Medical Education after Flexner: Re-examining the Re-standardization of Problem-Based Learning through Patient-Centeredness

This review traces modern medical education from the scientific standardization initiated by the Flexner Report (1910) to the shift toward learner-centered problem-based learning (PBL) in the late 1960s. It argues that the spread of PBL has produced a second, less recognized form of standardization, termed re-standardization, in which adopting a method replaces consideration of whether education serves its purpose. We conducted a descriptive review of Korean and international literature, searching PubMed, KoreaMed, and the Research Information Sharing Service for studies on three themes: the effectiveness and constraints of PBL, alternative or complementary methods, and patient-centeredness. Drawing on concept analyses, quality frameworks, and evidence linking patient experience to clinical safety and effectiveness, we frame patient-centeredness as a standard for assessing whether any method, including PBL, serves the patient, rather than as another educational method. Viewed through this standard, hybrid curricula, narrative-based education, and methods involving patients (patients as teachers, early clinical exposure, and longitudinal integrated clerkships) complement PBL by restoring what standardized PBL tends to lose: the voices and contexts of real patients. We also assess the limitations of the evidence supporting these approaches and the constraints on their implementation. Korean medical schools illustrate both the gains and the risks: PBL has spread in a hybrid form since the late 1990s, with its adoption reinforced by accreditation since 2005. Applying the patient-centered standard, we propose five directions, each tailored to the Korean context: matching methods to purposes, scaffolding self-directed learning, maintaining curricula that can be revised, evaluating methods against graduate competence and patient outcomes, and integrating social accountability.