Curriculum Types

I was just wondering about what types of curriculum the OPMs on this board are in. My school uses a mixed system- first year is traditional lecture/lab stuff for normal systems, but second year is problem based learning, with a few lectures thrown in. I'd be intereted in hearing how people in PBL curriculums like them. I'm curious how confident people feel with what they're learning in PBL, how you like it, and how it compares to lectures. I admit, I've gotten a bit spoiled this year being spoonfed (well, forcefed) a lot of information. In grad school I loved all the self-learning, but if I didn't learn something I needed to, it was just a lower exam score, not information I might need to treat a patient correctly. Just curious about what others further down the path think about the curriculums. Also, any suggestions about PBL studying? (Yes, it's early- I still have 15 weeks of first year, but I'm curious).

My school is mostly lecture based with a little bit of PBL thrown in now and again. I did not find the PBL style particularly useful, but then again it was so little I don't know how much I was expected to get out of it. It would definitely be quite different if the majority of the curriculum were taught that way. For some classes (neuroscience, for example) is almost exclusively case-based small group exercies. In groups of 10 with a instructor we go over short clinical neurology problems. Hour long lectures and some lab time is also thrown in on occasion but at least 15 hours of the week is spent in this small group learning. I find it very valuable and the method they use of teaching everything from the start with a clinical example is especially helpful and a lot less boring then say how we were taught immunology in which clinical examples were few and far between. I've already have had some use of my neuro knowledge on shadowing experiences. I don't think PBL would be for me.

Although Harvard is often thought of as a prototypical PBL school, in fact we also have plenty of lectures as well as other forms of small group learning, labs, etc. However, the tutorial (the small PBL group of 7-8 people) is the core of the curriculum, and we do not spend a lot of time in lectures compared to many other schools. (The ratio of time varies topic to topic; in my last it was about 2:1 lecture: small group work, which is about as lecture-heavy as it gets).
I think this method is helpful in several ways. First it helps you get very efficient at finding clinically relevant information. However, it is easy to think you are doing well by just grabbing something out of Harrison’s and more or less simply reading it out loud as if you had found the “right answer” and were done. This is poor form. You should do a more thoughtful reading of several sources, ideally including a journal review article–ok, I do a little more than most people do–and then learn to very concisely summarize and synthesize the larger amount of information you have gathered. (Gathering lots of information and then simply spewing it back at length is also poor form.) This is a skill that you should acquire and refine in PBL which I think will be very useful on the wards. However, it is difficult to “study for” this skill, and ultimately, you’ll just get it. Realize, however, that working hard for that reporting back to the group, and then thinking about how to concisely condense and summarize the information, is the way to get a lot out of PBL. Those who think of PBL as a supplement to didactic learning will miss the main benefit, which is your own engagement in your own learning process and that of your classmates.
PBL means more anxiety about whether you’re getting the information you need to take care of patients, but less anxiety about whether you’re pleasing the teacher. I hate the second form of anxiety so deeply that I would rather have more of the first form of anxiety, especially since it tends to focus your studying in the right direction. (You want to study for your patients, not for tests.)
In my view, the first two years of medical school are mainly spent getting a conceptual framework and a vocabulary; it is unreasonable to think you will remember all of it. Medical school is a process of learning a language; PBL is a form of immersion learning in which you acquire fluency in clinical topics by stumbling through it, in the same way that conversational language classes make you talk in the language you’re learning even when you are a bumbling incompetent. This is different than simply learning a language by didactic instruction; and I like to think it is a better approach to learning both the vocabulary and concepts of medicine.
Finally, I like PBL because it deepens my working relationships with my classmates and helps me learn how to do team problem-solving with groups of people I didn’t choose. I think this will also be an important skill to learn for my practice.

–boston joe

Thanks for the insights. I AM looking forward to starting PBL, but it makes me a bit nervous. I think I'll enjoy that style, though.
Well, back to studying Microbiology and doing my taxes (ick).

Hi there,
My school was lecture-based with PBL thrown in. I found the PBL pretty tedious and far from useful in the beginning but as a third and fourth-year student, the PBL sessions took on more meaning. My classmates were pretty diverse in first and second year (read some had no patient care experience) and were not able to figure out how to approach a clinical problem. As they picked up some clinical experience, PBL was more useful.
The one thing that PBL does is introduce you to reseaching medical literature pretty quickly. The most valuable course that I had in medical school was Medical Informatics, taught by the chairman of the Aquisitions Department at the National Library of Medicine. I still have his lists of databases and I still consult many of his internet resources.
We totally use Evidence Based Practice (EBP) in the Department of Surgery here at UVA. It was an easy transition from medical school to EBP here because my medical school was very strongly focused on EBP. If PBL is done correctly, you should have no problems making this transition easily.