Depth of understanding and excellence of practice: the question of wholeness and problem-based learning.

The paper evaluates the importance of conceptions underlying practices in medicine and in medical education. It uses a study of anaesthetists' approaches to practice, and of lectures in problem-based learning, to illustrate the influence of a conception of 'applying knowledge in, or to, practice' and of its apparently serious limitations reflected in practice. A brief background to the pervasiveness of the conception is given, together with discussion of an alternative, and arguably better, conception and its realization in rigorous problem-based learning in contrast to transitional, semi-problem-based learning.

The relation between understanding and practice in problem-based medical education.

The importance of conceptions of the soundness of medical education are considered briefly. This leads to the question of misconceptions. A pervasive misconception characterized by the separation of understanding from action and practice, illustrated by two examples from the literature on medical education, is discussed. Questions as to the soundness of medical education are usually approached in terms of empirical inquiry; this paper takes a different, complementary, approach. Five medical faculties in Australia, Sweden and the UK. Problem-based medical course staff and students. The practical effect of the separation between action and practice is illustrated in the question of problem-solving as conceived in transitional semiproblem-based curricula in common with traditional curricula, limiting the development of sound professional education. The centrality of the misconception generates a widespread approach to the curriculum, described as the 'Convenient peg' model. In contrast, the 'Growing web' model enables the design of rigorous problem-based curricula which acknowledge that action and practice are necessarily related to understanding in a way unrecognized in the 'Convenient peg' model. Consequently, rigorous problem-based curricula embody a thoroughly integrated curriculum enabling improved medical education.