Background: Ethics and professionalism are fundamental components of medical education. Traditional lecture-based methods often fail to engage students meaningfully in these complex domains. This study evaluates the effectiveness of Problem-Based Learning (PBL) as an innovative approach to teaching ethics and professionalism among Phase II MBBS students. Objective: To enhance knowledge, ethical decision-making, attitudes, and communication skills related to ethics and professionalism through the introduction of PBL. Methods: A descriptive interventional study was conducted among 138 Phase II MBBS students at KIMS & RF, Amalapuram. Pre-test and post-test assessments were carried out using validated questionnaires covering four key domains: Knowledge Understanding, Ethical Decision Making, Attitudes & Perceptions, and Communication & Skills. Data were analyzed using descriptive statistics and paired t-tests, with significance set at p < 0.05. Results: Significant improvements were observed across all parameters following the PBL intervention. Mean Knowledge Understanding scores increased from 2.68±0.68 to 7.64±0.71. Ethical Decision Making improved from 2.65±0.66 to 7.59±0.72. Attitudes & Perceptions rose from 2.78±0.68 to 7.38±0.91, and Communication & Skills improved from 2.74±0.67 to 7.49±0.90. Paired t-tests revealed statistically significant differences (p < 0.001) in all domains, confirming the effectiveness of PBL. Conclusion: The introduction of PBL significantly enhanced ethical knowledge, decision-making, attitudes, and communication skills among medical students. This learner-centered approach can be a valuable addition to undergraduate medical education to prepare students for ethical challenges in clinical practice.
Ethics and professionalism form the cornerstone of medical education, shaping future healthcare professionals' values, behaviors, and decision-making abilities. As the practice of medicine grows increasingly complex, there is a pressing need to equip medical students not only with clinical knowledge but also with the ethical competencies required to navigate real-world dilemmas responsibly and compassionately1.
Traditional lecture-based teaching methods often fall short in effectively imparting ethical reasoning and professional behavior. These passive learning approaches may fail to engage students or encourage the critical thinking necessary for ethical decision-making in clinical settings2. In response, there has been a global shift towards more interactive, student-centered methodologies such as Problem-Based Learning (PBL), which has demonstrated success in fostering active engagement, critical analysis, and deeper understanding of ethical principles3.
PBL presents ethical challenges through realistic case scenarios, allowing students to explore various dimensions of professionalism, communication, and moral reasoning in a collaborative setting. Such experiential learning not only enhances cognitive understanding but also shapes attitudes and interpersonal skills essential for holistic patient care4. In the Indian context, the introduction of bioethics modules into undergraduate medical curricula faces several challenges, including limited faculty training and resource constraints. However, innovative teaching strategies like PBL have shown promise in overcoming these barriers and improving the effectiveness of ethics education5.
This study was undertaken with the aim of introducing PBL as a teaching-learning method for ethics and professionalism among Phase II MBBS students at KIMS & RF, Amalapuram, Andhra Pradesh. The primary objective was to assess whether this approach could effectively enhance students' knowledge, ethical decision-making, attitudes towards professionalism, and communication skills, thereby preparing them for the ethical challenges of future medical practice
A descriptive interventional study was conducted among Phase II MBBS students at Konaseema Institute of Medical Sciences and Research Foundation (KIMS & RF), Amalapuram, Andhra Pradesh, with the objective of enhancing knowledge and application of ethics and professionalism through the introduction of Problem-Based Learning (PBL).
The study involved 138 second-year MBBS students who consented to participate. All students were exposed to the PBL intervention as part of their regular academic curriculum.
The PBL sessions were designed to focus on real-life ethical dilemmas and professionalism challenges commonly encountered in clinical practice. Carefully selected case scenarios addressing various ethical issues, communication barriers, and professionalism breaches were discussed in small groups facilitated by trained faculty members. Students actively participated in identifying problems, discussing ethical principles, and formulating solutions in each session.
A pre-test was administered before the PBL sessions to assess the baseline knowledge, ethical decision-making abilities, attitudes towards professionalism, and communication skills. The same structured questionnaire was used to conduct the post-test after the completion of the PBL sessions.
The questionnaire assessed four key domains:
Knowledge Understanding
Ethical Decision Making
Attitudes & Perceptions
Communication & Skills
Each domain was scored using a standardized scale to ensure consistency and objectivity.
The collected data were entered into Microsoft Excel and analyzed using SPSS software (Version 20.0). Descriptive statistics including mean, standard deviation (SD), and standard error of mean (SEM) were calculated for each parameter. The effectiveness of the PBL intervention was evaluated by comparing pre-test and post-test scores using the paired t-test. A p-value of less than 0.05 was considered statistically significant.
A total of 138 Phase II MBBS students participated in this study evaluating the effectiveness of Problem-Based Learning (PBL) in enhancing knowledge, ethical decision-making, attitudes, and communication skills related to ethics and professionalism.
The descriptive statistics for the pre-test and post-test scores across the four key parameters are presented in Table 1. Substantial improvements were observed in the mean scores for all parameters following the introduction of PBL. The mean pre-test score for Knowledge Understanding was 2.68 ± 0.68, which increased to 7.64 ± 0.71 in the post-test. Similarly, the mean pre-test score for Ethical Decision Making rose from 2.65 ± 0.66 to 7.59 ± 0.72 post-intervention. For Attitudes & Perceptions, the mean improved from 2.78 ± 0.68 to 7.38 ± 0.91, and for Communication & Skills, from 2.74 ± 0.67 to 7.49 ± 0.90.
Parameter | N | Pre-Test Mean | Pre-Test SD | Pre-Test SEM | Post-Test Mean | Post-Test SD | Post-Test SEM |
Knowledge Understanding | 138 | 2.68 | 0.68 | 0.059 | 7.64 | 0.71 | 0.059 |
Ethical Decision Making | 138 | 2.65 | 0.66 | 0.056 | 7.59 | 0.72 | 0.056 |
Attitudes & Perceptions | 138 | 2.78 | 0.68 | 0.059 | 7.38 | 0.91 | 0.059 |
Communication & Skills | 138 | 2.74 | 0.67 | 0.058 | 7.49 | 0.90 | 0.058 |
The differences between pre-test and post-test mean scores are detailed in Table 2. The largest improvement was seen in Knowledge Understanding with a mean increase of +4.96, followed closely by Ethical Decision Making (+4.94), Communication & Skills (+4.75), and Attitudes & Perceptions (+4.60). These findings highlight the consistent positive impact of PBL across multiple domains of ethical education.
Parameter | Pre-Test Mean | Post-Test Mean | Mean Difference |
Knowledge Understanding | 2.68 | 7.64 | +4.96 |
Ethical Decision Making | 2.65 | 7.59 | +4.94 |
Attitudes & Perceptions | 2.78 | 7.38 | +4.60 |
Communication & Skills | 2.74 | 7.49 | +4.75 |
To assess the statistical significance of the observed improvements, paired t-tests were performed for each parameter (Table 3). All four parameters demonstrated highly significant improvements with p-values less than 0.001. The t-values were -74.083 for Knowledge Understanding, -79.753 for Ethical Decision Making, -52.142 for Attitudes & Perceptions, and -55.521 for Communication & Skills, indicating robust and statistically significant differences between pre-test and post-test scores.
Parameter | t-value | Degrees of Freedom (df) | p-value |
Knowledge Understanding | -74.083 | 137 | <0.001 |
Ethical Decision Making | -79.753 | 137 | <0.001 |
Attitudes & Perceptions | -52.142 | 137 | <0.001 |
Communication & Skills | -55.521 | 137 | <0.001 |
The findings of this study highlight the effectiveness of Problem-Based Learning (PBL) in enhancing ethics, professionalism, and communication skills among undergraduate medical students. The significant improvement observed across all measured parameters underscores the role of PBL in fostering active learning and critical thinking, essential for ethical decision-making in clinical practice. These results are in alignment with previous studies that demonstrated the positive impact of PBL in various domains of medical education, including biostatistics and professionalism6,7.
PBL's strength lies in its ability to engage learners through realistic scenarios that mirror clinical complexities, thereby promoting deeper understanding and retention of knowledge8. This active learning strategy also encourages collaborative problem-solving and discussion, which are critical for developing interpersonal and professional competencies9. Unlike traditional didactic methods that often fail to contextualize ethical principles, PBL allows students to internalize ethical reasoning through application in simulated real-life situations10.
The improvement in students' attitudes and perceptions, as observed in this study, reflects the growing emphasis on teaching professionalism as a core component of medical training. Professionalism encompasses not only ethical behavior but also communication, accountability, and respect for patients—areas that can be effectively nurtured through interactive pedagogical approaches11. Furthermore, the study supports the idea that reforms in medical ethics curricula should prioritize active learning methodologies like PBL, which have been shown to be both feasible and impactful even in resource-limited settings12.
The primary strength of this study lies in its structured approach and the use of a pre-test and post-test design to objectively measure learning outcomes. However, the study has some limitations. It was conducted in a single institution with a relatively small sample size, which may limit the generalizability of the findings. Additionally, the study focused on short-term outcomes without assessing the long-term retention of ethical knowledge and professional behaviors.
The positive outcomes of this study suggest that PBL can be effectively incorporated into the undergraduate medical curriculum for teaching ethics and professionalism. Further multi-center studies with larger sample sizes and longitudinal follow-up are recommended to validate these findings and assess the sustainability of the acquired competencies.
The introduction of Problem-Based Learning (PBL) significantly enhanced the knowledge, ethical decision-making, attitudes, and communication skills of Phase II MBBS students regarding ethics and professionalism. The study demonstrated substantial improvements in all measured parameters, with statistically significant results confirming the effectiveness of this learner-centered approach. PBL allowed students to actively engage with real-life ethical dilemmas, fostering critical thinking, empathy, and responsible professional behavior. These findings highlight the potential of PBL to bridge the gap between theoretical knowledge and practical application in medical education. Incorporating PBL into the undergraduate curriculum can better prepare future healthcare professionals to navigate complex ethical challenges in clinical practice.