I Loathe PBL's!!!

[def jeff]

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Anyone else feel this way or am I the only one? I just think its very inefficient although a necessary evil maybe. Thoughts?

 

[Pinkertinkle]

I agree. Inefficiency is the best word to describe it.

 

[PeepshowJohnny]

They're 95% awful. Just absolutely atrocious. Every once in a while it's done right and it sticks with you, but it's rare.

 

[hb2998]

I'm glad my school isn't one of those all PBL schools. Bang for your buck its not an effective way to learn (one disease / week medschool would take 100 years!)
Its exciting when you get one right though 😉.

 

[QuantumMechanic]

it really depends on the faculty facilitator who moderates your small group. quality facilitators will teach you little, yet clinically relevant things that aren't covered well or at all in lecture.

inefficiency is horrible though. preparation time could be better spent studying for the regular coursework, and small group discussions often get in a far off track that wastes alot of time. We do a session a week for 2 hours which isn't too much time, since my facilitator is fine, I actually look forward to PBL sessions.

 

[def jeff]

I think that they are useless in the first year when you're just trying to build a foundation.

Case studies with actual pathology during the second year are helpful.

Yes, yes, that's what I mean (I'm a first year). The thing is that we have very little foundation to work with regarding some pretty complex diseases. But yet I know we have to be exposed to it at one time or another so why not now, right? That still doesn't make it any better when you are sitting through the monstrosity...

I do like to sit back and watch my classmates argue intensely with one another over things they probably have no real understanding!

it really depends on the faculty facilitator who moderates your small group. quality facilitators will teach you little, yet clinically relevant things that aren't covered well or at all in lecture.

inefficiency is horrible though. preparation time could be better spent studying for the regular coursework, and small group discussions often get in a far off track that wastes alot of time. We do a session a week for 2 hours which isn't too much time, since my facilitator is fine, I actually look forward to PBL sessions.

I agree 100%. Already I've had moderators who were great and really helped us work through it smoothly and some that literally just sit there and stare at our group as we fumble our way through. When it's like the latter, its like pulling teeth.

One much older doc even had a lot of trouble just working the powerpoint slides (i.e. having to double click to play movies, advancing slides, etc.) so over the span of a 3 hour PBL we probably spent 1/3 of it waiting for him to figure out how to work the computer. I mean, I know previous generations grew up in different times but co'mon man!

 

[CigarTragic]

Anyone else feel this way or am I the only one? I just think its very inefficient although a necessary evil maybe. Thoughts?

I don't have PBL... sorry.

 

[TrapperJohnMD]

I don't have PBL... sorry.

If done correctly, PBL is actually a pretty cool way to learn. I dont disagree that it can be inefficient at times --but again, if it is set up (and executed) correctly it can be pretty cool. I'm at an all PBL school and I love it (no bias here haha). At least at my school (1st year) the focus wasnt really about the actual disease so much as the basic science topics within the disease (this is why we didnt cover 5-20 diseases/week 1st year).

If the case was about ASD sure we learned about that specifically but that leads you into 1)embryo of heart 2) anatomy of heart 3) Physio of cardiac muscle contraction 4) cardiac v.s. pulmonary casues of SOB 5) clinically relevant tests and results 6) etc etc

If you concentrate on the big picture (facilitator important for this) the group discussions should be usesful. The depth of the material cover in the small amount of group time shouldnt be the only things you study either, there is no way you can cover it all in a weeks worth of 2 hour sessions. If you school supplements with some lectures those can be helpful as well. But hey, ya gotta love the amount of free time --no sitting in required lectures 8-5. For me (even more so in 2nd year) its come to lecture when you think you need some help, show up for group and participate for 1.5hrs, and the rest of the time is yours. Sleep in, study, hit the gym, what ever you want --just as long as you know your **** come test (and boards) time. Its great 👍

 

[QuantumMechanic]

But hey, ya gotta love the amount of free time --no sitting in required lectures 8-5. For me (even more so in 2nd year) its come to lecture when you think you need some help, show up for group and participate for 1.5hrs, and the rest of the time is yours. Sleep in, study, hit the gym, what ever you want --just as long as you know your **** come test (and boards) time. Its great 👍

most schools, PBL or not, don't require you to goto lectures (my school like many other podcasts the lecture along with the synchronized ppt if you really want to avoid the lecture hall). Some people are never at lecture and they just fine if not above average. PBL does have a downside: attendance is required which does force you to go. Fortunately, I like PBL, but if you hate it you don't have the option to skip it (unlike lecture, which if you hate, you always can just not show up).

 

[Sartre79]

Yeah, I'm not too fond of them either. Seems like the preparation time used could be better spent elsewhere.

 

[Grundlebug]

I love our school's PBL. I take more time preparing for our PBL sessions, but I retain the info much better than if it's just thrown at me during lecture. And when the group dynamic really gets going, it can be the best study session, because everyone comes prepared.

I'm an M1 and I don't feel like the goal of the cases has been to learn a single disease at a time, rather, focusing on certain diseases and understanding their pathology highlights important, fundamental biological functions. PBL is a dynamic, interactive way to learn physiology, histology, and pathology.

Just thought the thread needed some balance. 😉

 

[Pinkertinkle]

most schools, PBL or not, don't require you to goto lectures (my school like many other podcasts the lecture along with the synchronized ppt if you really want to avoid the lecture hall). Some people are never at lecture and they just fine if not above average. PBL does have a downside: attendance is required which does force you to go. Fortunately, I like PBL, but if you hate it you don't have the option to skip it (unlike lecture, which if you hate, you always can just not show up).

Yes this is an important point. PBL takes away your freedom. If you ask me, PBL is downright un-American.

 

[def jeff]

Yes this is an important point. PBL takes away your freedom. If you ask me, PBL is downright un-American.

I'll take it one step further and say PBL is communist!

 

[nlax30]

I'm at an all PBL school and our first 10 weeks is regular gross anatomy with normal lectures, and then we start full time PBL sessions of 2hr sessions 3x a week. So with just 6 hours of week (besides some other mini lectures and clinical/OMM lectures) that I have to be at school for PBL I think it's actually giving me a little more freedom than if I had to be there each day for several hours of lectures. And I know that a lot of people don't go to lectures and just use their school's note service, well then what's the point of lectures? I have access to similar lectures as well if I need an brief overview of a system/topic, but for the most I'll be studying straight from the major medical/physio textbooks and not just memorizing lectures.

I think that if PBL is well done then it can work well, if not then it'll just be a waste of time. At least here, the point of PBL is not to solve a case or figure out what is wrong with the "patient", in fact that part doesn't really matter at all. Instead it's the process of picking and learning about the basic sciences that come up during a case, and not just reading about a disorder or disease. The other week we were on a case where our pregnant patient just had a Down's syndrom child with an AV septal defect and duodenal atresia, and some of the "learning issues" we worked through were the development of Heart and GI system, some physio of the heart, along with reinforcing the anatomy/histo of those systems that we just went through during anatomy, not to mention starting to get familiar with the process of counseling the patient and breaking the "bad news", learning how to develop a diff. dx list, what tests to go through to start narrowing that DD list down, what treatments/surgeries were needed at what point during the newborn's life, etc...

So far we're still in the first few weeks of it since anatomy is just now ending, but I'm starting to get more and more comfortable with the idea. I do like the structure of lectures and the fact that it condenses things down for me, but I really don't learn in lecture at all. Plus, I'm just not a good memorizer, but if I can put an idea/fact in some sort of larger context, like in an actual clinical context and relate it to multiple systems then it sticks and I've got it. Plus it'll force me to work through the actual standard textbooks where I'll hopefully pick up some other minor details that I may not have seen elsewhere.

Just my take on it. I know some people are totally against it and that's fine. So far it seems to be working well here the school has gotten some really good feedback from rotation sites that our impressed with our 3rd and 4th years. And the system is constantly being tweaked, I think the class of '08 here (the first class at this campus) had some trouble with Step 1 (comlex), but after some changes the class of '09 did extremely well.

 

[def jeff]

I'm at an all PBL school and our first 10 weeks is regular gross anatomy with normal lectures, and then we start full time PBL sessions of 2hr sessions 3x a week. So with just 6 hours of week (besides some other mini lectures and clinical/OMM lectures) that I have to be at school for PBL I think it's actually giving me a little more freedom than if I had to be there each day for several hours of lectures. And I know that a lot of people don't go to lectures and just use their school's note service, well then what's the point of lectures? I have access to similar lectures as well if I need an brief overview of a system/topic, but for the most I'll be studying straight from the major medical/physio textbooks and not just memorizing lectures...

Of course my comments are tongue-in-cheek. I know that PBL's are important to expose us to the reasoning and differential diagnosis process behind medicine. Learning about the actual diseases is the least important part of the process. And for those that are required to only attend 6 hrs of school per week, that's pretty damn cool too.

I'm just complaining a bit, that's all. And the fact that we know very little about medicine right now just makes our sessions a teeny bit painful (if not a little entertaining if you have a great sense of humor).

 

[QuantumMechanic]

There are flaws to both the lecture-centered and PBL-centered curricula. PBL is probably the ideal system since, if done correctly, prepares students to think the way physicians should about clinical problems. At the same time, it puts a huge onus on the students to do alot of self-directed learning through "learning objectives," some of which can become huge tasks to research. Even organized and motivated students can get lost in the sea of information that is available, especially since most of us have access to primary literature and textbooks online these days.

At the same time, there is much virtue still with the traditional lecture format. Ideally, lectures guide learning, taking topics presented in textbooks and compressing it into a more manageable fund of information to learn. There are an infinite number of clinically relevant topics out there to study, along with many irrelevant sidetracks to get lost on. Lecture notes help us to avoid wasting our time (well unless the lecture writer sucks). I find that my school's lecture notes cover things that are board relevant for example. The danger of a PBL only system is the glossing over of significant topics since there simply isn't enough time, even if PBL sessions and research were never offtrack.

A hybrid system of the two seems the best compromise. Many schools incorporate PBL into their mostly lecture based curriuculum. The problem that some people here seem to have is that the implementation needs to be tweaked so that PBL sessions actually work better for the students.

 

[nlax30]

Of course my comments are tongue-in-cheek. I know that PBL's are important to expose us to the reasoning and differential diagnosis process behind medicine. Learning about the actual diseases is the least important part of the process. And for those that are required to only attend 6 hrs of school per week, that's pretty damn cool too.

I'm just complaining a bit, that's all. And the fact that we know very little about medicine right now just makes our sessions a teeny bit painful (if not a little entertaining if you have a great sense of humor).

Understood and we've had our moments as well.... 🙂 For the first couple sessions it seemed like we were looking up every other word.

 

[The Angriest Bird]

So I'm going to say something that's really an extreme point of view. I'm expecting a lot of backfire and disagreements.

I think, many things in life are those that sound so wonderful but it just doesn't work like how it sounds.

Group study is a perfect example.

Oh yeah PBL! A group of students from different backgrounds sit at the same table, working together to solve a clinical problem. They have different skills but by working together they complement one another. The discussion is vigorous but thoughtful. And they educate each other! The faculty illustrates unanswered parts but leaves the students to reach the destination by themselves!

Does it actually work like this?

Group study has 3 advantages

1. It allows the "better" students to show off and raise their self-esteem.

2. It allows the "worse" students to be lazy and be okay.

3. It provides opportunities for singles to mingle.

I'm not saying PBL is a complete waste of time. But keep in mind in medical school, studying with an inefficient method IS waste of time.

Most medical students work best by themselves. Why? Because if they had worked in group studies in college, they wouldn't even get into medical school.

 

[osli]

A hybrid system of the two seems the best compromise. Many schools incorporate PBL into their mostly lecture based curriuculum. The problem that some people here seem to have is that the implementation needs to be tweaked so that PBL sessions actually work better for the students.

I tend to like our school's curriculum (of course I do... I go there 🙂 ).

It is mostly lecture based with an organ/systems approach. However, lectures are framed around "case presentations" with specific themes for each week. For example, one week in the GI section might be "patient with diarrhea" and the next week might be "patient with N/V". During that week, most lectures will integrate patient presentations that are relevant to the them, typically by presenting the case history at the beginning of lecture, and then revisiting it at the end to highlight how the new material applied to the specific case. A "patient with diarrhea" presentation might describe Joe who has watery diarrhea etc. etc. and the lecture is on pathologic microbiology of the GI tract, or on physiology of water excretion in the GI tract, etc.

Thus our lecturers walk us through "PBL" type scenarios routinely. They certainly aren't the free reigning student directed PBL that many other schools use, but they do seem to at least avoid typical PBL pitfalls (while probably adding some of their own).

Additionally, much or our pathology is taught outside of the lecture format. We have weekly pathology labs wherein students present case histories of interesting and section relevant pathologies that they have studied and prepared, along with any radiographic, histologic, or gross slides that are available. The class is asked to "solve the case" based on history, labs, slides, etc. and take a shot at diagnosis. The presenting student questions the diagnoses proposed and the line of reasoning that led up to them, and ultimately walks the class through the entire differential and solution process.

 

[nicko18]

In the real world I guess it's trying to simulate how real medicine is practiced, but god awful during the first 2 years of med where youre just trying to thrash out completely wild differentials when you have no idea of medicine nor the full history.

You are an intern in a rural hospital when a patient presents with a headache, list 4,000 things it could be!

 

[nlax30]

So I'm going to say something that's really an extreme point of view. I'm expecting a lot of backfire and disagreements.

I think, many things in life are those that sound so wonderful but it just doesn't work like how it sounds.

Group study is a perfect example.

Oh yeah PBL! A group of students from different backgrounds sit at the same table, working together to solve a clinical problem. They have different skills but by working together they complement one another. The discussion is vigorous but thoughtful. And they educate each other! The faculty illustrates unanswered parts but leaves the students to reach the destination by themselves!

Does it actually work like this?

Group study has 3 advantages

1. It allows the "better" students to show off and raise their self-esteem.

2. It allows the "worse" students to be lazy and be okay.

3. It provides opportunities for singles to mingle.

I'm not saying PBL is a complete waste of time. But keep in mind in medical school, studying with an inefficient method IS waste of time.

Most medical students work best by themselves. Why? Because if they had worked in group studies in college, they wouldn't even get into medical school.

I would say that the PBL sessions are not where you are supposed to be learning or studying. The point is not to have people teach other in order to solve the case. One faculty member likes to say that only about 1% of the learning you'll do will actually be done in/during the PBL session. Rather it's just a framework for you to see what you need to learn, on your own or in a study group, and then come back the next time....and continue finding subjects you need to study, read/learn it, and then come back move further forward.

For us, so far, the learning that happens during PBL has been mainly about asking someone else to define a term you may not know, or to clarify a lab result of physio of something. I would say that it would be inneficient to come to PBL expecting to have the members of the group teach other other, say Biochem. If that is what's going on then even I'd be disappointed. Instead each member studies/learns the biochem however they want to (reading, notes, group study, etc...) and then we meet in PBL, apply it to the current case, find other areas that we need to study about, and then go study them. The other strength is that when you meet and apply whatever you read previously that then another member can say, "I just didn't understand X.....", and that's the time someone else can clarify an idea and make it a small teaching moment.

 

[SomeDoc]

I don't have the stats on hand, but I do remember hearing or reading somewhere that PBL students outperform students in standard curriculum, on the boards. Or perhaps it was only applicable to one school that I know of.

 

[Doctor Bagel]

I don't have the stats on hand, but I do remember hearing or reading somewhere that PBL students outperform students in standard curriculum, on the boards. Or perhaps it was only applicable to one school that I know of.

I have heard this from schools with different curricular paths. But a lot of those schools require you to apply to get into PBL and seem to select the most motivated/prepared students for the PBL path. That might explain performance more than the efficacy of PBL itself.

 

[achybrachy]

I personally feel like I should not be paying $35k+ per year to go look up the answers myself, I'm paying for an expert to wade through all the extraneous information for me and tell me which parts are important.

 

[Blade28]

There are flaws to both the lecture-centered and PBL-centered curricula. PBL is probably the ideal system since, if done correctly, prepares students to think the way physicians should about clinical problems. At the same time, it puts a huge onus on the students to do alot of self-directed learning through "learning objectives," some of which can become huge tasks to research. Even organized and motivated students can get lost in the sea of information that is available, especially since most of us have access to primary literature and textbooks online these days.

Fantastic summary.

I went to an all-PBL med school, and this method was good in teaching you how to think, research and critically analyze like a physician - identify problems and areas of learning deficiency, research those areas, present in a small forum to your peers to tackle the important issues. It helps integrate various disciplines and encourages an "organ-based" approach (versus the traditional "subject-based").

But it can lack some structure, which some people need. Others like the didactic format of 4-8 hours' worth of lecture a day. And it's a little tougher to study for Step 1, IMHO, because you're teaching yourself a lot of new material.

 

[Timmythemic22]

So I'm going to say something that's really an extreme point of view. I'm expecting a lot of backfire and disagreements.

I think, many things in life are those that sound so wonderful but it just doesn't work like how it sounds.

Group study is a perfect example.

Oh yeah PBL! A group of students from different backgrounds sit at the same table, working together to solve a clinical problem. They have different skills but by working together they complement one another. The discussion is vigorous but thoughtful. And they educate each other! The faculty illustrates unanswered parts but leaves the students to reach the destination by themselves!

Does it actually work like this?

Group study has 3 advantages

1. It allows the "better" students to show off and raise their self-esteem.

2. It allows the "worse" students to be lazy and be okay.

3. It provides opportunities for singles to mingle.

I'm not saying PBL is a complete waste of time. But keep in mind in medical school, studying with an inefficient method IS waste of time.

Most medical students work best by themselves. Why? Because if they had worked in group studies in college, they wouldn't even get into medical school.

Your sarcasm tastes SOOOO good...more, MORE!

Regardless of how serious your comment may be, I wholeheartedly agree. PBLs (or TBLs in my case) are a necessary evil as part of the era of "touchy-feely, warm in your tummy-tum" medicine, where respecting another's personal beliefs in laziness and acknowledging another member's feelings of being simple supercedes actually learning the material. If I'm going to participate in group study, I'd like to choose to do so rather than be forced.

(really needed to vent that, thanks)

 

[Flaxmoore]

I personally don't like PBL very much. It's easy, which is a plus, but I can't shake the feeling of not accomplishing anything in it. For example, our PBL is case-based, using a computer program through which we can ask patient history questions and order lab tests. Unfortunately, the lab tests are typically not worth much- how many first years know what they even are, beyond simpler ones? Spending four hours per case is kind of a waste.

There is one that has passed nearly into legend from last year where the patient had AIDS, all the classic symptoms, but the first ELISA test (done in the first meeting) was negative, as was the second. Only in the last meeting was it finally positive.

 

[Sean2tall]

I think PBL, along with "early clinical experience" are things which sound awesome as an applicant to med school, but are often a waste of time when you actually get to them. I think when you're applying, being a med student sounds super cool and all of those things in theory make you feel like it's Grey's Anatomy or ER or something.

And then of course the trend is to add these things to schools (if not already present), because to the faculty, it seems like a great idea by similar grand imagination. But then you get to med school and you realize it's just more school and stop going to class and read the books at home and do whatever you want to with your free time, making this stuff annoying as a waste of your free time. At least that's pretty close to my experience.

 

[FDoRoML]

It's funny, I've had really good and really, er, not good experiences with PBL. We have a combined curriculum and sometimes you actually get a lecture giving you background BEFORE a case that relates to it, but not always. But that's not the part that I'm finding irksome. Actually, the PBL experience depends a lot on the group dynamic and the motivations of individual students. I've heard horror stories from other groups and happily hadn't really experienced anything "bad" until this year.

My biggest complaint, other than arbitrary grading across different facilitators (one says "you're awesome, nothing could be improved" and gives you an 85; another gives you some good and constructive criticism and you get a 95), is really the group members. I understand part of the point is to learn to work with different personalities and all that good stuff, and having worked for a long time in the "real world", I feel like I am fairly good at it. BUT, I've had at least 40% of our group always be highly motivated and highly intelligent, another 50% be pretty smart and work extremely hard to gather info and learn the material, and that final 10% just be extremely quiet people who you need to bring out of their shell. Now I've just begun experiencing what's it like to deal with people that make me say, "how the heck did you get into med school?" Not only do they not seem to be all that with it, but they're not doing the work (despite being told by faculty what's important to read ahead of time), and seem offended when others actually know something and try to move the case along. It's so frustrating because, OK, I'm not one of those brilliant med students who just automatically gets everything and retains it and kicks butt on every exam, but I work my @$$ off, including in PBL, to try and get the most out of what our course directors think is important for us to know.

So, yes, I suppose I'm not a happy PBL person at the moment, although up until recently I've always gotten more out of that than sitting in lecture. It's kind of like anatomy-- when you sit and read, look at pictures, listen to lectures-- it doesn't make complete sense until you wrap your fingers around it and see it/feel it in 3-D.

OK, just venting after a really bad few weeks. My bad.😳