Teaching child and adolescent psychiatry (CAP) within an undergraduate curriculum poses a number of challenges regarding appropriate learning objectives, incorporation into existing modules, and time and resource limitations. Graduate training in CAP poses additional challenges of achieving competency in medical knowledge (one of the U.S. Accreditation Council of Graduate Medical Education's six core evaluation areas) and learning the specialty with enough depth and breadth to pass examinations—while carrying out clinical duties.

Problem-based learning (PBL) represents a major change in education that has had a large impact across disciplines worldwide. PBL is promoted by professional and funding bodies as a preferred strategy for professional education (1). The literature supports short- and long-term outcomes of PBL (2, 3). Compared with traditional learners, PBL graduates have better interpersonal skills, problem-solving skills, and self-directed and information-gathering skills (4). Through structured case scenarios ("problems"), PBL promotes understanding and retention of information that is directly applicable to clinical situations (1). Problems engage students and require them to apply core concepts to successfully solve problems. Good PBL problems (as opposed to vignettes that do not test problem-solving strategies) are usually not found in traditional CAP textbooks and are a challenge to create.

PBL was developed in the late 1960s at McMaster University, and, today, PBL is used extensively around the world (1). Ostensibly, because of its inherently integrative, bio-psycho-social nature and emphasis on teamwork and collaboration, child-and-adolescent psychiatry should be a specialty learned optimally through PBL (5). Thus, we established the PBL in Child and Adolescent Psychiatry Special Interest Study Group (SISG on PBL in CAP), which was accepted for the 2009 56th Annual Meeting of the American Academy of Child and Adolescent Psychiatry in Honolulu, HI. Through international collaboration and information-sharing, the SISG aims to promote knowledge among Child and Adolescent Psychiatrists on PBL, to explore evaluation methods of PBL in CAP, and to discuss development of PBL-based curricula.

At its first meeting, the SISG included Child and Adolescent psychiatrists from North and Central America and Europe, Chairs of Departments of Psychiatry, Directors of Psychiatric Residency Training, Directors of Medical Student Education in Psychiatry, professors, lecturers, junior doctors, and medical students. The first meeting focused on the differentiation between PBL and the traditional subject-centered approaches in terms of 1) curriculum organization; 2) learning environments; and 3) outcomes.

In PBL, the curriculum is organized around problems, with emphasis on learning skills as well as knowledge. We discussed resource development needed to implement PBL in CAP. We presented an example of a CAP residency PBL curriculum that was designed for in-depth understanding of complex problems and that was appropriate to CAP fellows' level of sophistication.

We discussed the interface between PBL and Evidence-Based Medicine (EBM). Confronted with a clinical problem, the EBM clinician formulates a question, searches for and critically appraises the evidence to address that question, and then applies that evidence to the patient that engendered the question. Since both PBL and EBM start with a clinical situation, the two processes should go hand-in-hand; however, PBL students often turn to sources of evidence that are on the evidence hierarchy. There should, however, be no reason that PBL students cannot also hone their EBM skills. On the basis of SISG participants' experience with teaching EBM in other contexts, it was suggested that CAP students could be guided to formulate, based on an aspect of a PBL case, a clinical question in the form of the "PICO" acronym (what is the Problem/Population, the Intervention, the Comparison, and the Outcome) (6), institute a literature search, and critically appraise apply the evidence. At the very least, tutors should ask learners to critically appraise the source of evidence they are providing in the PBL tutorial.

We also discussed and shared experiences regarding the learning environment of PBL. Learning is problem-initiated, and students work in groups to identify and use resources. Vital for success are problems that are strongly relevant to the real world, able to motivate students, and able to stimulate decision-making and clinical judgment. The core steps in PBL are the following: presentation of the initial problem; discussion of the problem, and development of learning objectives; independent learning focused on the objectives; and discussion, exploration of new ideas, and discovery of solutions in the reconvened group.

Different from the traditional teacher's role, the PBL tutor is an active facilitator who guides learners to identify issues and ways to learn, rather than a "content expert" who provides facts. Depending on the students' level of expertise, there are potential advantages of the tutor's fulfilling an expert role versus a purely traditional facilitator role. Some authors have reported that tutors who are content-experts may be better able to translate PBL problems into real clinical problems, (7, 8) whereas other research has reported mixed outcomes (9).

One challenge is evaluating learners' and educators' adjustment to new educational strategies (10). We discussed pros and cons of PBL for stand-alone teaching or CAP modules within traditional undergraduate medical courses, in which context students are less likely to adjust to a new learning model. Further evaluation is needed on the effectiveness of PBL/traditional hybrid approaches.

We also discussed outcomes of PBL. Knowledge learned in CAP training changes so rapidly as to become obsolete by the time of graduation. Students cannot learn all material, but can learn how to learn material. Thus, PBL prepares students and junior doctors to be lifelong learners and problem-solvers.

The participants—particularly those with little or no PBL experience—left the SISG with a better understanding of PBL applications in CAP. We believe that one of the most important outcomes from this meeting was bringing together a group of child and adolescent psychiatrists who can share knowledge, experiences, and mutual interests and who can collaboratively evaluate the effectiveness of PBL in CAP. We ultimately anticipate that the SISG will be instrumental in promoting PBL in the CAP community and improving education for future doctors.

If you would like to join this group, please contact Professor Anthony Guerrero at GuerreroA@dop.hawaii.edu or Dr. Norbert Skokauskas at N_Skokauskas@yahoo.com.

At the time of submission, the authors reported no competing interests.