The Effect of Problem-Based Learning on Improvement of the Medical Educational Environment: A Systematic Review and Meta-Analysis

OBJECTIVES: The aim of this study was to evaluate the effect of problem-based learning on improving the medical educational environment. MATERIALS AND METHODS: All relevant studies on problem-based learning and the medical educational environment were searched for in PubMed, the Education Resources Information Center (ERIC) catalogue, Google Scholar, China National Knowledge Infrastructure (CNKI) and WanFang Data (WF) databases for material dating from 1969 to May 2015 without any language limitation. Six randomized controlled trials of problem-based learning compared to traditional lecture-based learning were included. The Cochrane risk of bias tool was used to assess the quality of the included studies. Review Manager (Revman) version 5.3 software was used for data analysis. The effect size of the improvement on the medical educational environment was calculated as the mean difference and 95% confidence interval. Heterogeneity was evaluated with Cochrane's χ2 test and I2. Publication bias was assessed by funnel plot, Begg's rank correlation test, and Egg's linear regression test. RESULTS: The six included studies were at low risk of bias in all domains except for three that were at high risk of bias in the domain of allocation concealment. The pooled effect size showed that problem-based learning was better than lecture-based learning in improving the medical educational environment, as measured by the Dundee Ready Education Environment Measure (DREEM), with statistically significant differences. No significant publication bias was observed. The sensitivity analysis showed that the result was reliable. CONCLUSIONS: This study showed that problem-based learning was able to improve the medical educational environment as measured by DREEM. However, further studies with larger sample sizes and high-quality data are needed.