Med Educ Online [serial online] 2006;12. Shankar PR. Integrating subjects through problem-based learning: a South East Asian Perspective. 1 Integrating Subjects through Problem-based Learning: A South Asian Perspective P. Ravi Shankar Manipal College of Medical Sciences Pokhara, Nepal Abstract: South Asia is a densely populated region. Recently there has been a rapid increase in the number of medical schools. In Nepal the curriculum emphasizes the teaching of the basic science subjects in an integrated manner. The emphasis on problem-based learning and the methods of assessment varies between medical schools. The medical subjects in South Asia are taught in a tra- ditional, subject-wise fashion using didactic lectures. Problem-based learning uses clinical cases as the context for students to study basic and clinical sciences. It is difficult for medical teachers to tone down their passionate attachment to their specialty. In South Asia, problem-based learn- ing only rarely cuts across subjects. Certain medical schools have tried an integrated approach to learning using problems. The repetition of questions in examinations encourages rote learning. Problems are repeated, and the problem solving exercises become a matter of testing recall. Medi- cal schools should debate problem-based learning. Hybrid curricula can be considered. Problem- based learning across subjects should be considered. Students should be prepared for practice in the new millennium. South Asia is a densely populated region of the world. The countries of the region have gotten together to form an association called the South Asian Association for Regional Cooperation (SAARC). The members of SAARC are India, Pakistan, Nepal, Sri Lanka, Bangladesh, Maldives and Bhutan. Increase in medical schools in South Asia - Many of these countries had been ruled by the British, and the British legacy in medical education still continues. In the last sixty years there has been a tremendous increase in the number of medical schools in South Asia. In Nepal, there were a total of twelve medical schools in 2005 and two institutions offering only postgraduate courses. 1 In the year 2000, Bangladesh had 11 medical schools, India had 140, Pakistan had 19 medical schools, while Sri Lanka had 6 medical schools. 2 Recently many more medical schools have been opened. Curriculum and assessment in Nepal - The author teaches in a medical school in Nepal and was educated in India. In Nepal, the university curriculum emphasizes an integrated approach to medical education. The basic science subjects are to be taught in an integrated manner and are to be threaded into Community Medicine and Clinical orientation, as appropriate. 3 The Institute of Medicine, Kathmandu, Nepal emphasizes a community- based medical education and integrated, problem-based learning. 4 The assessment system in Nepal varies between medical schools. Some medical schools have a system- based assessment through problems while others assess on the basis of individual subjects. Traditional teaching and assessment - However, the medical curriculum in most schools is taught in a traditional, subject-wise fashion predominantly through didactic lectures. Assessment continues to mainly test factual knowledge and recall. Pharmacology and therapeutics is a vital discipline in medical schools. In pharmacology, an author has said that there can be no dispute that we as a group of academics have failed to keep the curriculum abreast of the rapid changes in the subject. 5 The author was mainly referring to India, but the scenario may also be applicable to other South Asian countries. Problem-based learning - Problem-based learning (PBL) uses clinical cases as the context for students to study basic and clinical sciences. 6 PBL provides an environment where the student is immersed in a practical, on-going activity in which he/she receives feedback from other students and the instructor. 7 The student receives guidance and support from friends and peers. Learning is multi-directional, including other students, tutors and professors. 8 The learning is functional, based on solving a real problem. ‘Subjects’ in the medical curriculum - PBL requires a problem-based and not a subject-based approach to learning. In basic sciences the material usually provided through lectures and laboratories seems irrelevant to the practice of clinical medicine. 9 Medical teachers have been trained as specialists, and it is difficult for teachers to tone down their passionate attachment to their specialty. In our institution, PBL takes place only in certain individual