Reflections on Remaining Obstacles in a Primary-Care Oriented Pure PBL Curriculum after Twelve Years of Implementation

A pioneer primary-care oriented pure PBL curriculum, based on constructivism and adult learning theories combined with Morin's complex thinking, was implemented in our medical school since 2002. Regardless of warnings opportunely made because the basic requirements for its successful implementation could not be fully fulfilled in practice, the experience was carried out and, while partially amended, still endures. This allows revealing several obstacles in many operational aspects, here recalled and/or characterized. Besides becoming helpful not only for counseling again to our own medical school about them but for warning and informing to those institutions with similar problems, the present analysis leads to a preventive final reflection: when designing and implementing a medical curriculum in general and particularly a pure PBL one, a thorough analysis of the contextual and operational factors, a flexible procedure and continuous objective evaluations for further adjustments become keystones for guaranteeing its fruitful implementation.