How Nepal's Medical Students Are Reshaping Their Education
In the bustling lecture halls of Nepal's medical schools, a quiet revolution is taking place. For decades, the traditional lecture method has dominated medical education, with professors delivering knowledge to rows of attentive students. But a new approach is changing this dynamic: Problem-Based Learning (PBL), where students work in small groups to solve real-world clinical cases with minimal guidance from tutors. This shift from passive reception to active engagement represents more than just a pedagogical trend—it's transforming how future doctors in Nepal learn, think, and prepare for patient care.
The debate between these teaching methods isn't merely academic; it's about how to best prepare the next generation of doctors in a country with unique healthcare challenges. As Nepalese medical institutions strive to balance global educational standards with local realities, understanding which approach works best—and for which subjects—has become crucial. Recent research conducted within Nepal's own medical schools provides fascinating insights into this educational evolution, revealing student preferences, knowledge retention patterns, and the optimal blend of teaching methods for training competent physicians capable of serving Nepal's diverse population 1 .
Problem-Based Learning arrived in Nepal's medical education system relatively recently compared to Western standards. The approach was first introduced at Tribhuvan University's Institute of Medicine in the 1980s, followed by more structured implementations at BP Koirala Institute of Health Sciences in 1998, and later at Kathmandu University School of Medical Sciences and Patan Academy of Health Sciences (PAHS) 2 .
"PBL enhances students' performance in many ways, including increasing knowledge horizon and retention, better understanding of basic sciences topics, integration of basic and clinical sciences, and improvement of problem-solving skills" - Dr. Ram Lochan Yadav of Chitwan Medical College .
Identify and clarify unfamiliar terms in the problem scenario
Define the problems that need explanation
Generate possible explanations based on prior knowledge
Structure explanations and formulate learning objectives
Formulate learning objectives for self-study
Gather additional information through self-study
Share findings and synthesize new knowledge
Recent studies conducted at Nepalese medical colleges have uncovered fascinating patterns in how students respond to different teaching methods. Research from Patan Academy of Health Sciences compared understanding and knowledge retention between topics taught through PBL versus traditional lectures. In this cross-sectional study, 99 medical students completed assessments with 50 vignette-based multiple-choice questions, equally divided between topics taught via each method 1 .
Data from Chitwan Medical College showing positive student attitudes toward PBL .
Where the research gets particularly interesting is in student preferences across different medical subjects. When asked which teaching method they preferred for various disciplines, students showed clear patterns:
| Subject | Prefer PBL | Prefer Lecture | Prefer Both |
|---|---|---|---|
| Physiology | 59.81% | 46.73% | 6.54% |
| Pathology | 51.40% | 49.53% | 0.93% |
| Pharmacology | 53.27% | 44.86% | 1.87% |
| Anatomy | 57.01% | 78.50% | 35.51% |
| Biochemistry | 40.19% | 45.79% | 4.67% |
| Microbiology | 28.04% | 42.99% | 1.87% |
Source: Research from Patan Academy of Health Sciences 1 3
These preferences likely reflect the different cognitive demands of each subject. Anatomy, with its heavy emphasis on factual knowledge and detailed structures, may be more efficiently conveyed through direct instruction. In contrast, physiology and pharmacology, which require understanding processes and mechanisms, may benefit more from problem-solving approaches.
Beyond subject-specific preferences, the overall attitude toward PBL appears overwhelmingly positive. At Chitwan Medical College, 85.5% of students found PBL interesting, 86.7% acknowledged it as interactive and promoting mutual learning, and 83.2% agreed it improved self-directed learning skills . Despite these benefits, 54.2% noted that PBL is time-consuming compared to traditional lectures .
To understand how researchers are investigating this educational question in the Nepalese context, let's examine a key study conducted at Patan Academy of Health Sciences—one of Nepal's pioneering institutions in medical education innovation.
The PAHS study employed a cross-sectional design involving the first two batches of medical students who graduated in 2016 and 2017. All 107 students were invited to participate, with 99 eventually completing the knowledge assessment component, and all 107 completing perception questionnaires. The study received ethical approval from the Institutional Research Committee of PAHS, ensuring proper protection of participants 1 .
The researchers took particular care with tool validation:
Percentage conversion:
The PAHS study revealed several important findings that extend beyond simple preference patterns:
Median score for PBL topics
Median score for lecture topics
Preferred both methods for Anatomy
These findings suggest that the most effective medical education curriculum in the Nepalese context might be a hybrid model that strategically employs different teaching methods based on subject matter, learning objectives, and available resources.
Implementing successful Problem-Based Learning requires more than just small group discussions. Research from Lumbini Medical College identified specific elements necessary for effective PBL sessions in the Nepalese context:
| Component | Function | Importance in Nepalese Context |
|---|---|---|
| Reliable Internet Access | Facilitates information retrieval during sessions | Addresses infrastructure limitations in resource-limited settings |
| Systematic Textbook Availability | Provides immediate access to reference materials | Compensates for limited digital resources in some institutions |
| Structured Presentation Formats (e.g., PechaKucha) | Ensures concise, focused presentations | Helps students organize and deliver information effectively |
| Clear Role Assignments | Defines responsibilities within groups | Promotes equal participation and accountability |
| Trained Tutors/Facilitators | Guides without dominating discussion | Critical for modeling clinical reasoning and keeping discussions productive |
| Trigger Materials | Presents realistic clinical scenarios | Engages students with clinically relevant problems |
The Lumbini Medical College study used action research to identify and address teamwork challenges during PBL sessions. They discovered that structured interventions—including improved resources, clear roles, and presentation formats—significantly enhanced team dynamics and participation 2 5 . This practical approach to improving PBL implementation highlights how educational strategies must be adapted to local contexts and constraints.
Despite its benefits, implementing PBL in Nepal faces several significant challenges:
Cultural and structural factors also present hurdles. As one study noted, "The attitude and preference for PBL are associated not only with the individual personality traits of medical students but also with the socio-cultural background" 2 . This poses a particular challenge for freshmen in Nepal, who face a steep transition from traditional learning to PBL's self-directed, collaborative approach 2 .
The evidence from Nepalese medical schools suggests that the most promising path forward is a thoughtful integration of both PBL and lecture-based methods, rather than exclusive adoption of either approach. This blended model would leverage the strengths of each method while mitigating their weaknesses.
This recommendation aligns with global trends in medical education. A meta-analysis cited in the research concluded that "combination of both the conventional lecture based and newer PBL curricula would provide the most effective training for undergraduate medical students" 3 .
The evolution of PBL in Nepal also reflects a broader shift in educational research. As scholars note, "Until the 1990s, studies were focused on the question 'Does PBL work?', however by the mid-2000s the focus shifted towards 'How does PBL work?' which allowed for a deeper understanding of the conditions and influences for effective PBL sessions" 2 .
The journey of medical education reform in Nepal illustrates a broader truth: effective teaching isn't about choosing between innovative and traditional methods, but about finding the right balance for specific contexts, subjects, and learning objectives. The research conducted within Nepal's own medical schools provides valuable insights that can guide curriculum development not only in Nepal but in similar resource-constrained settings worldwide.
Both PBL and lectures have distinct strengths for different subjects
Student preferences vary by subject and should inform curriculum design
Implementation must consider local resources and cultural factors
As Nepalese medical institutions continue to refine their educational approaches, the evidence points toward hybrid models that combine the efficiency of well-delivered lectures for knowledge transmission with the skill-development benefits of problem-based learning for clinical reasoning. What makes this particularly important is that these recommendations aren't based solely on international literature but on home-grown research examining the specific needs, preferences, and outcomes of Nepal's own medical students.
The ultimate goal remains clear: training doctors who are not only knowledgeable but can think critically, solve problems effectively, and adapt to Nepal's unique healthcare challenges. As the country continues to develop its medical education system, this research-driven, context-sensitive approach promises to benefit both students and the patients they will someday serve.