Does anyone out there actually enjoy TBL?

Burrell College of Osteopathic Medicine
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PL198 said:
How do you guys trust each other for these things to work? I'm sorry but I don't buy into the concept of other students looking out for my benefit and I SURELY would not trust that to happen. I specifically have had students in my class do things to cause others to perform worse. These concepts seem *****ic to me as a student isn't going to know what is important nearly as much as an instructor. Not to mention you could have a rainman kid in your group who magically thinks nothing in the lecture is worth covering since it's all "so easy" and then you get nothing or very little.

I'll add that I absolutely have groups that I study with and share resources, but in terms of being assigned randos or even trusting the people in the groups I pick to tell me what is important, no way jose.
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We have a pass-fail, competency based curriculum so there isn't really any competition. I haven't heard a person yet complain about their group or TBL in general in my class, and my group is like family, they're super awesome. I really think we've got kind of a unique thing going though, largely due to the student selection process. Team players and people ingested in primary care are what they look for. There's like, three kids goal in my school that are interested in surgery and a small handful that are interested in competitive specialties. A bunch of people wanting to do peds, FM, geriatrics, PM&R and psych, about a third of whom want to practice rurally, doesn't really make for a cutthroat environment.

My table is going for IM, pedsx2, EM, and Psychx2. We don't give a fuark.
 
I haven't had any exposure to TBL stuff yet, but we have had group discussions on ethics issues. I always hated team-based stuff as an undergrad, but it turns out it's a lot more interesting when everyone in the room is smart. Go figure.
 
Mad Jack said:
We have a pass-fail, competency based curriculum so there isn't really any competition. I haven't heard a person yet complain about their group or TBL in general in my class, and my group is like family, they're super awesome. I really think we've got kind of a unique thing going though, largely due to the student selection process. Team players and people ingested in primary care are what they look for. There's like, three kids goal in my school that are interested in surgery and a small handful that are interested in competitive specialties. A bunch of people wanting to do peds, FM, geriatrics, PM&R and psych, about a third of whom want to practice rurally, doesn't really make for a cutthroat environment.

My table is going for IM, pedsx2, EM, and Psychx2. We don't give a fuark.
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Is it "true" Pass-Fail?
 
Our school separates us into groups of 8 with one outside physician as our mentor (e.g. ours is an orthopedic surgeon). He gives us a case on Mondays and we have to work together as a group through the week and come back on Friday and tell him what we would do (what tests we would order, what we think the diagnosis is and why, etc.). I actually really don't mind this because it only takes up 2 hours on Monday and 2 hours on Fridays which really isn't that bad. We also have iRAT and tRAT coming up but it's only for biochem and genetics which I think is nice that it's not for everything. (Downside of my school is we actually go 8-4, 8-5 Mon-Thurs and half day Fridays, so it's not like we get the extra time during the day to study more anyways.)
 
DermViser said:
Is it "true" Pass-Fail?
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Half the curriculum is P/F, half is graded in the traditional H/HP/P/F way. I'll have to ask if they report class rank- I honestly don't know. Generally though, making your groupmates poorly prepared would be a bad idea- 40% of your medical science grade is team-based, so you really stand to lose a lot of your team performs poorly.

The competency based curriculum is rough though- if you miss a single competency question, you have to meet with the faculty to discuss why. If you miss multiple ones, you have to do a remedial oral exam. Theoretically you could score in the 90s and end up in remediation because you are hurting in key concept areas. So there's my curriculum's dark side.
 
Mad Jack said:
Half the curriculum is P/F, half is graded in the traditional H/HP/P/F way. I'll have to ask if they report class rank- I honestly don't know. Generally though, making your groupmates poorly prepared would be a bad idea- 40% of your medical science grade is team-based, so you really stand to lose a lot of your team performs poorly.

The competency based curriculum is rough though- if you miss a single competency question, you have to meet with the faculty to discuss why. If you miss multiple ones, you have to do a remedial oral exam. Theoretically you could score in the 90s and end up in remediation because you are hurting in key concept areas. So there's my curriculum's dark side.
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What competency questions?
 
DermViser said:
What competency questions?
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I'll PM you a list later. There's 314 critical structures we have to know for this exam. To give you an idea, for muscles you have to know origins, insertion, blood supply, function, nerve innervation, common injuries and how to assess them, and cranial levels that supply each innervating nerve. Miss one question about any of the above, and you're gonna have yourself a competency meeting. Get nervous and answer five or six wrong out of the 200ish questions on the written and practical exam and you've probably landed yourself a remediation. I don't know how lenient they will be with remedials, since this is the first year of the curriculum being set up this way.
 
Mad Jack said:
I'll PM you a list later. There's 314 critical structures we have to know for this exam. To give you an idea, for muscles you have to know origins, insertion, blood supply, function, nerve innervation, common injuries and how to assess them, and cranial levels that supply each innervating nerve. Miss one question about any of the above, and you're gonna have yourself a competency meeting. Get nervous and answer five or six wrong out of the 200ish questions on the written and practical exam and you've probably landed yourself a remediation. I don't know how lenient they will be with remedials, since this is the first year of the curriculum being set up this way.
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WHAT IS THIS TORTURE YOU SPEAK OF
 
Mad Jack said:
I'll PM you a list later. There's 314 critical structures we have to know for this exam. To give you an idea, for muscles you have to know origins, insertion, blood supply, function, nerve innervation, common injuries and how to assess them, and cranial levels that supply each innervating nerve. Miss one question about any of the above, and you're gonna have yourself a competency meeting. Get nervous and answer five or six wrong out of the 200ish questions on the written and practical exam and you've probably landed yourself a remediation. I don't know how lenient they will be with remedials, since this is the first year of the curriculum being set up this way.
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That is ridiculous. A competency is not a multiple choice question.
 
Mad Jack said:
I'll PM you a list later. There's 314 critical structures we have to know for this exam. To give you an idea, for muscles you have to know origins, insertion, blood supply, function, nerve innervation, common injuries and how to assess them, and cranial levels that supply each innervating nerve. Miss one question about any of the above, and you're gonna have yourself a competency meeting. Get nervous and answer five or six wrong out of the 200ish questions on the written and practical exam and you've probably landed yourself a remediation. I don't know how lenient they will be with remedials, since this is the first year of the curriculum being set up this way.
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What the ****
 
Mad Jack said:
I'll PM you a list later. There's 314 critical structures we have to know for this exam. To give you an idea, for muscles you have to know origins, insertion, blood supply, function, nerve innervation, common injuries and how to assess them, and cranial levels that supply each innervating nerve. Miss one question about any of the above, and you're gonna have yourself a competency meeting. Get nervous and answer five or six wrong out of the 200ish questions on the written and practical exam and you've probably landed yourself a remediation. I don't know how lenient they will be with remedials, since this is the first year of the curriculum being set up this way.
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That sounds like an inefficient and torturous way to ensure student competency. Since you said most of your class goes in to low competition residencies, I ask why? Why torture your students without outcomes that justify it?
 
DermViser said:
Maybe that's why the school has mostly primary care - bc they prepare people so badly for boards.
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They prep us pretty well for the boards from what I gather- our board pass rates are higher than average and students have zero complaints in that regard. Who knows how it'll be for us though, we're the guinea pigs for the new curriculum.
 
Mad Jack said:
They prep us pretty well for the boards from what I gather- our board pass rates are higher than average and students have zero complaints in that regard. Who knows how it'll be for us though, we're the guinea pigs for the new curriculum.
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Passing isn't usually the issue. It's the actual school average that matters - depending on your goals.
 
xffan624 said:
That sounds like an inefficient and torturous way to ensure student competency. Since you said most of your class goes in to low competition residencies, I ask why? Why torture your students without outcomes that justify it?
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I don't know how bad the competency based stuff is going to be, so I'll have to get back to you on how torturous it is. Right now it seems really terrifying though. Who knows, maybe they'll just be like "hey, why'd you call the coracoid the coronoid?" "Oh my bad, I was just nervous" and that's the end of it. Personally I'd rather just have a good 'ol "get 70% and pass" curriculum.
 
lol wut. if you miss 6 facets of a 312 question exam which each have multiple facets, you have to repeat the whole class? ummmm
 
PL198 said:
lol wut. if you miss 6 facets of a 312 question exam which each have multiple facets, you have to repeat the whole class? ummmm
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This can't be right. If missing a couple minutiae out of hundreds warrants remediation/repeat then nobody would ever graduate on time.
 
Mad Jack said:
I'll PM you a list later. There's 314 critical structures we have to know for this exam. To give you an idea, for muscles you have to know origins, insertion, blood supply, function, nerve innervation, common injuries and how to assess them, and cranial levels that supply each innervating nerve. Miss one question about any of the above, and you're gonna have yourself a competency meeting. Get nervous and answer five or six wrong out of the 200ish questions on the written and practical exam and you've probably landed yourself a remediation. I don't know how lenient they will be with remedials, since this is the first year of the curriculum being set up this way.
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You must go to school in the tenth circle of hell.
 
Mad Jack said:
We do cases three times a week, which takes up like five hours total, and we actually learn a lot by thinking through the problems and explaining what is going on to one another. My school is sort of unique though- their selection process is extremely personality based, so we've got a very awesome mix of friendly people that work well with others. If my group had even one gunner or argumentative/stubborn person, TBL would be the worst thing in the world.
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You are lucky because it's hard not to find a gunner or argumentative/stubborn person in group of 5 or more students in med school. I absolutely HATE TBL
 
We have 6 hours a week, and so far, I like it. It's a lot more interesting (and for me, sticky) to apply the details I'm learning in lecture to an actual disease or disorder than to make flash cards. I like the connections we're making between discrete topics - I simply don't know enough to make those connections on my own yet.

People have different learning styles (I personally tune out of didactic lectures unless they're taught really, really well), and I think the fact that my school is true pass/fail makes a lot of difference in my comfort level as well.
 
Dylasa said:
We have 6 hours a week, and so far, I like it. It's a lot more interesting (and for me, sticky) to apply the details I'm learning in lecture to an actual disease or disorder than to make flash cards. I like the connections we're making between discrete topics - I simply don't know enough to make those connections on my own yet.

People have different learning styles (I personally tune out of didactic lectures unless they're taught really, really well), and I think the fact that my school is true pass/fail makes a lot of difference in my comfort level as well.
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Maybe bc you're older?
 
My school has PBL 3x a week. Monday we get two cases for two hours and we make LOs, wednesday we do case 1 for two hours, friday we do case 2 for two hours. Two hours of science lecture mon-thurs, with humanities and clinical skills sprinkled in.

I like the PBL sessions because like others have said, it helps you apply things learned in lecture and makes you go and research things that you don't know. I primarily use Robbins and I feel that I'm learning a good deal more about medicine than I would have if we didn't have PBL.

TBL on the other hand... Hate it. We've had two TBL sessions and no one liked them. I'd rather have lectures on the material and do whatever case study or group game as a review on Friday.
 
Awared said:
My school has PBL 3x a week. Monday we get two cases for two hours and we make LOs, wednesday we do case 1 for two hours, friday we do case 2 for two hours. Two hours of science lecture mon-thurs, with humanities and clinical skills sprinkled in.

I like the PBL sessions because like others have said, it helps you apply things learned in lecture and makes you go and research things that you don't know. I primarily use Robbins and I feel that I'm learning a good deal more about medicine than I would have if we didn't have PBL.

TBL on the other hand... Hate it. We've had two TBL sessions and no one liked them. I'd rather have lectures on the material and do whatever case study or group game as a review on Friday.
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You have 8 hours of science lecture a week?
 
PL198 said:
You have 8 hours of science lecture a week?
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Monday: 2 hours PBL, 2 hours science
Tuesday: 2 hours science, 2 hours humanities
Wednesday: 2 hours pbl, 2 hours science, 3 hours clinical
thursday: 2 hours science, 2 hours patient centered
friday: 2 hours pbl, 1 hour patient visit, 1 hour review.

8am-12noon most days. Science classes aren't mandatory, but the PBL/humanities/etc are mandatory. This is for our first block at least.
 
TheShaker said:
This thread is 80% for me to rant about how much I hate TBL and 20% to see if there are others out there who hate it.

Seriously, I don't understand why schools everywhere are jamming their curriculum chock full of TBL. My school does at least two TBL days every week, totaling to about 6-8 hours in class and even more of preparation. I'm pretty sure my entire class unanimously hates the living hell out of this crap but the school feeds it to us by the spoonful for some unknown reason.

I find TBL to be a waste of time. Having a bunch of unqualified MS1's try to deliberate and teach each other the material turns out to be an unproductive mess. We either unanimously agree on one choice or have half hearted debate only to find out that all of the answers are right or wrong and none of this stuff is even relevant because it's too dumbed down to be practical in real life anyway. Now, I know, there are plenty of grey areas in medicine but this is not helping us learn the material. This entire week my team, and probably a lot of other teams, spent the entire session watching youtube videos, playing around on Reddit, and complaining about the stupidity of TBL via the Facebook group.

What I hate most is that nobody gains anything from this madness. If studying for med school is a full time job, then a TBL session takes away half of your workday during the most productive hours of the day. A TBL session takes away time that I could use to nail down 2-3 lectures. The preparation time itself takes away even more time, making it almost an entire day of studying wasted!

Why are medical schools everywhere so insistent about getting this TBL stuff into their curriculum? Do people out there actually like it? Is it actually helpful to our education or are they just trying to please the LCME?
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I haven't met a single classmates including myself that likes them.
The incoming first years were subjected to two weeks straight of TBL and I did not envy them.

It's funny how all schools seems to be trending towards them, when there seems to be an unanimous dislike of TBLs. As a professor said, the one or two schools that established these new techniques may have done it well. Then other schools try to do it too, but they don't make the necessary changes with the professors and the curriculum, so it just ends up being not effective and a waste of time.
 
I found all my PBLs so far to be great. But I agree that it's highly variable based on group competence/intelligence/how many ****s are given.
 
DermViser said:
Maybe bc you're older?
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Maybe... although, I kinda doubt it. The reason my school has chosen to explain this curriculum makes sense to me, though. It's not like we leave medical school and are set up for the rest of our careers in terms of knowledge base. Heck, by the time we graduate, a lot of what we're learning now will be bull****. We do actually have to learn how to get the newest information ourselves, without being spoonfed. This is part of being a bad ass professional, and it is something most people learn how to do in residency. However, it's a steep learning curve when you're also trying to figure out how to not kill your patient. Anecdotal, but I used to tell my mentees that if they didn't know how to do something, I didn't want to hear about it until they had exhausted their resources in trying to figure it out for themselves. I'm sure some of them thought I was being lazy (lolz), but in reality, I was trying to teach them how be self directed, curious and confident in their own knowledge base. Their research attendings thought they were outstanding.

I highly doubt that anyone is forcing schools to adopt this for ****s and giggles. The data that I read showed that in a quality program, students did as well as those in a didactic program, but tended to be happier, graduate on time and go into primary care, the last of which I'm betting is the goal. Not as anecdotal, let me link you up with a little fresh data from the google search I just did, yo... 😉

http://www.nature.com/srep/2014/140530/srep05126/full/srep05126.html
http://www.tandfonline.com/doi/abs/10.1080/00461520903213592#.VAJhqPldWSo
 
Dylasa said:
Maybe... although, I kinda doubt it. The reason my school has chosen to explain this curriculum makes sense to me, though. It's not like we leave medical school and are set up for the rest of our careers in terms of knowledge base. Heck, by the time we graduate, a lot of what we're learning now will be bull****. We do actually have to learn how to get the newest information ourselves, without being spoonfed. This is part of being a bad ass professional, and it is something most people learn how to do in residency. However, it's a steep learning curve when you're also trying to figure out how to not kill your patient. Anecdotal, but I used to tell my mentees that if they didn't know how to do something, I didn't want to hear about it until they had exhausted their resources in trying to figure it out for themselves. I'm sure some of them thought I was being lazy (lolz), but in reality, I was trying to teach them how be self directed, curious and confident in their own knowledge base. Their research attendings thought they were outstanding.

I highly doubt that NMBE is forcing schools to adopt this for ****s and giggles. The data that I read showed that in a quality program, students did as well as those in a didactic program, but tended to be happier, graduate on time and go into primary care, the last of which I'm betting is the NMBE's goal. Not as anecdotal, let me link you up with a little fresh data from the google search I just did, yo... 😉

http://www.nature.com/srep/2014/140530/srep05126/full/srep05126.html
http://www.tandfonline.com/doi/abs/10.1080/00461520903213592#.VAJhqPldWSo
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I think that is the only good thing about PBL/TBL. In the real clinical world, all your information isn't going to come from one textbook. Your attending/resident isn't going to spoonfeed you the information thru a didactic powerpoint. From MS-3 on forward the learning is all self-directed and you're expected to participate in "life-long learning" where you build on your weaknesses and capitalize on your strengths when it comes to your knowledge base. I think the best curriculums probably combine didactic learning with case-based PBL learning - although that is quite resource intensive - but considering the tuitions schools charge, students should get their money's worth.
 
DermViser said:
I think the best curriculums probably combine didactic learning with case-based PBL learning - although that is quite resource intensive - but considering the tuitions schools charge, students should get their money's worth.
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It's what my school does and it really is awesome and not resource intensive - it just requires making sure facilitators are on the same page and actually know how to, surprisingly, facilitate. It really does vary based on what I've gathered from SDN and it sounds like many schools just give PBL lip service. However as an education major and having several family members who are educators, TBL HAS no business in med school and most forms of educational settings in general.
 
WillburCobb said:
It's what my school does and it really is awesome and not resource intensive - it just requires making sure facilitators are on the same page and actually know how to, surprisingly, facilitate. It really does vary based on what I've gathered from SDN and it sounds like many schools just give PBL lip service. However as an education major and having several family members who are educators, TBL HAS no business in med school and most forms of educational settings in general.
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I meant one resource being time - i.e. facilitator actually taking the time to run things smoothly, know what they are talking about, etc.
 
DermViser said:
I meant one resource being time - i.e. facilitator actually taking the time to run things smoothly, know what they are talking about, etc.
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It honestly doesn't take any extra time. It comes down to expectations and knowing how to teach. The facilitators who fail at this are either lazy, zone out, and just use the excuse that "they're letting the students/groups figure it out" or are overbearing and more concerned about the group getting the right tests and diagnosis than actually learning and redirected them or give them additional info at the slightest misguided idea or response, thus defeating the purpose of PBL.

My current facilitator loves to sit back and watch us flounder down the wrong track and does an excellent job at redirecting us just by occasionally asking rhetorical questions when we're really off track. She's also excellent at catching bull **** and asking people questions until they can't bull **** her anymore. The look on students faces and her smile when it happens are priceless and honestly make for a really good learning environment.
 
TheShaker said:
This can't be right. If missing a couple minutiae out of hundreds warrants remediation/repeat then nobody would ever graduate on time.
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Either that or they're making the questions very simple and straightforward. Our Anatomy averages were in the 70s. A good chunk of the class regularly scored in the 60s. While the lab exam was fill in the blank, the lecture exam had long clinical vignettes with 2nd and 3rd order questions. For example: Mr. x was shot in the chest between x and x ribs at the ant mid clavicular line, which structures in order would be affected and what is the most likely cause of death?

Serous Demilune said:
I'm that argumentative guy. Not because I give a ****, but because I'm so bored and I like the sound of my own voice.
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Lol
 
I like TBL solely for the fact that I have an excuse to bake something for my group. Then I proceed to lose a few hours I 100% would rather have spent studying lectures or going over Anki cards.
 
operaman said:
Ours was hit and miss. It all hinges on how good your faculty preceptor is and how motivated and intelligent your classmates are. When those things sync, it's actually pretty good. When they don't, well, you know.
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Faculty preceptor? What's that? You mean the person who pops in for like 5 seconds 20 minutes into a 3 hour session to ask if we needed any help and then disappears for the rest of the day? Oh, there are schools out there that actually pays those people to ensure that every group has a preceptor?

Umm, yea... my school was too cheap for that.
 
Siggy said:
Faculty preceptor? What's that? You mean the person who pops in for like 5 seconds 20 minutes into a 3 hour session to ask if we needed any help and then disappears for the rest of the day? Oh, there are schools out there that actually pays those people to ensure that every group has a preceptor?

Umm, yea... my school was too cheap for that.
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Our faculty facilitators are present for the entire session and volunteer to facilitate. Shocker, some people actually enjoy teaching.
 
Our TBL is a bit different. Our class of 120+ people are split into two large rooms. Each person would first take a quiz and submit it. Then each room would have about 10 small groups working independently to solve the quiz, and some other open ended questions after that. Afterwards we all have a large Q&A. The faculty adheres pretty strictly to the material to be discussed, and moves the discussion along if we seem to be stuck on one topic.
 
compstomper said:
Our TBL is a bit different. Our class of 120+ people are split into two large rooms. Each person would first take a quiz and submit it. Then each room would have about 10 small groups working independently to solve the quiz, and some other open ended questions after that. Afterwards we all have a large Q&A. The faculty adheres pretty strictly to the material to be discussed, and moves the discussion along if we seem to be stuck on one topic.
Click to expand...

That's what classic TBL is. Other schools just have variations of what they call TBL.
 
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