Problem-based learning and performance-based testing: effective alternatives for undergraduate surgical education and assessment of student performance

The recent trend in medical education has been toward problem-based learning (PBL) and performance-based testing. An attractive alternative to traditional lecture-based instruction, problem-based learning emphasizes knowledge acquisition and its application in the clinical setting. In conjunction, performance-based testing offers a means of assessing student performance that measures not only the mastery of factual information, but also the application of knowledge in solving clinical problems often encountered in patient care. Since the installation of an undergraduate PBL surgery clerkship at the University of Kentucky (UKY) in 1989, several studies have shown that the performance of PBL students equals or exceeds that of students in lecture-based instruction on tests of factual knowledge. More importantly, PBL students perform significantly better on examinations designed to measure the clinical application of knowledge. The UKY studies also show that PBL students develop better clinical reasoning skills, increase their medical knowledge base significantly, and learn important time-management skills during the course of their PBL instruction. Moreover, the UKY data reveal clearly that performance-based testing provides an accurate and reliable method of assessing areas of student learning that traditional testing techniques (i.e. multiple-choice tests) fail to evaluate adequately.