The perception of the majority of students towards PBL was positive according to our findings. The data collected by us show that the students found PBL course interesting and informative. Similarly, 90.7% of students in a study done by Joseph et. al, 2016 revealed that the majority of the students strongly agreed that Problem-based learning helped in creating interest . This must be because, in PBL, student learning centers on a complex problem that does not have a single correct answer. In addition, PBL facilitates integration of knowledge, increases problem solving skills, and enhances learning benefits, including understanding and retention of course materials.
Another study revealed that the majority of the students (91.6%) thought that PBL promotes self-directed learning . The results are similar to the current study with 48.3% strongly agreeing and 46.6% agreeing to it. In contrast, a study conducted by Choi et al. on first-year nursing students in South Korea showed no significant difference in self-directed learning between the PBL and the lecture groups in a theory course, and the student's responses were found to vary based on their academic level at the school. First-year and novice students may find it difficult to adapt to PBL because they are used to the lecture method used in high school .
PBL has several advantages over the more traditional lecture-based courses: an integrated knowledge base, exposure to real-life experience at an earlier stage in the curriculum, etc . The current study showed that the majority of the students were positive that PBL integrates basic and clinical Knowledge and increases the ability to deal with authentic problems of patients.
The most impressive result of the study done by Klegeris et.al was that student's responses indicated that they not only enjoyed the process but that they believed that they were learning and retaining the information in a superior fashion compared with the traditional methods . Similar findings were found in a study done by Lama et. Al where 92.1% agreed that Problem based learning helps remember and understand better than traditional lectures . These findings are similar to the results of the current study where 35.9% strongly agreed and 44.9% agreed (Total of 80.9%).
54.8% agreed that it takes less time than conventional lecture in learning the course objectives in a study done by Yadav et al . The present study also showed that students think PBL takes less time than conventional lecture in learning the course objectives as almost half of the participants (26.1% agreed, 22.6% strongly agreed) agreed while 21.4% were undecided.
Win and his co-workers in 2015 found that PBL in collaborative groups encourages participation and increases learning, promotes presentation skills, the activation of prior learning, and problem-solving skills . Another study revealed similar findings where the majority of students in the study group strongly agreed that PBL methodology enhances collaborative learning skills (60%) . In this study, too, the majority of the participants agreed that it does (53.4% agreed, 38.5% strongly agreed).
According to Shankar et al 2014, individual interactions within the small group provide students with opportunities to ask questions, receive explanations, and discuss disagreements, which is when the facilitator/tutor has a pivotal role, individually evaluating the students and counseling them to improve group performance in PBL . In the present study, when asked if there is poor evaluation of students individually in PBL, more than one-third of the participants disagreed with the statement that there is poor evaluation of students individually in the PBL, while 29.9 % were undecided and the rest one third agreed.
In our study half of the students agreed that the tutor provides a source of information and helps use them in the discussion. A study conducted by Demirören et al. found out that the teacher evaluation scale is 3.83 and was statistically significant with self-efficacy for PBL at 0.05 level of significance . Another study found out challenging for PBL teachers to decide whether and when to give direction because students’ self-promotion and inspiration from each other is a particular aspect of PBL . Also that tutors should encourage them to participate actively during the sessions .
In our study, almost half of the students disagreed to hesitation in participation in PBL while one-third agreed to it. One similar study concluded that students were apprehensive and ambiguous when they were asked to research a topic and were not confident to teach it to the group effectively . A study conducted by Bickerdike et al. mentioned that use of surface learning; common in undergraduate education could limit opportunities in problem and case-based learning . Students' performance during PBL sessions could be a predictor of good results in their academic achievement .
The majority of the study participants agreed that they studied more regularly in PBL than in lectures to avoid being left behind in discussions. Though personality may relate to learning styles and learning outcomes, both individual and group behaviors dimensions related to learning processes . A study demonstrated the ways to learn from different sources, not just textbooks but journal articles, the internet, patients, experience, and each other . Our study has given similar results where students thought that discussions in PBL determine what they should study later. This is in concordance with another study by Wormley et al. which resulted that student expressed the experience of transforming into an "active learner" in both the classroom and the clinic environment .
Short PBL sessions can be held amidst integrated curriculum using a system-based approach Though this may require other issues for curriculum design and implementation to be tackled . This is per our results where the majority of the study participants agreed that a PBL session is necessary for the TU curriculum. Also, in a study conducted at CMC, Nepal found out that most of the students (86.7%) accepted that PBL is an interactive and a mutual learning method and improves self-directed learning (83.2%) owing to the importance of PBL sessions in the curriculum .
The majority of the study participants agreed that an IBMS course with PBL enhances student analysis and criticism skills regarding patient problems. A study done by Pu Dan et al. favored critical thinking disposition among PBL participants . It is found to enhance student analysis and criticism skills regarding patient problems. Improvement was seen in decision-making based on experience and evidence, as well as self-reflection and reasoning . The rationale for the PBL approach in medicine and the health sciences is that it develops student’s capacity for clinical reasoning and that it facilitates the acquisition of both basic and clinical sciences enabling retention of clinical tasks . In a nutshell, for medical students, PBL enhances empowerment through problem-solving .
TU-affiliated medical colleges still follow didactic lecture methods as the main teaching-learning strategy. In IOM (TU), initially, two cases of PBL were discussed for each of the two years of MBBS. But the medical colleges affiliated with the university organize PBL sessions according to their feasibility. At Nepalese Army Institute of Health Sciences, one session is organized altogether in 2 years of basic science. Around one-third of the study, participants disagree that the present PBL session is sufficient for TU based curriculum. The overall perception of students toward PBL and about the role of tutors involved in the PBL sessions was very positive from our study. This is in line with a similar study by Yadav et al .
Since this is a cross-sectional study based on a convenient sampling method and conducted in one medical college it cannot be generalized. Moreover, only three batches of students were taken for this study, so it does not show the perspective of previous batches of the same medical college. In addition, the small sample size data may be the limitation of this study in satisfying the full potential statistically. Pre-PBL and Post-PBL tests would have helped in showing if PBL had been effective, which could not be done due to time restrictions. Further studies must be carried out in medical colleges all over Nepal to conclude more valid outcomes of PBL.