醫學教育的擺盪：從講課為主的教學到問題導向學習及團隊合作學習

Medical Education Pendulum: From Lecture-based Learning to Problem-based Learning and Swing to Large-class Small-group Team-based Learning

本文回顧及討論醫學教育模式之轉變；從講課為主的教學(LBL)、問題導向學習(PBL)到團隊合作的學習(TBL)。如此的轉變是潛在地受到了各地人文經濟以及心理特質因素的影響所致。接納及調整這些創新醫學教育模式涉及持續改變、混亂和不確定的過程，而在傳統或創新、學生為中心或老師為中心、小組學習或大班教學，以及單一專業課程或整合課程之間來回擺盪。在TBL中，學生從PBL中所採納的自主學習態度很難完整地延續，但卻解決了老師在有效運行PBL上的不足。也就是說由較專業和主導性較強的老師帶領TBL，會讓學習符合老師期望的效率，但學生也少了自主性和開創性。毫無疑問的是TBL減少了PBL需要較多小組教師人力的壓力，故而被很多採取混合醫學教育模式院校所樂於採用。這並非對與錯的問題，但我們要關注的不僅只是教學管理的方便性，更重要的是如何才能有效的培養學生學習能力達到傳道、授業、解惑以及自我成長和服務人群的能力。

In this review paper, we discuss the recent historic progressive change of educational strategies, including lecture-based learning (LBL), problem-based learning (PBL) and team-based learning (TBL) in higher education with emphasis on medical education. Such a change has been found to be insidiously influenced by national and regional psych-socioeconomic culture. Adoption of and adapting to innovative educational strategy involves constant change, confusion and uncertainty. It sometimes encounters swinging back and forth between tradition and innovation, student-centeredness and teacher-centeredness, small-group learning and large-class teaching, as well as isolated specific courses and blurred integrative curriculum. The difficulties encountered by students to buy in self-directed learning (SDL) attitude in PBL relative to TBL may be reflected in students’distorted perception about the application of PBL principles and tutor’s deficiency in effective management of the PBL process. A more directive content-expert to lead the learning in TBL appears to be a timely salvation to make up such deficiencies perceived in PBL, especially in modified hybrid PBL. Undoubtedly, the need of fewer teachers to lead a large group of students remains the greatest advantage in TBL compared to PBL. There is no right or wrong strategy; rather we ask whether there is a more suitable strategy which is not merely for the administrative feasibility and convenience within the institutional and social culture, but more importantly, appropriate to cultivate expected outcomes following students’learning beyond knowledge acquisition to achieve personal growth and serving people.