SHORT COMMUNICATION Contextual considerations in implementing problem-based learning approaches in a Brazilian medical curriculum: the UNAERP experience Reinaldo Bulgarelli Bestetti*, Luce ´ lio Bernardes Couto, Gustavo Salata Roma ˜ o, Guilherme Teixeira Arau ´ jo and Carolina Baraldi A. Restini UNAERP Medicine School, University of Ribeira ˜ o Preto, Ribeira ˜ o Preto, Brazil Background: Despite being awell-established pedagogical approach in medical education, the implementation of problem-based learning (PBL) approaches hinges not only on educational aspects of the medical curriculum but also on the characteristics and necessities of the health system and the medical labor market within which it is situated. Aim: To report our experiences implementing a PBL-based approach in a region of Brazil where: 1) all pre-university education and the vast majority of medical courses are based on traditional, lecture-based instructions; and 2) students’ career interests in primary care, arguably the prototypical PBL trainee, are heavily disfavored because of economics. Results: Brazilian guidelines require that clinical training take place during the last 2 years of the medical program and include intensive, supervised, inpatient and outpatient rotations in pediatrics, family medicine, obstetrics and gynecology, internal medicine, and surgery. Throughout the pre-clinical curriculum, then, students learn to deal with progressively more difficult and complex cases typically through the use of PBL tutors in a primary care context. However, because of curricular time constraints in the clerkships, and students’ general preoccupation with specialty practice, the continuation of PBL-based approaches in the pre-clinical years and the expansion of PBL into the clerkships has become exceedingly difficult. Discussion and conclusion: Our experience illustrates the importance of context (both cultural and structural) in implementing certain pedagogies within one Brazilian training program. We plan to address these barriers by: 1) integrating units, whenever possible, within a spiral curriculum; 2) introducing real patients earlier in students’ pre-clinical coursework (primarily in a primary care setting); and 3) using subject experts as PBL tutors to better motivate students. Keywords: problem-based learning; peer tutoring; integrated curriculum; curriculum development; tutorial session; medical skills; primary care *Correspondence to: Reinaldo Bulgarelli Bestetti, Av. Costa ´bile Romano, 2201, Postal Code: 14096-900, Ribeira ˜o Preto, Brazil, Email: rbestetti44@gmail.com Received: 16 March 2014; Revised: 21 May 2014; Accepted: 28 May 2014; Published: 13 June 2014 I ntroduced at McMaster University in the late sixties for students already trained in higher education (1), problem-based learning (PBL) has become a well- established approach in medical education. Underlying PBL are principles of construction, self-direction, colla- boration, and contextual study (2). In brief, the process of knowledge construction is based on activation of prior knowledge and integration of new information (elaboration) by group discussion of a problem under the guidance of a tutor similar to what might be seen among medical teams in clinical practice. Typically, the tutor is a member of the professorial staff who is specially trained to facilitate the learning pro- cess (i.e., guiding learners on how to get the information needed). Thus, the PBL approach is student-centered, not teacher-centered (3, 4). During the tutorial session, after discussing the subject to activate previous knowledge, students establish learn- ing objectives for self-study by assessing what is known and not known relative to the problem (2). The similarity of the problem with a real clinical scenario is thought to facilitate the transfer of knowledge (contextualized study). Following self-guided study, the final, ‘reporting’ phase of the tutorial session brings students together to Medical Education Online æ Medical Education Online 2014. # 2014 Reinaldo Bulgarelli Bestetti et al. This is an Open Access article distributed under the terms of the Creative Commons CC-BY 4.0 License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license. 1 Citation: Med Educ Online 2014, 19: 24366 - http://dx.doi.org/10.3402/meo.v19.24366 (page number not for citation purpose)