Although problem-based learning (PBL) is widely used in medical education for its many virtues, a number of deficiencies exist. As means of enhancing the experience of PBL for students, two relatively simple adjuncts to PBL are presented. What Ifs are short hypothetical scenarios, appended to the end of a PBL case, that require students to revisit elements of the PBL case just completed and apply their newly acquired knowledge to clinical reasoning in an altered scenario or to explore anew another dimension of the PBL case. Multi-directional symptoms PBL cases are cases where a common presenting symptom, rather than a specific pathology, is the focus of the PBL case and, following a core narrative of the initial patient presentation, a series of independent continuation narratives with appropriate histories, examination findings and investigation results, lead students to divergent diagnoses and management issues. In addition to keeping the PBL process fresh by rotating new materials regularly, these adjuncts extend the PBL process in the direction of case-based learning.
Beyond multiple-choice questions: using case-based learning patient questions to assess clinical reasoning
