Université de Sherbrooke - case study

Training a new kind of physician: problem-based learning at the Université de Sherbrooke

Thirty years ago the Université de Sherbrooke’s medical school faced a challenge: its curriculum was becoming increasingly content-heavy as medical knowledge continued to advance. Yet the traditional lecture-based approach to getting that information into students’ heads was becoming less and less efficient with every new curriculum addition. Students were overwhelmed, uninspired and lacked sufficient opportunities to apply their book knowledge to real life healthcare situations.

After several years of discussion, reflection and planning, in 1987 the university became one of the first in the world to do a full-scale conversion of its medical school curriculum from one that was traditionally-based to one that used problem-based learning (or PBL) as its central pedagogical approach. For guidance, it drew on the examples of McMaster University, which had pioneered PBL at its fledgling medical school nearly 20 years before, as well as Maastricht University in the Netherlands, which started up PBL in the mid-1970s.

The change was made with adjustments to the school’s operating budget, but without any extra money. Nevertheless, strong leadership and faculty training in teaching methodology were essential, says Paul Grand’Maison, Sherbrooke’s outgoing [as of October 2011] vice-dean for undergraduate medical education and a participant in the 1987 curriculum overhaul.

“Money is not the most important,” says Dr. Grand’Maison. “It’s the commitment of the people.”

That commitment was toward a much greater proportion of small group learning opportunities, developing students into self-directed learners, and emphasizing a community focus, training students to be sensitive to the needs of the patients and communities for which they would eventually care. Over time, the medical school administration and faculty have gone through periodic reviews and changes to the curriculum, but active and small-group learning have been mainstays.

“We like to say that our curriculum is always in motion,” says Dr. Grand’Maison.

Under the previous system, a standard teaching unit in cardiology was taught over five or six weeks, using about 25 hours per week of lectures. With PBL, the unit is still taught over five weeks, but students are presented with 10 problems – two a week – that they must solve using a combination of analysis, self-directed learning, and small group discussion. Lectures are cut down to four hours per week. Small groups are a maximum of eight students, with the faculty member acting as a facilitator, rather than a lecturer.

The results? Sherbrooke medical graduates have continued to score well on national tests and at least one study found the change to a community-oriented, PBL approach resulted in significant improvement in preventive care and continuity of care. The medical school has been recognized for producing a high percentage of graduates who choose, and remain at, rural practices, where greater resourcefulness is an essential skill (students must do at least one-third of their residency outside of a major teaching hospital). Students comment that the use of active learning and small groups has been a highlight of their educational experience. In 2006, the school expanded its program to two other sites – in Saguenay, Québec and in Moncton, New Brunswick – bringing the total number of students per annual class to about 200.

None of this happens without faculty training of course.

As Dr. Grand’Maison puts it: “Faculty development is a long-term capacity-building activity that never ends.”

Pedagogical workshops spanning from a half-day to two days are compulsory for teachers new to the medical school and refresher courses are offered annually. Lengthier courses and study programs in medical pedagogy are also offered, with the hope that they will be a training ground for future medical education leaders. In 2001, the school became the only one in Canada to be designated a World Health Organization Collaborating Centre on Health Science Education and Practice.

Faculty who wish to be promoted within the school can move up only if they are engaged in the medical education program. And in a bid to better recognize the importance of teaching at the faculty, a practice plan approach to compensation is used. Faculty members pool their university and clinical compensation and the funds are redistributed according to a formula that recognizes each member’s combined efforts in teaching, administration and research.

This has “put education in its rightful place,” says Dr. Grand’Maison. “We want to make sure that we recognize the task of education as an important one.”