Ok, this is in response to the PBL discussion over in Efex101’s wonderful Mayo thread. I just didn’t want to hijack that thread, so I’ll ask this here.
How can I tell which schools are really dominated by PBL and how good a job they do of it? Nearly every school I’ve read about or applied to seems to offer some version of it. Also, a lot of schools are emphasizing how they integrate different subjects such as basic and clinical sciences, or how they teach on an organ basis.
Is there some kind of insider’s guide where I can get the low-down on what all this really means? To be honest I’m scared of PBL. I’m not even sure how integrated I want things to be. But then I don’t really know. Another thing I’ve noticed is how often schools seem to be changing their curriculum. A lot of them emphasize the point that students have great input into discussions of curricular change. But my question is, why should things change so often? Isn’t there some tried and true basic medical curriculum that over time has been proven to really work, with adaptations here and there of course? If not, how were things different in the past that I should be aware of when I am comparing the newer curriculums?
I haven’t really found the brochures from schools to be too helpful in answering these questions, which I’ve had for awhile. So I thought I’d throw this out there.
I knew that PBL was just not going to be my cup of tea and from my understanding schools like Yale are heavy on PBL where there is hardly any class time BUT you have to dig stuff yourself and find out things on your own. Obviously these students do well but it is not for me. I like the way that I am used to from undergrad going to class getting good handouts and learning from that. Joe replied to my post and saying that to have a good PBL it needs to be done right now what schools do it right…no clue maybe Joe knows. I just know that first of all how much detail do you need to know from PBL? what will be tested by your exams and on the USMLE? how do you know of your colleagues dug deep enough or maybe were caught up in too much minutiae? you can control what you do but you cannot control the other folks…
I think PBL’s are fun and the learning is much more high yield than lecture. (If it’s appropriately integrated)
First, you learn how to solve medical problems. Second, you can begin to understand why carbohydrate metabolism, for example, is important to medicine. Third, you get to look at clinical work ups and apply them to the lecture knowledge you are learning.
However, there are times when I find the sessions useless and could have been directed better.
That having been said, I would think that schools that do it all the time are better at it than schools that do it to supplement their curriculum. Don’t be afraid of it though!
At worst it’s a chance to work face-to-face with your classmates in a fun and challenging environment. At best, you can gain valuable skills and learn clinical information in your very first year.
Danielle
Quote:
A lot of them emphasize the point that students have great input into discussions of curricular change.
Input into discussions does not mean ability to implement change. I can only speak for Minnesota - Twin Cities campus. The process is more similar to a slight change of the boat’s rudder to stay on course than a complete change of direction. As an example, a course director proposed removing weekly review sessions. Students countered with requests to keep the sessions, but change the format. Ultimately, the Curriculum Committee, using the students’ and the professors’ input, will probably decide the fate of the review sessions.
The best way to determine if PBL is a major teaching methodology at a school is to ask. Most medical schools have a Dean or Associate Dean of Education. Your student tour guide will also be able to answer, or you can post the question here.
As for UMN-TC, there’s almost no PBL here. We do switch from a traditional first-year curriculum to a system-based second year curriculum - thankfully. I find it much easier to connect drugs to histology to physiology to pathology when everyone is forced to limit their discussion to the cardiovascular system.
HTH
Susan - Chicago/Minneapolis
former Ed Council member
More about problem-based learning.
Problem-based learning is the idea that people learn better when working through a real problem than simply getting facts to learn. That is, when you can apply knowledge you remember it better. And, when you solve problems again and again, you get better at solving problems. (The simple corrolary is in the pre-med classes like physics and chemistry where the only way to succeed is to solve problems again and again.)
Small student-directed tutorials are not the most efficient way to impart information. Their supporters wouldn’t claim that they would be. On the other hand, lectures are not the best way to teach people to solve problems.
One of the problems with problem-based learning as it is sometimes practiced is that it is easier for everyone to think about the test coming up, and teachers and students alike can begin to orient themselves towards what’s important for that particular class and not for their careers as doctors. For instance, my fellow students and I regularly shut down the expansion of our differential diagnoses with a quick, “But it’s gastrointestinal month, so that’s not going to be the problem.” Obviously not a good way to think about medicine. And not a good way to solve problems. Like solving for x on a multiple choice algebra test: x= one of four possibilities.
As I started to spend more and more time in the hospital at the end of second year, and now that I’m totally in clinics and the hospital, I appreciate more and more the value of expanding out the differential and thinking through problems thoroughly. If anything, I wish I’d had more challenging problem-based learning courses; and I wish I’d spent more time studying; but one thing I definitely do not wish I had more of is lectures by med school professors. On the other hand, my USMLE 1 score sucked. My curriculum didn’t prepare me well for it, and unlike many of my very disciplined counterparts, I didn’t prepare particularly well for it on my own.
So, as a third-year, I often feel inadequate in what I know; but I often feel that how I think and how I approach problems may yet become my greatest strength. Still working on it, though.
I can’t believe how challenging it is to think through real clinical problems in the hospital. I wish the first two years of medical school were better at equipping us for doing it. I think problem-based learning is one reasonable attempt to do so.
cheers
joe
I’m in the midst of my fourth year at a heavy PBL school (UTMB in Galveston). It has been so long since I thought much about the first two years it is hard to realize how much PBL helped. The vast majority of the students I work with (I’m doing the third of my four away rotations this month) have the same basic knowledge base as I do. I feel much better prepared, however, for doing FOCUSED research to answer clinically appropriate questions that come up while caring for patients.
As an example, I saw a patient in the ED the other day with right lower quadrant pain radiating to his lower back and gross hematuria. The top two on my differential were appendicitis and kidney stones. The question came up about the best approach to imaging. You traditionally need a CT with contrast to diagnose the appy and a CT without contrast for the stones. The problem is the oral contrast takes, approximately, forever to get in a patient. After a quick pubmed search, I found that the sensitivity for non-contrast CT is actually fairly high for appendicitis. I think my background in answering this type of question frequently in PBL helped. Not that it helped convince the radiologist, but that’s another story.
UTMB does a hybrid PBL-lecture curriculum and I think it works well. We do about 9 - 12 hours a week in PBL and about 8-10 hours per week in lecture with another 8 or so in lab. I think that’s a nice balance.
The thing to remember about Step I is that, with few exceptions, nobody feels comfortable for that thing regardles of where you went to school or the type of curricula you had. It is designed that way on purpose. Hit the review books and do lots of questions (QBank, anyone?) and it really won’t matter much how you learned, just that you did learn.
Good luck!
Jeff
This is an excellent question. I often hear people talk about “PBL” versus traditional. I also sense from these people a negative connotation with traditional. Don’t get me wrong - I really don’t enjoy sitting in a large classroom being lectured at, but my worry with PBL is that because it student-directed, it is easy to shirk responsibility.
I’m the type of person that I’m not the most disciplined, although I try, but I’m just not the most structured naturally and I find that I really need the system to impose structure on me. You’d think that I’d flourish in an environment that is not structured (sort of like the Montessori mission of education), but I find that if left to my own devices, I tend to put in as little work as possible to get it right.
Also, even in my premed lectures, I’ve seen how one student can derail a class because of their tangents or their need to take the class one step further. What happens if the person leading the tutorial misses the mark? I hate it when I or someone else asks a question in class in a student interrupts the professor and tries to answer the question. I didn’t ask another student…I asked the professor!
Anyhow, it seems like I’m pretty opiniated and favoring traditional medical school education in this post, but I’m not sure I actually understand what PBL is. Could someone break it down for me?
PBL translated, of course, is “Problem-Based Learning.” But there seem to be as many iterations of it as there are medical schools using it. I have heard of schools with a “PBL-based curriculum” – they seem to have figured out a way to structure the entire medical school knowledge base in a PBL sort of format. I don’t have any experience with that and so can’t comment on how it works. I believe that Jeff Jarvis, MS-4 at UTMB, and Linda Wilson, MS-2 at WVCOM, are in PBL-based programs and hopefully at some point they’ll emerge to give their viewpoints.
I think my experience is more common. At GWU we had mostly traditional lecture-based education in the first two years. However, we had a catch-all course, “Doctor, Patient and Society,” which encompassed physical diagnosis, interviewing, informatics, and small group sessions that were labelled as “PBL.” In our PBL sessions we were given case studies and had the opportunity to address all the different aspects of a problem - from the hard science to the social services.
The problem with these sessions was their uneven quality due to group dynamics and faculty participation. There were groups where faculty really pushed the students to address all aspects of a situation - “biopsychosocial” - and then unfortunate groups like mine where the faculty mentor was a basic science geek and didn’t give a flying fajita about psychosocial “crap.” (His words) This despite the fact that the cases were CLEARLY written to address psychosocial issues… oh well. (Hey, I’m outta there! 
)
One thing particularly good about our PBL sessions, which were two hours once a week with a new case every 3-4 weeks, was that the conclusion was a large group presentation where someone who’d actually experienced an illness or issue like that presented in the case would come and talk to us. So we had a person with sickle cell disease, for example; one of our deans actually came and talked about his experience of getting tuberculosis while a resident (!!), and I was one of the panelists for a discussion about depression.
Anyway, looking back on it, PBL was useful for teaching me how to quickly search the literature and come up with a ton of information, then winnow it down to a presentable format. This is a skill you will find VERY useful in third and fourth years… and it’s something you’ll have to do as a practicing physician 'cause you never have time to immerse yourself in everything written about a particular problem.
And I think PBL really hammered into us early that EVERY PATIENT has “biopsychosocial” aspects to his/her situation. You cannot ever forget that. And the good docs I know, whether they’re surgeons or FPs, always keep that in mind.
Anyway, back to the original question: you can’t assume a dang thing about what “PBL” means when you see it mentioned in a school’s literature. You’ll have to find out what THEY mean by it when you go there and find out more about the school.
Mary
Yes, I’m still here. Sorry I have taken so long to get into this discussion.
I began PBL here at WVSOM in the first year it was offered as a curriculum. Here we have 84 students in SBL (systems-based [lecture] learning) and 21 in the Class of 2007 PBL, with 24 in the Class of 2008.
The advice I would give to those considering PBL is that you must have good time management skills and be able to keep yourself focused on your studying. While we only meet in groups for 2 hours a day, 3 days a week, we leave each of those meetings with learning issues which we have determined. There are usually four or five different issues which will require a good amount of time spent on them. While time spent studying varies from student to student, I spend about 8-10 hours a day studying during the week, and usually about 20 total hours on the weekend, including some catch-up time for issues I don’t yet feel comfortable with and some board review time, which I feel is mandatory as boards are coming up in June. (I don’t want to wait until the last minute and get caught with my pants down! 
)
Mary is absolutely correct in saying that PBL is great for learning how to research subjects quickly and efficiently. When you don’t have professors notes handed to you on a subject, and you have to find the material yourself, you soon learn just how to do so.
For me, PBL is a godsend. It really does make it easier for me to maintain interest in a subject when I can correlate it to a particular case. And I have found that I retain information much better, and am able to correlate it to other medical situations as well.
Our learning issues are based on a pyramid with a foundation of osteopathic principles, proceeding up to psychosocial issues, systems, tissues, cellular, sub-cellular and molecular levels. The one thing we always try to remember as we are studying the basic sciences is to NOT forget our patient. What are the family, social, economic, religious, cultural effects, etc., on her medical condition? Are there methods other than medications or surgery that might be useful in treatment? And so on.
We started getting clinical experience within the first month of school, spending 2-3 hours a week with a physician. This was not shadowing. We were expected to examine patients, discuss our findings, etc. As time went by, many of us began writing our SOAP notes and, if osteopathic manipulative treatment was called for, we would be allowed to provide it (under supervision, of course).
I believe this program prepares us well for our third and fourth year rotations. We will be comfortable with patient interviews and exams. We will be able to write up progress notes without too much hesitation. And we will be able to communicate with our preceptors/attendings in a professional manner.
If you have any questions about the PBL here at WVSOM, don’t hesitate to email me! I loved it when I began last year, and I still love it today! 
Jumping in late on this thread, but here is my two cents worth, now that I’m in third year and can reflect back on the curriculum a little.
At MSUCHM we do the first year in the traditional lecture style (although we have several small group sessions on various topics, plus Clinical Skills), and then second year is PBL on M,W,F, with lectures from 8 or 9 until about noon on Tues and Thurs. I liked PBL, but it did require a lot of independent learning. However, now in preparing for Shelf exams on rotations I find the PBL method was helpful, because I use the same study methods I used for PBL. Not that my study techniques were necessarily the ones recommended by the PBL faculty!
So after a year of studying from traditional lectures and a year of PBL, my opinion is that it was easier to prepare for class exams with the traditional lectures (I knew what I was expected to know, while with PBL I always wondered if I’d covered all the right stuff) PBL prepared me more for studying for third year exams.
As far as Step 1 goes, I don’t really think either curriculum has much advantage, based on what I’ve seen on this board, and talking with students from other schools. I felt I was prepared by the curriculum, and I used my PBL systems style approach for boards, and it worked quite well for me.
Epidoc
Wow, these responses are really helpful! Thanks everyone for chiming in.
I’ve interviewed at a few schools where PBL is a huge part of the curriculum, and at some others where it is designed more to complement lectures and clerkships. Hmmm… how I feel about it depends on the way it’s organized, and also what kind of mood I am in that day.
At one school that’s almost entirely PBL I was super impressed–the groups were small, there was ample faculty supervision, and from the sound of it, the cases were pretty interesting, which seems a lot better than having to learn the stuff by slogging through chapters in books and lecture notes. Students got to change groups every quarter too which I see as a plus. At another school we had a sample PBL session, and I found it pretty interesting.
I love to investigate things on my own or in a group, so that part of it I think I’d like. Also I can see where PBL would help me bring information together in a way that relates to a patient’s situation. So the whole “integration” idea is starting to make some sense.
On the other hand I hate disfunctional groups. I have come to the conclusion in life that most groups tend to be this way. If I got stuck in some haywire group I’d go crazy. Also, if this is going to be a place where particularly outspoken students talk all the time, that too would bug me. Then there’s the risk that I’d end up BEING that member of the group, always racing to get the answer… 
Or if it’s a totally unregulated environment in which one person’s bias dominates everything (say some prof who has a particular slant on things)… In those cases I’d prefer to just hit the books on my own or sit through lectures. I’m not a big fan of handouts actually–I like books better, although that’s a minor point.
Well, enough rambling. I think I’d probably find benefits to either type of curriculum. It’s hard to figure out which style of learning I would most enjoy for the next few years. I also don’t want to be in class every day from 8 to 5. One school I interviewed at has classes starting at 9. If only I could find a school that combined 9 or 10 am classes with getting out at 1 or 2!
Thanks again!