title: To what degree do problem-based learning issues change with clinical experience?
abstract: BACKGROUND
  Problem-based learning has been advocated for preclinical and clinical instruction because the learning issues are adaptable to students with varying previous knowledge and ranges of experience.
  
  
  OBJECTIVE
  The aim of this study was to evaluate whether the distribution in the types of learning issues generated to standardized problem-based learning cases changes with increasing clinical experience during the 3rd year of medical school.
  
  
  METHODS
  Learning issues collected for students performing their 3rd year family medicine clerkship were categorized into broad areas by three reviewers with agreement achieved through consensus and compared over time.
  
  
  RESULTS
  The distribution of learning issues remained relatively constant over the academic year with the exception of topics in the basic sciences and medical decision making. Basic science issues were more slightly common earlier in the 3rd year and decreased over time whereas the opposite trend was observed for medical decision-making questions.
  
  
  CONCLUSIONS
  This study suggests that students do generate different types of learning issues with more clinical experience. Students may show a very slight shift in interest from basic science concerns to higher-order medical decision-making issues over time, but the shift in this interest is very small.
authors.affiliation: Department of Family Medicine, Medical University of South Carolina, 295 Calhoun Street, PO Box 260192, Charleston, SC 29425, USA. huestowj@musc.edu
authors.forename: William J
authors.initials: WJ
authors.lastname: Hueston
authors.forename: Robert
authors.initials: R
authors.lastname: Mallin
authors.forename: Donna
authors.initials: D
authors.lastname: Kern
mesh_terms: D002982:Clinical Clerkship; D002983:Clinical Competence; D006801:Humans; D018794:Problem-Based Learning; D014481:United States