Nowadays many schools in higher education implement problem-based learning to foster active learning processes by students. In some schools with a number of years of experience with this approach, phenomena can be observed which indicate signs of wear. The implementation of a large-scale innovation such as problem-based learning (PBL) seems to provoke different activities and attitudes in those actors who are most involved. Students and staff members seem to behave in a way which could be counterproductive to the development of self-directed learning. In the first part of this paper, we briefly describe the cognitive psychological background of PBL. In the second part various adjustments observed in problem-based curricula and their effects on students' learning are analyzed. Arguments are presented about adverse effects on the implementation of this educational innovation. Special attention is given to teachers' concerns. In the third part suggestions are made about ways to revitalize PBL processes as well as suggestions about effecting educational innovations on a more solid basis.

Tutors' competencies had a positive effect on the learning of students. This suggests that it would be worthwhile including these competencies in staff development.

The superficial approach to learning was mostly preferred among first and second year medical students, and the least preferred among students in the final clinical years. These results may be useful in creating future teaching, learning and assessment strategies aiming to enhance a deep learning approach among medical students. Future studies are needed to investigate the reason for the preferred superficial approach among medical students in their early years of study.

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Within Problem-Based Learning successful learning depends on the quality of cognitive, social and motivational contributions students make to the tutorial group. But at the same time, not all students in PBL automatically contribute in a high quality manner, which might impede successful group functioning. This study investigated whether peer process feedback combined with goal setting can be used to improve the quality of students’ individual contributions. A mixed-methods explanatory design, in which 74 second-year Health Sciences students participated, combined a pre- and posttest with a focus group. The results indicated that the quality of the contributions only increased for students with a below average score on the pre-test. The qualitative data confirmed that the impact of the feedback could be increased by combining individual reflection by means of goal setting with face-to-face discussion. Another suggestion is to investigate whether midterm peer process feedback is more effective for first year students, because they are still developing their tutorial behavior, as opposed to second year students.