Graduate Entry Students' Reflection on Alternating Problem-Based Learning and Clinical Placements

Abstract

Problem-based learning (PBL) and early clinical placements (CP) are recognised as complementary strategies for developing clinical reasoning (CR) in medical education. However, how alternating between these formats influences the CR process from students’ perspectives remains underexplored. This qualitative-led exploratory mixed-methods study examined how curriculum sequencing shapes Graduate Entry Medical students’ perceptions of their CR process. Fourteen Year-2 students participated across two pre-existing streams: one began with PBL and the other with CP before switching. Across these alternating phases, students completed the Self-Assessment of Clinical Reflection and Reasoning (SACRR), applied reasoning through vignette-based single-best-answer (SBA) questions to prompt reflection on their reasoning processes. Students’ reflections were further explored through in-depth semi-structured interviews. Thematic analysis formed the primary interpretive strand, supported by descriptive quantitative data. Interview findings revealed that alternating PBL and CP encouraged students to reflect on, apply, and progressively refine their reasoning skills. Students valued the complementary relationship between classroom discussion and authentic clinical exposure, citing case-based dialogue, GP teaching, and supportive environments as key enablers, while heavy workloads, examination pressures, and over-guided PBL sessions were perceived as barriers to CR process. Overall, CR development emerged as a gradual, experiential process enhanced by the dynamic interplay of PBL and clinical learning. These findings underscore the importance of integrating structured discussion with authentic patient encounters rather than privileging one learning format or sequence over the other.