McMaster University (Hamilton, Canada) is most well known for the development of problem based learning. McMaster has been involved in advising many other programs from Hawaii to Harvard ("the new pathway") on how to set up a similar system. The problem based learning (PBL) approach relies on people. The cornerstone is no longer the building, the faculty nor the equipment. The basis for the education is the student, the rest is the supporting cast. As the antithesis to the lecture hall, students are assembled into small groups of 6-8 students and are presented with real clinical scenarios. The challenge is to solve the problem with no medical experience. This requires team-work in order to cooperate and divide labor; self-directed learning to access and understand the information (a skill which is vital for the practicing physician); and finally, back to the team to teach, to learn, and to consolidate.
Neame et al iterated the following questions which a group of students involved in problem based learning might be expected to address, with regard to a specific clinical problem:
- What might have caused the complaint?
- What is the best way to differentiate between the possible causes?
- What is the pathophysiological mechanism responsible for the
complaint and clinical condition?
- How might it best be managed?
- What brought it on, and how?
- How might it be prevented from occurring/recurring and/or earlier detected for treatment?
Thus changes in medical education, in large part as a result of relatively new medical schools, have been quite significant. The body systems approach, problem based learning, and other innovations like the early immersion of medical students into hospitals and other clinical settings (another anti-Flexner development; see history) have been slowly spreading throughout medical schools in North America. Never has metastasis been so welcome.