differences in organ-based, systems-based, pbl, etc.

[basha]

hi, im applying this june and wanted to ask u more about these differnet approaches used in med school. Can you tell me the most common approaches used by the majority of med schools. It would be helpful to know the pros/cons so i can decide which schools do apply to. I think so far organ-based approach is favored most by med students - seems to be the easiest since there is a mini-exam instead of one big one consisting of all the organs.

---

Members don't see this ad.

 

[LR6SO4]

I believe that most schools are very similar in the first year with standard biochem, physio, histo and anatomy courses, etc. I'm sure there are some schools that are organ based in the first year, mine is not. In the second year we have PBL that is systems based. I like it, we have one exam per system every 3-4 weeks. Of course each exam is like a final and pretty stressful as each system is one class. One shot to pass, that's it. The advantage from my point of view is that it makes sense to learn this way, ie to learn the microbiology, pharmacology, and pathophysiology of a given system all at once. For me it helps to integrate these ideas and hopefully will make me think like a doctor. I can't comment on schools that have a 'traditional' curriculum in the second year. Be aware though that while the first two years will be important, it is the last two that really count. Then you want to look for places with strong departments of whatever you are interested in, good times to schedule electives and stuff like this. Seriously check this out early even though it seems a long ways off. If they won't let you schedule any electives in the third year seriously think about it twice.

 

[basha]

Thanks LR6 for the helpful reply. Im still a little indecisive on which teaching and testing system is the most comfortable with med students. Its probably organ-based, but anybody wanna second that.

 

[BeeGee]

Systems based testing is exactly what you will face when you take the USMLE. Questions are no longer posed to directly i.d. the problem. Now, they involve the patient who comes in with a past medical history of hypertension, being managed with an antihypertensive med, and now presenting with complaints of a new onset cough.. what's going on? Make sure your medical school teaches you in a way such that you really understand that most illnesses effect the entire body in some way. My own school used a type of Systems based approach and I would recommend it be no other way. It was great and REALLY prepared me for my boards because of the example that I just described. And I've found that when managing patient problems, especially in Family Medicine and Internal Medicine, you must think entire body all of the time because the chronic hypertension will end up affecting the kidneys and so no Diuretics and so on and on and on. It is excellent that you know to look for these types of teaching methods before choosing what school you are going to. I did have some knowledge of different types of teaching during my interviews but couldn't foresee the consequences of not having a systems based approach. Guess I got kinda lucky. Good luck in your decision making. --BeeGee

 

[BeeGee]

Also, my test blocks were every 4 weeks. The example question above is too easy for what you will see for the USMLE, but because you aren't yet in med school I supposed that you might need an example that makes it easier to understand about systems based testing. Questions you will definitely encounter will be about the 52 yo pt with 12 yr history of hypertension, Type II diabetes, asthma and being treated with about 5 to 10 different medications... These examples on tests aren't made to make your med school life miserable although you will think so. I've found out, since the start of my clinical years, that these are TRUE stories for alot of patients. They deal with these problems everyday. So, that's my little soapbox for the IMPORTANCE of systems based learning... --BeeGee

 

[basha]

wow beegee!!! system-based really seems to be the only teaching system rite for me. I dont quite understand the 4 week testing block - it seems like every 4 weeks there is a test on a diff. subject, isn't it less harder on students to have a short test - one given every week or so, rather one big one every month.

Also, do med schools have several diff. testing approaches - depending on which subject - instead of just one approach throughout.

Thanks a million for the help Beegee, good luck to u too.

 

[LR6SO4]

In regards to the 4-week test block, I have that right now in 2nd yr. First year was a test pretty much every Monday morning (7:30am), and about 4-5 tests/class so you could bomb one and not have it matter too much. The tests once a month or so are BIG but so are the boards. I think that the way we approach the material it would be impossible to have a test every week without making it non-systems based. Only at the end of 4 weeks are you ready to answer integrated questions on the pharmacology, physiology, microbiology, pathology, and pathophysiology of a given system. So in other words to keep it systems based the 4 week test period works. And the tests are really long (100+ questions) so you can still get a lot wrong and still pass!

 

[Acro Yali]

My advice for PBL is know thyself before going to a school with a PBL curriculum. Lets just say its not for everybody.

 

[Scooby Doo]

Originally posted by Acro Yali:
•My advice for PBL is know thyself before going to a school with a PBL curriculum. Lets just say its not for everybody.•••


SO who does a PBL curriculum fit better to?

What type of personality?

 

[LR6SO4]

From what I have seen with PBL it would be hard to get a total view of it without trying it. People at my school often said they chose it because of the PBL. Many of those are now unhappy with it. Some found they like it, and others of us learned to like it. The main thing that I see is that you can only cover so much stuff in group. The cases in group don't give you what you need to pass the test, so you have to learn great deals of material on your own. And keep in mind that you don't get to choose who you work with, so if you don't get along well with others, are a gunner, and don't like sharing knowledge, you will hate PBL.

If you like more free time, you will like PBL. If you are undisciplined you will not like PBL. If you like reading textbooks, PBL is for you.
If you have a personality that 'clashes' don't do PBL.
If you need a professor to tell you everything and what is on the test, don't do PBL.

Hope that helped.

 

[basha]

Sounds like PBL is only for specific applicants, and that it takes up time which could be better spent learning the material on your own. And if a certain subject requires group studying, because of its shear complexity then one should form groups himself and get the most out of it that way.

In choosing which schools to apply to I've assesed that med students are most comfortable with organ-based approach in their 1st yr, and system-based in their 2nd yr. Apart from these two, are there any other things in the curriculum that differ from school to school. In other words, are there any other factors in the medical school which are worth looking into. Thanks to all for you helpful advice.

 

[Vader]

Originally posted by basha:
•
In choosing which schools to apply to I've assesed that med students are most comfortable with organ-based approach in their 1st yr, and system-based in their 2nd yr. Apart from these two, are there any other things in the curriculum that differ from school to school. In other words, are there any other factors in the medical school which are worth looking into. Thanks to all for you helpful advice.•••

What is the difference between organ-based and system-based approaches?

 

[Dr. Kermit]

Originally posted by basha:

Sounds like PBL is only for specific applicants, and that it takes up time which could be better spent learning the material on your own. And if a certain subject requires group studying, because of its shear complexity then one should form groups himself and get the most out of it that way.

In choosing which schools to apply to I've assesed that med students are most comfortable with organ-based approach in their 1st yr, and system-based in their 2nd yr. Apart from these two, are there any other things in the curriculum that differ from school to school. In other words, are there any other factors in the medical school which are worth looking into. Thanks to all for you helpful advice.[/QB]••

I may be mistaken, but from my recollection of tours of med schools and talks with med students, many schools (with the exception of those that have accelerated curriculums) have a very similar first year. In the first year, it is subject based. The classes are usually histology, physiology, anatomy, etc. Then, in the second year, it can be organ based. Students learn about the renal, digestive, cardiac, etc. systems but their classes incorportate pathology, pharmacology, etc. The other system is having pharmacology, pathology, etc. individually and having to learn each organ system within the class. PBL is usually incorporated into both the organ and subject based curriculums. PBL usually tries to get you out of the classroom and acclimated to working with others.

 

[Jeff698]

Originally posted by basha:
•Sounds like PBL is only for specific applicants, and that it takes up time which could be better spent learning the material on your own. And if a certain subject requires group studying, because of its shear complexity then one should form groups himself and get the most out of it that way. •••

I'm a first year at UTMB and we use PBL extensively (although not exclusively). The key thing to understand about it is that it is designed to encourage self-directed learning. In other words, you aren't supposed to be able to learn/answer everything in the PBL session. It is there as a way to present the case and share the information you have discovered (on your own) with others.

LR6S04 (I LOVE that screen name!) is dead on about a couple of things. If you have a malignant personality (I know, it isn't you, its everyone else) or are a gunner who doesn't work/play well with others, PBL certainly isn't for you.

I'm in my third PBL group now (we change each block) and each has had different group dynamics. I have to work with folks with different learning styles and different personalities. Sometimes I get annoyed. Of course, life is alot like that too. Dammit.

PBL also isn't the meca of all learning that the hardcore PBL-ites make it out to be. Our school uses it one of several approaches, including traditional lecture and lab. I think it is a valuable tool and, like most things in life, not to be over or underdone.

Take care,
Jeff
MS-I, UTMB

 

[LR6SO4]

Jeff,
I'm interested to hear more about how your school incorportates PBL in the 1st yr. My school is a 'hard core' PBL school, but only in the second year. I call it hard core because they were supposedly the inventors of it (at least they told us that at orientation--and Harvard stole it from us...). However we still have 6-7 hrs of lecture even in our PBL year versus 20 in the first year.

 

[Jeff698]

Originally posted by LR6SO4:
•Jeff,
I'm interested to hear more about how your school incorportates PBL in the 1st yr.•••

Howdy!

If you don't mind, where are your going to school? I ask b/c of the ongoing discussion of the origins of PBL. The most consistend I've heard of is McMaster.

Anyway, back to your question. It varies from block to block, but this is the general outline. We have three, two hour blocks per week for a total of 6 hours in small groups. Each day we're presented with multiple progressing descriptions of a patient.

The key for us is to generate 'learning issues' that help us understand concepts important to the case. For this, we are on our own. We have a faculty advisor there, but they are really there to facilitate, not teach. In fact, frequently they are from another discipline and we know more than they do.

At the beginning of each day, we discuss what we've learned about the learning issues from the previous day.

At the end of the second day, we're given a list of issues we should have covered. That's how UTMB ended up dealing with the issue of different groups covering different things. This is important since our exams have about 30% coverage from PBL.

Finally, we take an open book, group discussion quiz on at the end of the last day. These are typically 4-5 question quizes that take about an hour. Needless to say, they are not straightfoward, knowledge based questions. You really, really have to think and apply your knowledge to get the answer.

While these PBL sessions are going on (they are typically scheduled from 8 - 10 am), we have one or two lectures per day that address the general topic we working on in PBL. For example, we're doing immunology right now. our case is on type I hypersensitivity. In addition, we have two, two hour labs per week (with the obvious exception of anatomy which has much more lab). These are also aimed at the same issue as is being discussed in the PBL & lectures.

Again, our exams (usually two per block) are about 33% PBL, 33% lectures, 33% lab.

I hope this helps!

Take care,
Jeff
MS-I, UTMB

 

[basha]

Jeff - that sounds like a lot of work. I think going to lectures/labs can be vigorous enough for most medical students, except for the ones who really need to know everything possible on every topic. Those people like pbl because they obviously have the potential to all that and stay sane. I look to ease the challenges of medical school, although not by neglecting what is needed to make me a good doctor. Come june, i'll opt for the not so hardcore PBL schools, schools with blocks each week for the first yr and blocks each month for second yr. As tough as systems based is, it is needed since it helps for the step exams, and the first yr shouldnt be that bad if you got small exams.

 

[Jeff698]

Originally posted by basha:
•Jeff - that sounds like a lot of work. I think going to lectures/labs can be vigorous enough for most medical students, except for the ones who really need to know everything possible on every topic. Those people like pbl because they obviously have the potential to all that and stay sane. I look to ease the challenges of medical school, although not by neglecting what is needed to make me a good doctor. Come june, i'll opt for the not so hardcore PBL schools, schools with blocks each week for the first yr and blocks each month for second yr. As tough as systems based is, it is needed since it helps for the step exams, and the first yr shouldnt be that bad if you got small exams.•••

Even though the whole point of medical school is not to be easy, I think you may have a misunderstood something in what I've written. I don't think our curriculum (which is organ system based, by the way, these terms are not mutually exclusive) is particularly difficult. We're out of class before noon on at least 4 days a week and have plenty of study time. In fact, I can't really say that I've been all that challenged and I'm not that great of a student.

Some of the schools I interviewed at were almost straight lecture from 8 until 5 every day. That includes schools that had an organ-based curriculum and schools that had a straight topic based curriculum. Being in class that long and then having to come home and study all night long strikes me as pretty hard.

BTW, there are certainly a lot of people who prefer lecture based curricula to those with PBL in it. It lessens the need to apply and synthesize knowledge and increases the emphasis on memorization but is much more like undergraduate coursework than our curriculum.

The key here is that everyone should really understand the various curricula before deciding.

Good luck with school wherever you decide to go!

Take care,
Jeff
MS-I, UTMB

 

[basha]

Jeff - As I understand it PBLs good point is lesser class time and more study time. And its not-so good point is the work that the student must do himself/herself. But does it work for the majority of students? which curricula isn't too harsh on the students ? I would appreciate your insight on this. Thanks for the help so far and good luck in your endeavors as well.
- Syed

 

[LR6SO4]

basha, I'll chime in here too:
As I understand it PBLs good point is lesser class time and more study time.
-This is true, but the whole point of PBL as Jeff stated is to integrate knowledge in a way that applies to a clinical case, just like a doctor does.

And its not-so good point is the work that the student must do himself/herself.
-Very true. If you're like me it means basically reading everything twice, once to get an idea of it, once to learn it. PBL schools do give you a very detailed view of what is needed to know though, basically ALL of Robbins Path for every domain plus other relevant pathophys and pharm stuff.

But does it work for the majority of students? which curricula isn't too harsh on the students ?
-People don't leave medical school very often at all. Few people fail out, once you're in they try to keep you the best they can. So both work just fine. I know some research was done a while ago on PBL vs. non-PBL and board scores. I really wish I remember what the results were though! Obviously if PBL didn't work people wouldn't pass the boards and schools would have abandoned it a long time ago. In the last several years though more and more schools are incorporating PBL somewhere into curriculums. Which isn't too harsh on students? Same material, same harshness, different ways to learn it. Personally I got nothing out of day long lectures first year. If I showed up for lecture having read something about it, then it was great (but my butt still got sore!). Otherwise lecture to me is just taking notes. Same thing for PBL, show up unprepared and you'd be better off staying home. You will effectively waste 2 hours of your time. On another note the group dynamics of PBL can be great or really bad depending on personality. If you don't want to share and explain things then you won't like PBL at all.

 

[Jeff698]

Howdy Syed!

Mr. Eye Movement (have I mentioned I love the LR6SO4 name?) pretty well nailed it. You get out of any curriculum what you put into it.

The deal with board scores as best as I understand it, is the traditionally PBL schools do worse on Step I and better on Step II. I think this probably reflects the various clinical foci on these exams. Of course, everything I've read says the exams are moving more and more toward clinical vignettes. This is probably why more schools are adopting PBL (that and the whole trendy thing).

The interpersonal dynamics thing is certainly true. Fortunately, I've been lucky so far but can see how it could get ugly.

Another thing about PBL is it is less structured so you have to decide more on your own what and how to study. Most of the time I like that but every so often I get really tired and just want someone to say "learn this!".

PBLs, for me anyway, increase my interest level in what would otherwise be painful. Take ELISA for example. If I couldn't see the use for that test, I'd never learn it. My undergrad biochem is proof of that. Now that I have a better understanding of where it fits in the clinical picture, I can tolerate it better.

I did, however, have a clinician leading a discussion group the other day who had a beautiful Freudian slip. When asked how she would test for some obscure lab finding, she replies (with an absolute straight face):

"Oh, that's easy! I draw the blood, fill out a piece of paper and send it to the lab. They send me another piece of paper with the results on it." God, I love that woman!

I think the most important thing to focus on when picking a school is where you will feel most comfortable and be most happy. You'll be able to do fine wherever you go. Just pick a place where you won't end up on Paxil before you graduate.

Take care and good luck!
Jeff
MS-I, UTMB

 

[basha]

thanks LR6 and jeff for both of yours help. I guess PBL works just as fine as all other methods.

 

[Cameron]

Originally posted by basha:
•thanks LR6 and jeff for both of yours help. I guess PBL works just as fine as all other methods.•••


Basha, I'm a little late chiming in on this thread but couldn't resist. I'm in my 1st year at Ohio State and am a part of the PBL curriculum. At OSU we have 3 pathways to choose from: Lecture, Independent Study, and PBL. There has been no statistically significant difference in board scores over the past 10 years. I comes down to choosing what learning style fits you best. If you work hard, you'll do well. The descriptions of PBL in this thread have been accurate with my experience as well. It works for me!

 

[Starflyr]

Im going to chime in too....(Hi Jeff!)

To decide what curriculum is right for you, determine how you learn best. Are you good a rote memorization? If you are, perhaps a "traditional" lecture-based curriculum would be better for you. Are you good a grasping concepts and figuring out details as you go along? A PBL-based curriculum might be good. Are you good at disciplining yourself to go do some self-directed learning? If so, PBL, if not, traditional.

As to organ-based vs not-organ based, I think that its kind of incidental which you end up with. I personally like our organ=based approach, mostly because it takes learning more out of the realm of "stupid and theoretical" (i.e. straight biochem) and more into "something with cool clinical correlates". I mean sure, you need to have some basic stuff first, like anatomy and what we call MCT (biochem, molecular, cell, histology, etc), and of course patho, but here at UTMB they do a good job of correlating even this to clinical stuff (i.e. anatomy comes with radiology). Go to the schools, ask about the curriculum. Talk to the students - do THEY like it? What kind of person are you? Are you ok with being in class 8 hours a day? compare your personal "ideal vision" with what the schools offer. In any case, you will still get a good medical education, whether or not its PBL, traditional, organ-based or not.

Star

 

[basha]

this is really cool info so i'll bump it up for other to check it out.