Problem-based learning (PBL) has been part of Australian medical education since 1978, when the method formulated at Canada’s McMaster University in the late 1960s was adopted by the University of Newcastle. Our own school at the University of Melbourne adopted PBL in 1999. From its inception, PBL has usually been implemented as part of broader curriculum reform involving changes to the way the curriculum is conceptualised, structured and delivered. Accordingly, the introduction of PBL to established medical schools was frequently a highly charged social, pedagogical and political process. By the time newer Australian medical schools came to devise their curricula, however, PBL had become “mainstream”, a key part of the medical educational landscape and explicitly endorsed by the Australian Medical Council (AMC). The design and implementation of PBL has continued to evolve, to the point that debate now centres on the details of the approach, rather than its justification. It is therefore timely to reflect on how and why PBL has come to occupy such a central place in Australian medical (and other professional) education, and (re)consider its impact and value as a teaching and learning approach.