"1-2 kids who do all the work, 2 kids flirting, 1-2 totally clueless, and another 1 goofing off [in reference to PBL]" this quote makes me giggle... as if people out there actually think med school is anything like high school... =P
PBL does get a mixed reaction out of students at VTC... but first, a little background on how everything plays out in PBL... you work with a small group of med students(7 total) and 1 facilitator... The cases typically are written to follow the course of a patient or 2 or 3. Monday(2 hours), you see what the patient presented with and it gives you the opportunity to properly formulate and discuss a differential and generate a list of tests you would like to run. On Wednesday(3 hours), you get test results back and you typically base presentations on a confirmed diagnosis. Friday(3 hours) is clean up where we finish presentations and receive last minute case details. Afterwards all students meet in a lecture hall to hold a discussion with patients, family members and physicians involved with the case in a no-holds-barred steel cage match of Q&A. This was the original layout... but some changes have been occurring based on student feedback:
-Students were bothered by having to individually put together 2 presentations a week spending 4+ hours on each. As mentioned, this really cut into study time. Recently, the school has been allowing groups to assign 1 presentation per student per week and allowing us to cater our presentation topics to be more comprehensive, high yield, and relevant.
-The school has organized a set of learning objectives(that are tested on during exam week) they feel you should get from the case and in the past, they wouldn't issue these until Wednesday leaving the groups to guess on LOs for the first set of presentations. Obviously, this would sometimes backfire and groups would present on half a weeks worth of topics irrelevant for the case. This has recently changed and groups have been receiving official LOs on Monday to accomodate the 1 presentation/week policy change. This has also made it easier to free up presentation time slots for groups to use for USMLE review or just go over topics the group was uncomfortable with from any aspect of the medical curriculum.
- Current discussions/complaints are varied and minor in my view... sometimes juggling 3 patient cases in a week(standard in second year) can be tasking and there have been some requests to tone down the case load (a request I am sure is going to be prevalent through our entire careers, ha!)... also, one of the more interesting discussion amongst the students is that PBL does not let the student "fail"... as in, no matter what, we will have the right diagnosis and treatment plan by the end of the week. Some of us feel that this format doesn't motivate us to be better doctors and that it might be more interesting to do away with case objectives and just let the group freely think through a case. They may not get it right the first 10 or so cases, but by the end of the 2nd year, I wouldn't be surprised if groups were batting a 1000 and the academic/professional value of that skill set would be unfathomably great!
- the rest of the criticisms really revolve around the dichotomy you will find in any med school... many students feel that studying for the boards is the ONLY priority and many of the students feel that learning clinical theory and method is the ONLY priority... you wouldn't think the 2 philosophies are mutually exclusive, but sadly, they are very much so... anyways, your USMLE crew typically avoids lecture and buries themselves in any number of board review books... ultimately, they generally don't get along with PBL because, well, PBL isn't necessarily designed to focus all of your studies on boards and that can be seen by some as time wasted. Your clinical crew typically has fun in PBL because its an oppertunity to play doctor in a safe, non-threatening situation! Take it for what you will...
Overall, PBL does have some critics, but I doubt anyone at VTC would say it was a complete waste of time(personally, I had good PBL days and bad PBL days... but overall, I am glad I did it). The material you focus on is typically very high yield for boards and practice. Further, the critical thinking and medical problem solving skill set you acquire is invaluable. One more subtle benefit that I would like to point out is that by working with new group members each block, you are taught how to not only deal and find benefit from people you would typically wish to avoid, but you also form some really strong professional and personal bonds with your fellow classmates. I know all 84(both classes) of my peers at VTC as if they were family. Take GDplastics for example. That guy is intense, driven, and extremely intimidating. Everytime that guy opened his mouth during our first year I had to sit back and rethink my career choices. Hell, that guy even makes some faculty feel out of their league! And, when I was assigned to a group with him, I was terrified. I mean, we all spend several hours putting together top notch 15 minute presentations not to impress faculty, but to perform at the level our group expects us too! Peer motivation is the name of the medical game and working with GDplastics would motivate anyone to feel like they had to already hold an MD and a few PhDs on top of that. Anyways, long story short, not only did I thoroughly enjoy working with him, but I feel I am a going to be a better physician because of it. You'll have a lot of stories like that in PBL.
One final note... Facilitators. You will have facilitators from a wide variety of fields. Clinicians, bio/biomed researchers, nurse practitioners, etc... In my opinion, they are doing their best to ensure that the group stays on track(which occurs naturally in most situations). I enjoyed getting clinicians that could provide little anecdotes of information as you proceed in the case. In the beginning, a lot of them were just trying to figure out their own role in the academic process and you would sometimes get a facilitator that would take over the group and really just get in the way. Today, you don't see that as much. They typically hang back, observe quietly and only interject if the group is way off track. Further, they can provide some great feedback to use to improve your presentation, research, and confidence skill set. In 2 years of VTC you will see 16 facilitators. Will all of them be great? Probably not, but I wouldn't be surprised if you had positive things to say about working with 15 of them.
anyways, sorry for the book... ramble on!
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