Author’s Note
The original title of this paper was ‘Is the Asian Culture an Inhibitory Factor in PBL?’ As I thought about it, I realised that by borrowing the title from Kishore Mahbubani’s thought-provoking book ‘Can Asians Think?’, it would be easier to approach this issue.

Can Asians do PBL? Adopting the same approach as Mahbubani in his book Can Asians Think?, the answer is “No”, “Yes” and “Maybe”. Before I explain this ambiguous answer, PBL needs to be defined as it is generally accepted. Recently, PBL has been recognised as an innovative educational approach although it has been practised for more than 30 years in medical education at McMaster University. It has been shown to have the potential to enhance the educational process and its outcomes. The basic principle is that learning can be initiated by starting with a problem that the student wants to solve. In trying to solve the problem, the student generates hypotheses and then identifies learning issues for which he needs more information. Generally, it is practised as a small-group tutorial where the students are actively involved and take responsibility for their own learning and the teacher (tutor) facilitates the learning process. Thus, PBL is a student-centred approach in which content learning occurs in a context where knowledge acquired is applied to understanding or solving problems commonly encountered in practice. Thus, PBL is problem-first learning.

No, Asian students cannot do PBL. Why? In Asia, the student-teacher relationship tends to be stiff and formal. The teacher is seen as a distant figure. While students may tend to have blind respect for their teachers, this could be a result of teachers expecting to be respected without necessarily earning that respect. In our schools in Singapore, there is a subject called ‘Moral Education’ where respect for elders (including teachers) is emphasised. Our students do not ask questions in class. They are shy, lack self-esteem, and may be extremely polite. We may also have teachers who put down students who dare to ask questions and view such students as rude. Our Asian culture values loyalty and deference toward the teacher. Our teachers may be authoritarian and expect the students to have a quiescent attitude. Asian society also tends to be intolerant of mistakes and thus students will not be more active in class for fear of being wrong. To make PBL successful, the students need to be constantly asking questions and seeking answers by themselves. The student-teacher relationship has to be more open and liberal. Students can be freely critical of their teachers and should feel free to make mistakes and learn from them. Thus, our Asian traits both on the part of the students as well as the teachers would appear to prevent the behaviour that is necessary for the successful implementation of PBL.

The answer can be “Yes”. Despite the gloomy picture I have painted above, I have reasons to be optimistic. A survey of Korean medical students who had participated in a 4-week posting at some Canadian teaching hospitals with their Canadian counterparts showed that the environment can change student behaviour and expectations. To the Korean students, the Canadian students’ learning by active and open dialogue with their teachers was very impressive. After their first week of anxiety and depression, the Korean students became more comfortable and relaxed. The Canadian teachers found the students to be extremely keen to learn. Bearing in mind that the Korean students had language difficulties, they did become more active in the more favourable learning environment in Canada. Thus, even students who have been taught in a traditional way can show favourable behaviourial traits in a different educational setting.

Our own experience in NUS encourages us to answer “Maybe”. Up till 1999, the Faculty of Medicine has followed a traditional British-style curriculum where the first year is devoted to learning the basic sciences such as Anatomy, Biochemistry, and Physiology and the second year to para-clinical subjects such as Microbiology, Pharmacology, Pathology, and Family Medicine. The next three years are spent in the clinical departments learning the necessary clinical skills. Such a system has worked well for many years. The method of delivery of the content has evolved over the years from being predominantly lecture-based to the introduction of more small-group learning activities. However, the main complaint about this curriculum has been that in the first two years, the amount of content is overwhelming and much of the material that is taught seems remote from the practice of medicine. Thus, a more integrated curriculum for the first two years with 20% of curriculum time spent on PBL was introduced in July 1999.

After the first semester of this new curriculum, the medical students responded to a survey on their reactions to the new teaching/learning style of PBL. Many of the students’ concerns were linked to their unfamiliarity with their new role of looking for information themselves and seeking clarification from experts other than their PBL tutors. In general however, most of the comments were highly positive. Many felt that the PBL sessions were fun and enjoyed the increased interaction among the students and tutors. They thought that PBL encouraged thinking and active integration of information and had improved their research skills. The PBL trigger problems also helped to reinforce their knowledge of basic science and its relevance to clinical practice. The tutors indicated that they were pleasantly surprised at the students’ willingness to participate actively in the PBL sessions. This observation confirmed the report on the Korean students that even students who have followed a traditional curriculum for most of their lives are able to change their behaviour when placed in a different educational setting.

Of course, one semester’s positive experience does not necessarily mean success for the PBL experiment in NUS. So ask us the same question in a few years’ time after we have gained more experience with PBL. After our students and staff have become accustomed to a more open system of teaching/learning that emphasises more student-centred and self-directed educational activities, maybe the answer will be “Yes”.

References

Mahbubani, K. (1998). Can Asians Think?. Singapore: Times Editions.

Ahn, D. (1999). ‘Visiting Elective Students at the University of Toronto from the Korea University Medical College’. Medical Education. 33, 460–465.