INTRODUCTION

Effective medical education demands dynamic, and evidence-based teaching-learning methodologies to prepare competent doctors equipped with clinical expertise, analytical thinking, and lifelong learning skills. Medical institutions employ multiple approaches like traditional lectures for foundational and theoretical knowledge, bedside teaching for clinical skills, and case-based learning to bridge theory with practice. ^{1, 2} Among these, Problem-Based Learning (PBL) is a student-centric active learning method encouraging collaboration, self-directed research, and problem solving skills essential for lifelong learning and patient care. ^{3, 4, 5}

PBL was first developed at McMaster University in the 1970s as a teaching learning method where students solve real clinical problems using their existing knowledge. ^{6, 7} In PBL, small groups of students work together to analyze patient cases, identify gaps in their understanding, and conduct self-directed research between sessions. A faculty tutor guides these discussions, helping students connect basic science concepts to clinical practice. ^{6, 7, 8}

In India, the National Medical Commission (NMC) introduced a Competency-Based Undergraduate Curriculum in 2019, emphasising student-centred methods, early clinical exposure, and attainment of specified competencies, including professionalism, communication, and lifelong learning. ⁹ PBL aligns closely with these CBME objectives. However, the successful implementation of PBL requires adequate infrastructure, including small group discussion rooms, trained faculties, access to clinical cases, and technological tools for virtual PBL. ^{10, 11} Although a nationwide survey of medical faculties in India highlighted the high student-faculty ratio as a significant barrier to PBL implementation. ¹²

Additionally, a systematic review and other studies reported variable experiences with PBL by both medical students and teacher in non-Western countries, leading to inconsistent student engagement and effectiveness in learning, and limited effectiveness for exam preparation. ^{4, 5, 13}

To address implementation challenges ^{11, 12, 13} of student-centered active learning strategies aligned with competency-based medical education (CBME), sensitizing first-year MBBS students to multiple teaching-learning methods and evaluating their perceptions is important. This cross-sectional study aimed to: (1) assess first-year MBBS students’ perceptions of a four-week Problem-Based Learning (PBL) module on pulmonary function tests, (2) compare these perceptions with traditional lecture-based instruction, and (3) analyze gender-based differences in learning preferences.

MATERIALS AND METHODS

RESULTS

DISCUSSION

This study evaluated first-year MBBS students’ perceptions of a four-week PBL module on pulmonary function tests and compared these with traditional lectures. In line with the NMC’s Competency-Based Undergraduate Curriculum for Indian Medical Graduates ⁹ , which emphasises learner-centred methods and early clinical exposure, 70% of our students found PBL engaging and 72% reported improved concept clarity. Gadicherla et al. ¹⁴ similarly found 68% of first-year MBBS students in India perceived PBL as an effective learning tool, and Parekh et al. ¹⁵ reported a mean satisfaction of 3.8 out of 5 (≈76%) with PBL in physiology.

Outcome research spanning 22 years confirms that PBL enhances critical thinking and knowledge integration in preclinical settings​ ³ , and scoping reviews report similar gains in problem-solving skills and application of basic science to patient care. ⁴ Similar observations were made in the current study where 74% reported improved problem-solving skills, and 57% felt PBL effectively linked basic science with clinical practice. These results were consistent with those of a study by Ibrahim et al. ¹⁶ , where students expressed a preference for PBL over lectures in enhancing the integration of basic and clinical sciences.

Despite these benefits, many students expressed about PBL’s broader utility. Only 26.6% believed PBL would help in examination preparation, comparable to 40% in a Saudi cohort ​ ¹⁶ and 45% among Indian dental students​. ¹⁷ Approximately 62.8% of our cohort found facilitators helpful, a figure similar to 79% approval rates of students for PBL implementation reported by Usmani et al. ¹⁸ in Pakistan. High neutrality and disagreement regarding orientation (39.6%) and facilitation (37.2%) in this study is consistent with Solano et al. ⁵ , who noted that over 80% of respondents in developing countries cited inconsistent facilitator training and resource constraints as important barriers of effective PBL implementation. In contrast, Wondie et al. ¹⁹ found that 82% of students in Ethiopia still perceived PBL as effective despite limited resources. Chan et al. ¹³ reported 78% adoption of PBL methodologies in non-Western medical schools, reflecting a growing preference that parallels our 59.3% overall PBL preference. However, Epstein et al. ²⁰ and Vanishree & Tegginamani ²¹ found that PBL alone may not address all learning objectives or knowledge breadth without complementary strategies​.

To address these gaps, blended or hybrid models have proven effective. Bukumiric et al. ²² and Zhou et al. ²³ showed that integrating PBL modules improve exam performance in a randomized pilot study and improve clinical thinking respectively.

Taken together, these studies suggest that while PBL offers clear advantages, its alignment with CBME assessment practices and consistent facilitation are critical to maximise its impact.

Strengths of this study include high response rate and use of a validated instrument. Limitations include reliance on self-report, absence of objective post-PBL assessments, and single-centre and single-topic design. To optimise PBL’s impact, we recommend a blended curriculum that pairs PBL modules with targeted formative assessments, periodic facilitator training, and regular feedback. Such a model can preserve PBL’s engagement and problem-solving advantages while aligning more closely with examination requirements and competency outcomes.

CONCLUSION

The findings of this study highlight that Problem-Based Learning (PBL) is perceived by a majority of first-year MBBS students as an engaging and effective method for enhancing conceptual understanding, problem-solving abilities, and clinical integration. However, the variability in perceptions regarding examination preparedness and facilitator effectiveness indicates the need for better orientation, structured implementation, and alignment with assessment strategies. While PBL cannot entirely replace traditional lectures, it can significantly complement them when implemented thoughtfully. PBL can be incorporated as core component of the undergraduate curriculum under the Competency-Based Medical Education (CBME) framework, supported by adequate training, resources, and curricular alignment, will help in development of critical thinking, self-directed learning, and competency-based outcomes in future medical professionals.

Disclosure

Funding: None

Conflict of Interest: None Declared

Author Contribution: All the authors involved in study have contributed equally at all stages of work

Acknowledgements: I would like to express my appreciation to all those who have supported and contributed to the completion of this project