：近年來，問題導向學習(Problem-Based Learning, PBL)在醫學教育上的應用日漸普 遍。一般認為，PBL讓學生在問題情境中學習知識的使用與產出問題解決的原則，但實證 研究顯示，關於PBL成效沒有一致性的看法。因此，本文目的為以認識論與心理學觀點為 核心，針對PBL可否促進臨床能力之議題，分析支持與反對PBL可提升臨床實務能力的立 場辯證，提出良好規劃的PBL課程實務。由理論辯證中發現，PBL認識論觀點強調具實用 性的做中學，以及建構學習，與醫學教育欲培育具備臨床能力的醫生相符；由情境學習理 論的觀點，PBL將臨床案例融入問題情境中，模擬臨床實務，協助學習遷移，亦是符合醫 學教育發展核心能力的需求。基於上述結果，本文以Skilbeck之情境模式作為課程設計的 架構，建議PBL教案應提升擬真程度，促使外顯與內隱記憶發展，符合情境學習需求，並 能讓學生有機會做中學；課程實施上選擇合適PBL模組實施課程；而在評量上應整合多元 測驗，尤其是提供主觀性評量以檢視整體的學習成效。最後，透過本文所提出之理論與實 務連結的PBL課程設計，期望可作為成功詮釋PBL成效之基礎。

Problem-Based Learning (PBL) has been used increasingly and more widely in medical education in the recent years. PBL involves the use of context of problems that allows students to use their prior knowledge for producing principles of problem solving. However, the empirical researches show that the effectiveness of PBL is not conclusive. In concert with the outcomebased medical education, the purpose of this article was to outline the epistemological and psychological perspectives of PBL and to discuss whether PBL enhance clinical competencies. Furthermore, the argumentations of supportive and opposite opinions of PBL were analyzed to propose strategies for designing a PBL curriculum. From the perspective of theoretical dialectic, the epistemology of PBL stressed on learning by doing and constructive learning, corresponding to the medical education that fosters clinical competence of doctors. From the situated learning perspective, PBL applied clinical cases of real-life scenarios to demonstrate clinical practices and to facilitate learning transfer, which also fulfilled the needs of medical education in developing students’ core knowledge. Our findings based on the Skilbeck’ s situational model of course design, suggested that a higher level of authentic PBL environments should be created to facilitate the learning of explicit and implicit memories and to meet the requirements of situated learning. Adaption of an appropriate PBL module would help students in learning by doing. The effectiveness of learning should be evaluated by multi assessments such as subjective evaluation. This article may be referenced to provide a theoretical basis for practice applications of developing of a well-designed, effective, and successful PBL curriculum.