Hard to believe, but in just a few hours, I will be sitting in our classroom writing away on our first mid-term. We have two blocks this semester, with one mid-term and a final in each block. Our exams are 50% of our grade, so I don’t want to do too poorly.
(Who am I trying to kid? I will be absolutely miserable if I don’t do my very best!) 
Anyway, it’s an essay test. Three questions. Three hours to finish the exam. And every question is customized to cover just the material that we turned is as our learning issues for our first PBL case. So. . . I think I’ve studied it just about as much as I possibly can. I think I’ll just go take a quick little power nap, get a good (but light) lunch, and go tackle the first strictly PBL exam.
Wish me luck! I’ll let you all know how it went after I get my score back. For now, I can’t wait until I’m finished with this exam so that I can head over to my D.O.s office for a little manipulation of my neck and lower back!
Good luck Linda!!! I'm sure you will do great!
Good luck Linda - we will be waiting for you to report back. I'm interested in PBL as well.
Okay, guys. Here were the questions for our group. Remember, each group submits their learning issues and the questions are drawn from those. So, it was all of three essay questions. . . . . and here they are!
Describe the expected physical examination differences between patients with acute low back pain due to lumbar strain, lumbar sprain, and lumbar radiculopathy (sciatic neuritis)
Acetaminophen appears to have a similar mechanism of action to that of the non-steroidal anti-inflammatory drugs (NSAIDs); however, acetaminophen is not considered to be an NSAID and is used differently. Briefly describe the shared mechanism of action and explain why acetaminophen is not classified as an NSAID.
Describe the mechanism of striated muscle contraction including the structure of thin and thick filaments, their organization in the sarcomere, interactions between them during contraction, and the role of calcium in the initiation of contraction. You may draw pictures to help illustrate your written descriptions.
So. . . what do you guys think? Personally, I found it fun. I had spent a lot of time studying in more detail the neurophysiology of pain, but simply managed to include that in my description of acetaminophen vs NSAIDs.
Now, it’s wait and see time. Think I did pretty good, though. I’ll let you know when we get them back! But, can you see the advantage of PBL, how the questions correspond to the case you’re studying?
I LOVE IT!!! Couldn’t be happier 
I really like the questions. The first seems like it really gets you thinking about a diferrential Dx and will help your reasoning process when you have to do it for real. The second is just an interesting question that I have thought of before but have never actually researched to find the answer. Are you interested in telling (briefly))? Finally the third question really makes you think about the physiology of a muscle contraction in the reference of an every day activity and gets to the heart of whether you understand the sliding filament theory or not? Cool stuff!
what cush test!!! Damn why can’t they do that here? Man I am jealous…
Hope you did well Linda. I am sure you did.
One of the things I like best about PBL is how it allows you to design your own style of learning. We will cover all the same material, and end up covering it in depth as far, or further, than the SBL group.
But, we get to do it all while relating it to a particular case scenario. At the same time we are learning our physician's skills and physical diagnosis skills, learning about a lot of different illnesses and how they present, and taking each one as far as we feel comfortable with in respect to biochemistry, molecular biology, physiology, etc.
While the test looked relatively simple, our learning issues were a lot more in depth than they look. The biochemistry of pain and inflammation. . . . wow! Figuring out the synthesis of prostaglandins, learning the complement system and what it means, neurological pathways of pain and inflammation, etc.
Anyway, our new case is conjunctivitis. . . . so now we're into medical microbiology. And for now, that's where I'm headed. Back to my books!!
Linda, this indeed sounds great. I have some questions for ya if you don't mind.
How do you know your going down the right path and not wasting time on some other interesting aspect of medicine? I can see myself doing that - looking something up and getting lost on something else.
How are you guided? I know you have someone overlooking in a general way (or are they more involved). Are your learning issues well defined? What I mean by that is just how far into something do you look - when do you know when to stop? Or perhaps you don't stop until you get to the molecular level?
When researching some aspect of the learning issue, there must be many branches - is there a guid that tells you which paths are worth looking into now, others later?
That all (for now!)
Thanks
Okay guys, I'll try to answer the questions.
Damon - In a nutshell: first acetaminophen does help relieve minor pain, but it does not inhibit the prostaglandin formation- prostaglandin is synthesized from arachidonic acid via oxygenation by cyclooxygenase, and is one of the major players in inflammation. Prostaglandins are vasodilators, which lead to increased capillary permeability, allowing tissues to become edematous, and allowing more macrophages, basophils, and lymphocytes to be brought into the area. All of these contribute to continued inflammation. However, NSAIDS such as ibuprofen and naproxen inhibit cyclooxygenase, thus decreasing the production of prostaglandins, and thereby reducing inflammation.
Okay, that's that one!
Now, BAC - the questions you have raised are the very ones that concern us the most. However, history of PBL has proven that, when the course is self-directed, those involved usually attain as much, if not more, information on the subjects at hand than those involved in SBL. The difference is that you are the one determining your own destiny and are the one responsible for seeing that you learn what is necessary. And, the material you learn with each additional issue is something you will tend to recall more easily because it is associated with a case.
Are we guided? Loosely. The facilitators are there to encourage us when we choose the right learning issues, to guide us if we get too far off course, and to make sure we cover appropriate material for the case. However, they will not tell us what learning issues to do.
The purpose of PBL is to help us learn to work as a group, learn what is important, and learn to apply what we have studied. All issues are discussed before we make them official learning issues, and they are only added to the list if the majority of the group agrees. Do we differ on what we want to do? Of course. We all have our own way of learning, and our own areas of interest. But what we are finding is that we can cover the general learning issues at hand, and continue going to any depth we personally want to do. The thing is, only the depth that the group agreed upon will be what you are tested on.
I know it sounds hard to understand. But, while I worked at the University of Missouri School of Medicine, I saw every medical student there enter afraid that they were not going to learn enough through the PBL course, and that's all that was offered, only to discover as time went by that PBL is a great way to learn.
You have to learn time management skills. . . so start now! But, all in all, I can't imagine a better way of learning. And statistics show that those in PBL programs do as well, and often better, on their boards than those in SBL programs.
Part of being in the PBL track is trusting that those designing the program know what they are doing. . . . and I believe our Dean of PBL, who previously helped design the PBL at Ohio State, is one of the best! So when I get doubts, I just look at the others around me, look at how much I've already learned, and marvel at how much I am enjoying the learning process.
I hope this one wasn't too long. But PBL is a subject I love to talk about!
Its easy to see why you love PBL Linda. We start doing similar programs in 2nd year here. Its very rigorous and very intensive since they are already in the NHS hospital doing rounds and being responsible to do work up and stuff 2 days a week. So this year is our major class room year. We get a healthy dose of clinical scenarios in both Anatomy and throughout the day. Every class ends with 30 minutes of clinical information. You are expected to get it.
I do like what you are doing though…I'd trade ciriculums…
Got the midterm grade back. . . . 85. Not quite as good as I expected, but I'll take it. If I can just do as well on the OMT practical next week, I'll feel really good.
As to PBL, still loving every minute of it. Very thankful for my medical laboratory and research background. Can't wait to get to a case where my immersion in immunology will be advantageous!
Spent time at the clinic this week. Got to do a history, make a diagnosis, observe a colposcopy, do an eye exam, and sit in on an emergency visit with a sick 4 year old.
Not bad for my first block of med school, huh?!
Next week get to learn how to do ear, nose, and throat exams. I sure love having my doctor bag and all the goodies that go with it. You know, the ophthalmascope, the otoscope, the reflex hammer, penlight, and tuning forks. And it seems so much like the doctors kit I had when I was. . . . . oh, about 6. But this time the instruments really work!