what are your opinions on the PBL system now used in some Medical Schools? I've been in this system for 2 years now and really feel it's a whole lot of bull****.. I don't think there is enough emphasis put on the basic medical sciences but instead is more clinically orientated. convince me that it does work out to produce quality MDs.
how good is problem based learning?
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I think its a pain in the a$$ because I spend a bunch of time looking for some stupid piece of information to present it to my small group that probably won't be tested. I could be studying for anatomy instead. Why can they teach behavioral sciences like they teach the rest of the crap. Binge and purge would be much more manageable.
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ambai said:
PubMed has lots of articles on the efficacy of PBL. According to one author, "Norman and Schmidts 1992 review found that students taught with PBL curricula were superior in knowledge retention but inferior in overall knowledge and competence when compared with students taught by traditional curricula."
The good news is that PBL students usually perform better on the USMLE: "Major PBL ... may have contributed to higher scores (on the USMLE)." Academic Medicine.
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deuist said:
I'm not sure about that, I haven't looked up articles, and don't have time to because I am busy studying for my very traditional, didactic anatomy class, but anecdotally, most places that have implemented PBL have initially seen a drop in USMLE scores that has required some attention to remedy.
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I doubt I'll be able to convince you regarding the long-term effects of PBL for the first 2 years, but I would like to state that PBL has produced simply astonishing results at my school. For my class, our Step I average was 236, 0 failures. So far, our Step II score (75% taking) is ridiculous, like 253 or so.ambai said:
I don't think basic sciences will have any eventual large effect on what type of doctor you'll become, but doing well on your Step I (which PBL can greatly improve your chances on) can help you get into the specialty of your choice. And then the rest is up to you.
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It's encouraging to hear some good comments about PBL. I'm a MS1, and have been wondering for the past couple of weeks about this PBL curriculum and whether it was helping or hurting me.
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PBL is really what you put into it, as is any med school. If you feel your weak in the basic sciences then that's your fault if your not finding time to strengthen that. The beauty of PBL is that you have the time to do that. But honestly how is memorizing all the amino acids gonna help me be a better doctor? It's not, so why should I bother even worrying about that when I can be spending more time learning other clinical aspects of biochem etc. . .
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ms1finally said:
Let me get this straight: I point to articles that have done statistical analysis of PBL and the USMLE and you say that you don't believe the research and would rather go with non-citied, anecdotal story? I sure hope that you don't approach everything in medicine with an attitude of, "I'm not going to bother with looking up the evidence on this medication; I'll just go with anecdotes."
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Ok, so I was the type in undergrad to ONLY go to lectures when I had to...If a class went by the book even 75% I would not go and just study entirely from the book...Then usually do well because it was better more full learning than memorizing lecture notes or slides. I love studying independently from texts, and I dislike spending a lot of time in class. I've never been a big 'study in groups' type.
Does this mean that I should avoid hardcore PBL programs? Even the most "PBL" of schools...how much will there be? Is there always a major traditional lecture component, or usually?
Does this mean that I should avoid hardcore PBL programs? Even the most "PBL" of schools...how much will there be? Is there always a major traditional lecture component, or usually?
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My school was mostly PBL in the preclinical years with some lectures and I found one main benefit of PBL: TIME FOR YOURSELF. It's great to not be stuck on a 9-5 (or worse) lecture schedule.
The PBL was a fun way to instill general principles and start thinking about clinical scenarios early but the downside is that you really don't cover alot of ground in the week when you take stock of what you actually learned. This isn't to say that lectures are any better. I HATE lectures and find it difficult to memorize lists and minutiae out of context.
It's the lesser of two evils but I say it's the best of what's available. Just be prepared to put in some muscle on your own to cram in the missing details that don't get covered. But hey, I'd rather do it on my own time than have someone make me goto a lecture hall and have it shoved down my throat that way....
The PBL was a fun way to instill general principles and start thinking about clinical scenarios early but the downside is that you really don't cover alot of ground in the week when you take stock of what you actually learned. This isn't to say that lectures are any better. I HATE lectures and find it difficult to memorize lists and minutiae out of context.
It's the lesser of two evils but I say it's the best of what's available. Just be prepared to put in some muscle on your own to cram in the missing details that don't get covered. But hey, I'd rather do it on my own time than have someone make me goto a lecture hall and have it shoved down my throat that way....
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crys20 said:
So at our very PBL school, we have an hour of PBL a day where we discuss a case. Then, we usually have a lecture. After that, we have our labs (histology, anatomy or radiology). Some days have no lecture though and a longer time in anatomy. This is just the first block. Later blocks have PBL 2 or 3 times/week rather than 5. I find its a good balance. You need the lectures to focus your PBL discussions and there is a big effort made to integrate labs, lecture and PBL. I hate "studying in groups" as well but the PBL really isn't that and is more like being on a team trying to solve problems with each member tackling a different aspect rather than a group of people all rehashing the same stuff on a problem set. I think it works really well in keeping us interested in the material.
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deuist said:
Learn how to read. Seriously, it might help you get through med school. I said that from what I had heard, most schools had seen an INITIAL drop in USMLE scores. For all I know, this was soon followed by an upward trend, as the article you cited mentioned. However, I didn't (and still don't) have time to look it up.
I did NOT contradict you. I just added to what you had said.
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deuist said:
I did research on PBL use in medical curricula as an undergrad. I did that for at least 3 years. You'd think that'd make me pro-PBL, but I am still not convinced that it is superior to traditional didactic methods. Sure you can find data that support PBL. I know there are articles that you can easily look up on pub med that say how such and such school's Step 1 scores improved after implementing PBL. But in my own experience, if the results of a PBL study don't agree with what the experimenters were looking for then they will re-design the study and try again. The vast majority of people doing research on PBL are pro-PBL and won't publish if their results don't mesh with their beliefs. My own research group wouldn't publish until we could support our initial claims. It shouldn't surprise anyone. It happens all the time. Not just in medicine, but in every discipline. You won't publish something that goes against what you believe in.
My med school is very traditional with only sprinkles of PBL every once in a while. We have a very didactic, lecture/lab-based curriculum. I love it. I am learning a lot and don't feel like am am bogged down with studying either. Nor do I feel that this design is leading to clinically incompetent physicians. I'm confident that most of what we're learning is clinically relevent, and yes, that includes amino acids structures. How are you supposed to know what's wrong with someone with PKU if you don't know what phenylalanine looks like?
I'm not saying get rid of PBL completely. It's definitely beneficial as an adjunct to your regular course load. But to have a your entire curriculum based on PBL is a little extreme.
p.s. To the poster from HMS. Harvard could do whatever it wanted with its curriculum and it'd still produce quality physicians and high board scores. I don't think its example should be used to support PBL.
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bigfrank said:
Wait a second..I think I know you. You got some insanely high score on Step 1. Like 260 or something right? Mind if I ask where you went to med school? Should results at that school necessarily be considered typical?
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PBL works for some personalities and learner styles and it doesn't for others. having been someone who graduated from a PBL curriculum I can say for ME there are no regrets and would do the same thing again without hesitation, but there were people in my class who found it a waste of time. i like the independence, the under-reliance of classroom time, the group problem solving process -- it's much more reflective of real learning that takes place in the clinical setting. nonetheless we all did well and moved on to life beyond med school. i can honestly say i have had patients with PKU and have never had to draw the amino acid nor could i remember the structure of any of the other amino acids beyond first year and no one has suffered. since i was a product of PBL i'm really comfortable at looking stuff up on the fly and if i ever need to show a patient a picture of phenylalanine then i'll google something up for them. 🙂
there are pros and cons to every curriculum, and the best ones are those that have a balance of small group/pbl/formal lectures which is what a lot of schools do. there are different competencies that are emphasized in the different curricula. a traditional lecture curriculum weighs much more on knowledge, while a PBL curriculum will sacrifice some knowledge to also teach interpersonal/communication skills, professionalism, and some of the other core competencies. The thing is that schools that use the lecture based curricula teach those competencies as well sorta...just later on, and maybe not as well since they are letting residents and physicians who aren't usually educators to teach them.
for me, the big sell was being in class from 8am to 1pm. who wants to be stuck in a room or a lab for 8 hours?
there are pros and cons to every curriculum, and the best ones are those that have a balance of small group/pbl/formal lectures which is what a lot of schools do. there are different competencies that are emphasized in the different curricula. a traditional lecture curriculum weighs much more on knowledge, while a PBL curriculum will sacrifice some knowledge to also teach interpersonal/communication skills, professionalism, and some of the other core competencies. The thing is that schools that use the lecture based curricula teach those competencies as well sorta...just later on, and maybe not as well since they are letting residents and physicians who aren't usually educators to teach them.
for me, the big sell was being in class from 8am to 1pm. who wants to be stuck in a room or a lab for 8 hours?
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you need PBL, but i'd say that it shouldn't take up more than 25% of the curriculum.
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One thing people don't emphasize about PBL is that it prepares you for the real world by teaching you to research information for yourself. You've always heard that that 50% of what you learn in med school will be obsolete in 10 years- at least with PBL you in principle should acquire a toolbox of skills to research new information to solve problems that will last a lifetime.
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YouDontKnowJack said:
Agree. Our school is 'traditional' but uses some PBL type learning experiences. What I've found is that I learn my assigned material very well, possibly at the expense of some other material. I like the fact that we have the opportunity to think 'like a clinician' to break up the constant memorization. But I would not want to have it everyday.
Also, even though my school is largely lecture based, we usually get out of class at 12 or maybe 2. It is a rare day that we have lecture until 3 or 4 and lectures are not required (unlike the PBL stuff).
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I really enjoy PBL and wish we had more of it (we have it only once a week), but I don't think I could do a PBL-only curriculum. I think PBL makes things more interesting and is very important to include, but learning everything without lectures or notes takes a special kind of person.
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In my PBL program, we have three hour small group case discussions with a facilitator three days a week. I think it's fantastic. It integrates the material, promotes intimacy between classmates, keeps me awake and on my toes, and makes medicine exciting. I doubt that problem based learning produces significantly better physicians, but I think that it provides a much higher quality of life for students.
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Kazema said:
So are you gonna get a set of lectures and notes b4 u see patients in your office?
Unless you actually go to a PBL school its kind of hard to comment, b/c you really have no idea what it is like...imo, PBL is essentially no different than your average Joe at Med School X who chooses to not attend lectures and studies on his own. Joe gets notes and studies on his own... just like I do. The only difference is I show up 3 times a week for class and talk about basic sciences in a clinical aspect.
Granted, for some topics i wish there were lectures, but nonetheless, i get the same thing accomplished by reading or going and talking to faculty if i have questions.
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I've always wondered this:
with the tests in a PBL setting- would all the questions be clinical based? Like for embrology- would they be asking deformities and how they happened. I can't imagine doing a whole test on that. And would it still be multiple choice. Or is it just got the typical basic sciences anatomy/histo questions with a vignette of clinical asides?
with the tests in a PBL setting- would all the questions be clinical based? Like for embrology- would they be asking deformities and how they happened. I can't imagine doing a whole test on that. And would it still be multiple choice. Or is it just got the typical basic sciences anatomy/histo questions with a vignette of clinical asides?
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Freakingzooming said:
our exams are all multiple choice, usually around 200 or so questions, and probably much like your tests at a "typical" school....i'd guess around 20% are vignette style (mostly the pathology and histology).
honestly, i believe there is really little difference btw PBL and your typical school...one major difference is obviously the blending of multiple disciplines rather than discrete subjects; however i think that it is minimal. I think people who have never done PBL just dont know what it is really like and make bad assumptions.
so to summarize my thoughts: PBL and lecture based are mostly similar except for the fact that PBL tends to be integrated in terms of disciplines..ie. we dont learn anatomy, then path, then histo.....we learn them all simultaneoulsly, in a case based approach
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YouDontKnowJack said:
🙄
Totally depends on how you learn. Drexel has a traditional and PBL curriculum. Those in the latter this year had an avg Step One score of about 225 and had no one fail. Last year, they outscored their counterparts in the traditional curriculum. So it seems those results contradict your statement.
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Callogician said:
Heheheh Sounds like a speech I used to give to applicants. You don't look familiar though.
Anyway, I would be hesitant to use my composite photo as my avatar...they're just don't give a good indicator of how you look normally.
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Pompacil said:
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Callogician said:
👍 😀
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I really really like PBL, right now it's the only class I look forward to, I pretty much agree with Kazema. Kaz, we have PBL twice a week for two hours. On Monday the case is presented and on Friday we discuss learning issues, it's pretty enjoyable and I lucked out with a pretty decent group dynamic.
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As a student in a predominantly traditional lecture/lab style program and about 15% PBL (maybe less), I will say that PBL for me was a load of crap. The main reason is that the core clerkship year is all PBL and to try to mimic the real thing was a waste of time when a few months later you could see it in real life while wearing a white coat and talking to a real patient. That's what the clerkship year is. For example, you're on internal medicine, it's 6PM on your call night and Mr. J comes to the emergency room with X symptoms. You work him up and actually see changes, not just getting the follow up parts to the PBL scenario. Your admission note (all 9 pages of it) covers all possible ddx, and even delves into the current literature on the most up to date treatment. Hey, if you're lucky you might even get to do a rectal exam on him. You see real changes and progression and adjust your plan as the patient's clinical course changes. Aint no PBL can top that.
The main reason I dont think PBL works well at my school is that we take Step 1 AFTER our core clerkship year. So I in essence have had all of my basic sciences crammed into one year, plus a full year of or clerkships (i.e. PBL with real people) and have seen the material at least twice before I even start studying for USMLE.
Anybody out there think that taking Step 1 after the core clerkship year would make sense?
The main reason I dont think PBL works well at my school is that we take Step 1 AFTER our core clerkship year. So I in essence have had all of my basic sciences crammed into one year, plus a full year of or clerkships (i.e. PBL with real people) and have seen the material at least twice before I even start studying for USMLE.
Anybody out there think that taking Step 1 after the core clerkship year would make sense?
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Uncle Izzy said:
NO.
That's too much separation from the basic science years.
Unless you see a lot of Kayser-Fleischer rings down there in Durham.
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wait...there's an alternative to 6 hours a lecture a day?
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Pompacil said:
Believe it or not, I actually did see a case of Wilson's Dz... No rings though. The patient's eye color was too dark.
You do make a good point though...I didn't see everything in Harrison's while on clerkships. However, I did see more than I would have ever expected. Those write ups also included considerable differential diagnoses so triple the number of things you're learning about in a clinical context.
Just my $0.02.
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Try 6 hours of discussion time a week instead. I love being in PBL. There is no way med school would have worked for me as well if I didn't get into a school with the PBL tract.bananachip said:
Our exams are mostly essay exams with some multiple choice first year then by the end of second year they have become mostly board style questions.
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I really think it depends on HOW PBL is done. At my school, we're a mix of PBL and lectures. For our biochem/cell bio course, the PBL (in my opinion) was awful - crazy rare diseases, and we were supposed to figure out how everything worked before we even saw it in lecture. Didn't learn much from that. This year, in our neuro course, the PBL is great - it's just twice a week (4 hrs. total) and the cases are related to material covered earlier in the week, so you actually have some idea of what's going on. Overall, if you have a PBL curriculum, you have to make sure to study boards stuff on your own (even if it seems unimportant for quizzes), otherwise I think that you will be a little behind those with a traditional curriculum. On the other hand, since we get out at 1pm every day, we have a lot of extra time to do just that.
Q
Q
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quideam said:
ah yes...the second year neuro course is a fantastic course. i STILL remember things from that course 7 years later and i almost never need any of that stuff in my day to day work. (actually i need very little from first and second year...hell, third and fourth year too) in my day to day work. the next course is pretty good too. i think one thing that impressed me both was the passion and the energy that people brought to the various courses...hope you're having a good time at ol' WMC.
i will say that even if you don't have a PBL course, people do study boards stuff on their own since schools that take traditional approaches still tend to focus on the minutiae of their lecturers rather than what's necessary for boards, wards and real world patient care.
