approach that places students at the center of their education through real clinical scenarios. The shift has sparked lively debates among educators and students alike about what truly prepares future physicians for the complexities of healthcare.
Nepal's journey with PBL began in 1978 at the Institute of Medicine under Tribhuvan University, but it wasn't until 1998 that PBL was formally structured into the curriculum 1 . The approach gained significant momentum in 2001 when Kathmandu University School of Medical Sciences, with support from Harvard University, launched the first effectively structured PBL sessions in a Nepali medical college 1 .
This article explores how medical students in Nepal are responding to this educational transformation, whether PBL enhances their learning experience, and what it means for the future of healthcare in the country.
At its core, the debate between problem-based learning and lecture-based learning represents two fundamentally different approaches to education.
An educational strategy that begins with a clinical problem rather than foundational knowledge. In typical PBL sessions, small groups of 8-10 students work together to analyze a patient scenario, identify what they need to learn to understand the problem, and then research those topics independently before reconvening to share findings 1 8 .
This method aims to develop not only content knowledge but also critical thinking, problem-solving, and self-directed learning skills – all essential competencies for physicians 8 .
Follows the traditional model where an expert transmits knowledge to students through structured presentations. This teacher-centered approach emphasizes efficient information delivery and has been the dominant method in medical education for centuries 4 .
| Feature | Problem-Based Learning (PBL) | Lecture-Based Learning (LBL) |
|---|---|---|
| Focus | Student-centered | Teacher-centered |
| Starting Point | Clinical problem | Theoretical knowledge |
| Student Role | Active participant | Passive recipient |
| Primary Skills Developed | Problem-solving, critical thinking, collaboration | Knowledge acquisition, note-taking |
| Faculty Role | Facilitator | Content expert |
| Assessment Emphasis | Process and application | Content recall |
Nepal's medical education system has evolved significantly over the past five decades. The country now produces approximately 1,895 MBBS doctors, 1,128 specialists, and 83 super specialists annually through both government and private medical colleges 9 . This growth has been accompanied by ongoing efforts to enhance educational quality.
MBBS Doctors Annually
Specialists Annually
Super Specialists Annually
The National Medical Education Act 2075 represents a significant step toward regulating medical institutions and ensuring curriculum aligns with societal needs 9 . This legislation aims to revisit curricula, evaluate infrastructure, and determine national requirements for producing competency-based skilled manpower – creating a favorable environment for educational innovation, including PBL implementation.
PBL introduced at Institute of Medicine, Tribhuvan University
PBL formally structured into curriculum
Kathmandu University launches structured PBL with Harvard support
PAHS conducts landmark PBL vs LBL study
However, PBL adoption across Nepal's medical colleges has been uneven. While institutions like Patan Academy of Health Sciences (PAHS) and Kathmandu University have embraced PBL, implementation challenges persist. Many colleges have adopted a hybrid model that blends PBL with traditional approaches rather than fully replacing lectures 1 . This compromise reflects both practical constraints and ongoing debates about optimal educational strategies.
In 2014, researchers at Patan Academy of Health Sciences (PAHS) conducted a landmark study to objectively compare the effectiveness of PBL and lecture-based learning. This research involved 107 medical students from the first two batches graduating from PAHS, providing valuable insights into how these methods perform in the Nepalese context 2 5 .
The study employed a cross-sectional design where students completed two types of assessments. First, their understanding and knowledge retention were tested using 50 vignette-based multiple-choice questions. Importantly, half of these questions covered topics taught through PBL sessions, while the other half addressed content delivered through traditional lectures during their basic science years 2 5 .
Additionally, students filled out a detailed perception questionnaire that captured their preferences and opinions about both teaching methods. This combination of objective knowledge assessment and subjective preference measurement provided a comprehensive picture of PBL's effectiveness and reception 2 .
The findings revealed fascinating nuances in how PBL and lectures impact medical education:
The data showed no significant difference in knowledge retention between topics taught through PBL versus lectures, with median scores of 17 and 16 respectively 2 5 . This finding challenged assumptions that either method superiorly conveys factual knowledge.
However, when researchers examined student preferences across different subjects, a more complex pattern emerged:
Students strongly preferred PBL for physiology, pathology, and pharmacology – subjects with strong clinical applications. Conversely, they favored lectures for anatomy, biochemistry, and microbiology – more foundational sciences requiring substantial factual knowledge 2 5 . For anatomy specifically, many students requested that concepts be taught through both methods simultaneously.
Beyond subject preferences, students reported higher motivation, class attractiveness, and practical usefulness with PBL, though some found lectures more helpful for answering exam questions .
Investigating educational methodologies requires specific research approaches and tools. The PAHS study exemplifies how medical education research is conducted in real-world settings.
| Research Element | Function in the Study | Example from PAHS Research |
|---|---|---|
| Vignette-based MCQs | Assess understanding and knowledge retention | 50 questions divided between PBL and lecture topics 2 |
| Perception Questionnaire | Measure student preferences and satisfaction | 30 questions on a forced Likert scale 2 |
| Cross-sectional Design | Collect data at a single point in time | Students assessed after completing both PBL and lecture courses 2 |
| PBL Scenarios | Stimulate problem-solving in PBL sessions | Clinical cases representing authentic patient problems 1 |
| Standardized Assessment Rubrics | Objectively measure clinical competence | Evaluation tools for operation skills and case analysis 4 |
The PAHS findings align with international research on PBL. A 2023 systematic review and meta-analysis of studies in surgical education found that PBL and LBL showed no significant difference in theoretical knowledge scores, but PBL demonstrated clear advantages in developing clinical competence and student satisfaction 4 .
Another 2022 scoping review of international evidence concluded that PBL is particularly effective for enhancing social and communication skills, problem-solving abilities, and self-learning capabilities 8 . These competencies are increasingly recognized as essential for physician success beyond mere factual knowledge.
However, implementing PBL effectively requires addressing significant challenges. Research from Lumbini Medical College identified that communication barriers, unequal participation, and varying preparation levels can hinder PBL effectiveness 1 . Successful implementation requires both infrastructural support (reliable internet, resource access) and pedagogical structure (clear role assignments, systematic participation frameworks) 1 .
As Nepal continues to refine its medical education system, emerging approaches suggest a future that blends the best of various methods. Competency-Based Medical Education (CBME) is gaining traction, focusing on ensuring students can demonstrate specific skills and competencies before progressing 3 . The 2025 MBBS curriculum updates emphasize early clinical exposure, digital learning tools, and community medicine integration 3 .
Focus on demonstrated skills rather than time spent
Integration of technology in medical education
Patient contact from earlier stages of training
Hybrid models that strategically combine PBL and lectures based on subject matter and learning objectives represent a promising direction. As the PAHS study revealed, students recognize the strengths of each method for different types of content 2 . Future curriculum development will likely leverage these insights to create more effective and engaging learning experiences.
Team-Based Learning (TBL) represents another evolving approach that incorporates elements of both PBL and lectures. TBL uses a structured sequence of individual preparation, group testing, and application exercises 7 . This method maintains the collaborative problem-solving benefits of PBL while providing more guidance – potentially addressing some student concerns about PBL's uncertainty 7 .
The debate between problem-based learning and lecture-based learning in Nepal's medical schools reflects a broader evolution in how we prepare physicians for complex healthcare challenges. The evidence suggests that neither method is universally superior; each has distinct strengths that serve different aspects of medical education.
What emerges from the research is the importance of purposeful educational design – matching teaching methods to learning objectives, whether that involves conveying foundational knowledge through lectures or developing clinical reasoning through problem-solving. As Nepal continues to develop its medical education system, this nuanced understanding will help create training programs that produce not only knowledgeable but also adaptable, compassionate physicians equipped to meet the nation's healthcare needs.
The ultimate lesson from Nepal's experience may be that the most effective medical education doesn't require choosing between PBL and lectures, but rather thoughtfully integrating the best elements of both to create a comprehensive, student-centered learning experience.
References will be added here in the appropriate citation format.