In this thread we talk about how crappy PBL is

[Textbookversion]

---

Members do not see this ad.

PBL is ridiculously time inefficient.

PBL suffers from the same problem lecture does -- if I had nothing better to do with my time it would be highly entertaining. Considering I am responsible for memorizing a bucket full of material in a week, wasting time with something that doesn't net me much extra learning is a huge waste.

In isolation, I find our two hours of PBL a week fairly enjoyable. But it's not getting me anything I couldn't memorize in 20 minutes on my own.

In my mind 1 min. in my living room = 2 min. lecture = 6 min. PBL in terms of material covered. If you've got 40-50 hours a week of school related stuff (I skip lecture to study), and then change to tons of PBL all the time or actually attend lecture your time obligations suddenly can rocket from "full time job" to "nasty full time job" to "workaholic" to "crazy person." Be careful future medical students, avoid PBL like the plague.

 

[NickNaylor]

Hmm I think I go to your school. This is exactly why I had to buy mine. It was around upper $400 i think

He does. 😉 He's in my class.

(sent from my phone)

 

[NickNaylor]

PBL is ridiculously time inefficient.

PBL suffers from the same problem lecture does -- if I had nothing better to do with my time it would be highly entertaining. Considering I am responsible for memorizing a bucket full of material in a week, wasting time with something that doesn't net me much extra learning is a huge waste.

In isolation, I find our two hours of PBL a week fairly enjoyable. But it's not getting me anything I couldn't memorize in 20 minutes on my own.

In my mind 1 min. in my living room = 2 min. lecture = 6 min. PBL in terms of material covered in my mind. If you've got 40-50 hours a week of school related stuff (I skip lecture to study), and then change to tons of PBL all the time or actually attend lecture your time obligations suddenly can rocket from "full time job" to "nasty full time job" to "workaholic" to "crazy person." Be careful future medical students, avoid PBL like the plague.

But PBL is like what real doctors do!

(sent from my phone)

 

[KnuxNole]

The people that say "It's good because it means you HAVE to be there, instead of having lectures that you skip OMG!" are usually the people that are annoying to have in rotations "What, you aren't coming one hour early and staying till midnight? Gotta prepare for internship!"

 

[urbanclassic]

Our school does a lot of PBL. For anatomy, it's pretty good because we learn the stuff as we do PBL, so immediate application helps it stick so much better. For a biochemistry/histology-type course, we are going to do PBL first, THEN have lecture. Which I think is stupid. They say there is a reason they do it that way, but I'm not convinced it makes sense... we will see...

 

[FIREitUP]

I hate PBL/CBL/TBL/*-based learning/Problem Solving Sessions/Patient Oriented Problem solving, etc.
More disconcerting, in my opinion, is the use of the word "professionalism" as fearmongering, which serves to ensure attendance in mandatory sessions, by stating that not attending would be deemed non-professional behavior. I've found the word professionalism has been turned into an essentially empty term with a strong connotation that has been the rationale for forcing us to attend mandatory sessions, case base learning, etc. The central claim is that not attending essentially useless and poorly run group assignments and mandatory sessions is an exemplification of "unprofessional" behavior that is unbecoming of a medical students and is grounds for disciplinary measures. While I know it may sound silly, but I find this to be an abusive use of power. I also take offense to the fact that while medical students are held to a higher level of morality and professionalism, administrators can essentially make threats by using powerful words that imply that students who do not attend sessions that are in essence, ****tily run and are of limited teaching utility. I think it's ironic that, with the excessive use of professionalism that administrators don't realize how unprofessional it is to have *-based learning that is poorly run and disorganized, and forcing students to sit through it.

 

[KinasePro]

I hate PBL/CBL/TBL/*-based learning/Problem Solving Sessions/Patient Oriented Problem solving, etc.
More disconcerting, in my opinion, is the use of the word "professionalism" as fearmongering, which serves to ensure attendance in mandatory sessions, by stating that not attending would be deemed non-professional behavior.

Couldn't agree more. "Professionalism" is such a joke in medical school... it basically translates to "we define your professional role and if you don't agree or comply, you're unprofessional." Coming from a prior career where true professionalism was very important and highly valued, I have to say that medical school administrators are making a mockery of it. Expectations and high standards in medical school are a one-way street. Students are expected to stand in line with a smile, but administrators/lecturers/attendings/proctors can do whatever they want. Unfortunately, I don't think that will change anytime soon.

 

[deleted6669]

I'm surprised at all the PBL hate on this thread. PBL is a great chance to leave the world of the classroom and start discussing real cases with colleagues, come up with differentials, and plans and see outcomes. At least in my program, PBL was essentially case discussions based on a particular system every session. this is real world medicine, not stuff from a book. We were encouraged to bring in info from real patients we had interacted with and walk the section through the presentation, frequently stopping to ask how others would work the case up, what their thought process was, etc. I found PBL to be one of the best parts of school. the part of school that could be done alone at home was the dry lecture material. PBL is the bridge between didactic and clinicals which helps to integrate book knowledge with actual patient's cases. I don't understand how any program could teach effectively without a significant PBL component.

 

[FIREitUP]

Couldn't agree more. "Professionalism" is such a joke in medical school... it basically translates to "we define your professional role and if you don't agree or comply, you're unprofessional." Coming from a prior career where true professionalism was very important and highly valued, I have to say that medical school administrators are making a mockery of it. Expectations and high standards in medical school are a one-way street. Students are expected to stand in line with a smile, but administrators/lecturers/attendings/proctors can do whatever they want. Unfortunately, I don't think that will change anytime soon.

we seem to share many of the same ideals. I know it won't change, however, it does institutions a disservice because it seeds resentment and basically guarantees students will steer clear of academia after they graduate.

 

[Textbookversion]

I'm surprised at all the PBL hate on this thread. PBL is a great chance to leave the world of the classroom and start discussing real cases with colleagues, come up with differentials, and plans and see outcomes. At least in my program, PBL was essentially case discussions based on a particular system every session. this is real world medicine, not stuff from a book. We were encouraged to bring in info from real patients we had interacted with and walk the section through the presentation, frequently stopping to ask how others would work the case up, what their thought process was, etc. I found PBL to be one of the best parts of school. the part of school that could be done alone at home was the dry lecture material. PBL is the bridge between didactic and clinicals which helps to integrate book knowledge with actual patient's cases. I don't understand how any program could teach effectively without a significant PBL component.

The medical school basic science years aren't rocket science. I don't need to hold hands and sit in a circle to remember the superior mesenteric artery supplies the midgut and is located at L1. I also don't need to talk to anyone about the wonders of lipolysis or how pretty chief cells look.

I don't care what my fellow classmates would do to "work-up" a hypothetical patient--I'm not tested on that.

Two years of clinical rotations offer plenty of time to play the "PBL" game and apply the basic science to clinical situations. Plus the whole internship and residency thing.

The first two years of medical school test your ability to remember and apply information that is readily available and well-organized in review books, textbooks and online resources. There is no need to garner the opinion or insight of a fellow medical student who is also experiencing their first exposure to the material.

I think you underestimate the amount of material covered during the basic science years of medical school.

Your PhD program in "health science" or w/e it is isn't really the same type of learning style/academic demands. If you were referring to your PA program, again that is a whole different ball of wax in terms of what you are expected to retain and the time-frame of the program.

 

[deleted6669]

There is no need to garner the opinion or insight of a fellow medical student who is also experiencing their first exposure to the material.
.

that is one difference between med school and pa school. In pa school your classmates are paramedics, nurses, resp. therapists, etc. who actually have valuable info to contribute from their past experiences working in the medical field....I've learned a lot about vent management, tricks to doing A-lines, etc, etc from resp. therapists over the years. don't discount the experiences of others in your learning. the whole concept of medicine is based on an apprenticeship model with knowledge passed down from senior clinicians to junior clinicians in training. this is at the heart of the pbl clinical concept taught during the didactic period of training. our pbl didn't review basic science concepts at the exclusion of clinical presentations. every pbl was about an actual patient and not just folks sitting around talking about A+P and physiology that could be read in a book on our own time.

 

[Siggy]

that is one difference between med school and pa school. In pa school your classmates are paramedics, nurses, resp. therapists, etc. who actually have valuable info to contribute from their past experiences working in the medical field....I've learned a lot about vent management, tricks to doing A-lines, etc, etc from resp. therapists over the years. don't discount the experiences of others in your learning. the whole concept of medicine is based on an apprenticeship model with knowledge passed down from senior clinicians to junior clinicians in training. this is at the heart of the pbl clinical concept taught during the didactic period of training. our pbl didn't review basic science concepts at the exclusion of clinical presentations. every pbl was about an actual patient and not just folks sitting around talking about A+P and physiology that could be read in a book on our own time.

...except the psychomotor skills are given basically zero coverage during pre-clinical years of medical school. Vent settings? We barely covered different mechanical ventilation settings. How to do arterial lines, venous lines, or various other skills? Not covered, not tested on. It's not about discounting information from people who have prior experience doing something, albeit from a different perspective from a physician. It's about discounting perspectives that aren't pertinent to the material being covered and and tested on. Just because you want to sit around and swap tips and war stories about placing arterial lines doesn't mean that everyone else should have to listen when we should be learning about the scientific and clinical basis of disease and treatment.

 

[deleted6669]

...except the psychomotor skills are given basically zero coverage during pre-clinical years of medical school..

too bad. it actually helps in the transition from sitting at a desk to seeing patients on rotations. we had several procedures labs our first yr before hitting rotations.

 

[FIREitUP]

that is one difference between med school and pa school. In pa school your classmates are paramedics, nurses, resp. therapists, etc. who actually have valuable info to contribute from their past experiences working in the medical field....I've learned a lot about vent management, tricks to doing A-lines, etc, etc from resp. therapists over the years. don't discount the experiences of others in your learning. the whole concept of medicine is based on an apprenticeship model with knowledge passed down from senior clinicians to junior clinicians in training. this is at the heart of the pbl clinical concept taught during the didactic period of training. our pbl didn't review basic science concepts at the exclusion of clinical presentations. every pbl was about an actual patient and not just folks sitting around talking about A+P and physiology that could be read in a book on our own time.

what you're describing bears little to no resemblance to medical school PBL, at least from my experience.

 

[deleted6669]

what you're describing bears little to no resemblance to medical school PBL, at least from my experience.

fair enough. as I mentioned above ours was basically interactive, goal directed grand rounds.

 

[MilkIsGood]

Couldn't agree more. "Professionalism" is such a joke in medical school... it basically translates to "we define your professional role and if you don't agree or comply, you're unprofessional." Coming from a prior career where true professionalism was very important and highly valued, I have to say that medical school administrators are making a mockery of it. Expectations and high standards in medical school are a one-way street. Students are expected to stand in line with a smile, but administrators/lecturers/attendings/proctors can do whatever they want. Unfortunately, I don't think that will change anytime soon.

agreed. the course info for my biochem mentions professionalism so many times, its a bit ridiculous.

 

[notbobtrustme]

I'm surprised at all the PBL hate on this thread. PBL is a great chance to leave the world of the classroom and start discussing real cases with colleagues, come up with differentials, and plans and see outcomes. At least in my program, PBL was essentially case discussions based on a particular system every session. this is real world medicine, not stuff from a book. We were encouraged to bring in info from real patients we had interacted with and walk the section through the presentation, frequently stopping to ask how others would work the case up, what their thought process was, etc. I found PBL to be one of the best parts of school. the part of school that could be done alone at home was the dry lecture material. PBL is the bridge between didactic and clinicals which helps to integrate book knowledge with actual patient's cases. I don't understand how any program could teach effectively without a significant PBL component.

Medical school PBL is vastly different. Any idiot who has watched a season of House can order the correct tests for these cases. There is nothing unique nor stimulating about them and so far, the diagnosis is right there in your face if you just googled the 2 or 3 salient symptoms. As others have said, the 3rd, 4th and residency years are PBL when it actually matters. Preclinical PBL is just a waste of time because no one has any idea of what they are doing and any "prior experience" is basically garbage they picked up from House, Grey's Anatomy or read in some random news article and should be purged instead of being reinforced in these sessions.


Secondly, remember, doctors get trained in a vastly different manner than PAs. You guys are done after 2 years of school and then off you go into the real world. You need to know more about the nuts and bolts about equipment because that's your primary focus whereas most physicians' primary responsibility is correct diagnosis and management of disease and that requires a far more in depth education.

 

[deleted6669]

You need to know more about the nuts and bolts about equipment because that's your primary focus whereas most physicians' primary responsibility is correct diagnosis and management of disease and that requires a far more in depth education.

you apparently have no idea what a pa is. "nuts and bolts about equipment". wtf?
maybe this will help: "Physician assistants, also known as PAs, practice medicine under the direction of physicians and surgeons. They are formally trained to examine patients, diagnose injuries and illnesses, and provide treatment."
source: http://www.bls.gov/ooh/healthcare/physician-assistants.htm
"under the direction" does not mean direct supervision, it means "in affiliation with". I have not been in the same room with my sponsoring physician of record in years. he doesn't know what days I work. he reviews my work after the fact, sometimes weeks to months later and very occasionally leaves me comments. that is our working relationship. as a new grad I presented lots of cases but that was years ago.
we aren't some kind of tech. we do h+p's, order/interpret tests, make dx, write rxs, etc. I have my own license and dea #. my charts are cosigned hours to weeks after the patients have already been seen. I work for a group of physicians and make them a crap load of money.
we practice medicine. I run a small er by myself with a doc available by phone for consults who I call rarely. I teach med students and residents now as a regular part of my job. I teach them emergency medicine, not "nuts and bolts about equipment".

 

[Bojack Horseman]

http://youtu.be/cZlNNSjsELs


Sent from my iPhone using SDN Mobile app

 

[KnuxNole]

I'm glad I didn't have to deal with PBL. Hearing these stories on this thread, in other topics, and from students from schools which had it...seems like a nightmare.

On rotations, I want to stab my eyes out when another student tries to correct the resident on rounds, or brings in journals to educate us all(which the attending doesn't even read), when in reality they are annoying and just like to hear themselves talk. I can see this happening in a PBL group, some student randomly bringing in articles or tries to act like they are highly knowledgeable. At least with lectures, the only time you hear these people is when they raise their hands and wants to engage in a discussion about a topic no one cares about, in which you can doze off for a minute.

 

[Druggernaut]

The medical school basic science years aren't rocket science. I don't need to hold hands and sit in a circle to remember the superior mesenteric artery supplies the midgut and is located at L1. I also don't need to talk to anyone about the wonders of lipolysis or how pretty chief cells look.

I'm at an almost completely PBL curriculum school. Much of our anatomy was group work rather than lectures, and yes, it sucked. Enormous waste of time.

But we didn't call that PBL. For us, PBL is 8 students and a facilitator who's job is just to keep things on track and give us the lab values and responses to medications that we "ordered" (though most will ask questions to encourage discussion and chime in with their own expertise). It starts with a sheet with something like, "A 72 year old man presents to the emergency department complaining of shortness of breath," then a student acts as the physician and takes the history of whoever is playing the role of the patient. Then we go over the a handout of the physical exam findings of the patient, and proceed through the workup. At the end of the session, we select relevant readings in our textbooks, and each group gets tested on the material they covered. I'm sure it's less time efficient than memorizing powerpoint slides, but I think it's more interesting, gives a greater depth of knowledge, and forces you to do the same kind of thinking you'll be doing on rotations.

I think we have a fairly good system, but I'd be miserable if I had to sit through "PBL" as you guys are describing it.

More disconcerting, in my opinion, is the use of the word "professionalism" as fearmongering, which serves to ensure attendance in mandatory sessions, by stating that not attending would be deemed non-professional behavior. I've found the word professionalism has been turned into an essentially empty term with a strong connotation that has been the rationale for forcing us to attend mandatory sessions, case base learning, etc.

Absolutely. And what's even more frightening is that some students, even a few who have had "real" jobs in the real world, actually buy into it. It's almost brain-washing. Whenever I hear a classmate say that administration is right in these situations because this is how it'll be in the workforce and we need to get acclimated to it, I can't come down hard enough on it.

It's this kind of thinking that makes it okay for the Joint Commission gestapo to tell physicians and nurses that they can't have a cup of water tucked away next to their work area in a secluded area of the nursing station that no patient will ever set foot in (infection control my ass). We get hammered with these negative descriptors so often some of us apparently lose the ability to see that the behaviors they're trying to discourage are in no way related to professionalism or whatever else they're calling it, but we certainly don't want to be labeled as such, so we roll over and take it without a peep.

 

[deleted6669]

For us, PBL is 8 students and a facilitator who's job is just to keep things on track and give us the lab values and responses to medications that we "ordered" (though most will ask questions to encourage discussion and chime in with their own expertise). It starts with a sheet with something like, "A 72 year old man presents to the emergency department complaining of shortness of breath," then a student acts as the physician and takes the history of whoever is playing the role of the patient. Then we go over the a handout of the physical exam findings of the patient, and proceed through the workup. At the end of the session, we select relevant readings in our textbooks, and each group gets tested on the material they covered. I'm sure it's less time efficient than memorizing powerpoint slides, but I think it's more interesting, gives a greater depth of knowledge, and forces you to do the same kind of thinking you'll be doing on rotations.
I think we have a fairly good system, but I'd be miserable if I had to sit through "PBL" as you guys are describing it.
.

my pbl was as you describe here which is why I found it helpful and a good use of time.

 

[calvnandhobbs68]

my pbl was as you describe here which is why I found it helpful and a good use of time.

Cool story bro too bad you didn't go to med school and this is in the allo forum.

 

[deleted6669]

Cool story bro too bad you didn't go to med school and this is in the allo forum.

PBL is PBL, regardless if it is an md program or a pa program. you might not realize it but the 2nd yr of pa school is interchangeable at many places with your ms3 year. programs that have both often schedule either an ms3 or a pa2 into a rotation slot.

 

[ArcGurren]

PBL is PBL, regardless if it is an md program or a pa program. you might not realize it but the 2nd yr of pa school is interchangeable at many places with your ms3 year. programs that have both often schedule either an ms3 or a pa2 into a rotation slot.

Don't mind the trolls. As long as you're on topic it's not a big deal to post in this thread.

I've experienced the "good" side of PBL and while yes there's a lot of memorization to be done in the basic science years, I didn't find PBL to be as horrible as some folks try to make it out to be. I'm sure some people have had very bad experiences with PBL/TBL but it's not all bad; but naturally this is the internet and therefore this is where you hear the worst stuff.

PBL works if someone is there to properly facilitate discussion and learning, and if the people participating it in it aren't moaning all the time about it. It does not work if you just throw everyone into the wind and say "here's some material you'll be tested on, look it up and learn it" and then provide maybe minimal structure and support.

 

[deleted6669]

Don't mind the trolls. As long as you're on topic it's not a big deal to post in this thread.

PBL works if someone is there to properly facilitate discussion and learning, and if the people participating it in it aren't moaning all the time about it. It does not work if you just throw everyone into the wind and say "here's some material you'll be tested on, look it up and learn it" and then provide maybe minimal structure and support.

Thanks...
our pbl was always facilitated by a doc or working pa to keep us on task and run as I mentioned before very much like interactive case study presentations/grand rounds. these were always small groups of fewer than 10 folks.

 

[calvnandhobbs68]

PBL is PBL, regardless if it is an md program or a pa program. you might not realize it but the 2nd yr of pa school is interchangeable at many places with your ms3 year. programs that have both often schedule either an ms3 or a pa2 into a rotation slot.

We just won't get your type of PBL though which is why that's not useful for medical students. We won't get to sit around in a group with PAs, therapists, nurses, paramedics, etc. We get to sit around in a group with other medical students who don't know any more than we do. Even if we did, we wouldn't focus on vent management and A-lines. PBL is during the science years so we get to sit around and discuss the steps of the coagulation cascade or some missense mutation. Which is all well and good until people start discussing stupid crap or keep focusing on something everyone else knows but they don't get. I guess that's why you have to have a good moderator.

 

[SpecterGT260]

We just won't get your type of PBL though which is why that's not useful for medical students. We won't get to sit around in a group with PAs, therapists, nurses, paramedics, etc. We get to sit around in a group with other medical students who don't know any more than we do. Even if we did, we wouldn't focus on vent management and A-lines. PBL is during the science years so we get to sit around and discuss the steps of the coagulation cascade or some missense mutation. Which is all well and good until people start discussing stupid crap or keep focusing on something everyone else knows but they don't get. I guess that's why you have to have a good moderator.

At my school, PAs sit in on our PBL sessions. They have to play catchup a little bit and I don't find their reports terribly helpful, but that is probably because they are pretty green to the process.

 

[calvnandhobbs68]

Don't mind the trolls. As long as you're on topic it's not a big deal to post in this thread.

Bad grasp of what troll means considering I have a legitimate reason for saying that which I just explained.

 

[calvnandhobbs68]

At my school, PAs sit in on our PBL sessions. They have to play catchup a little bit and I don't find their reports terribly helpful, but that is probably because they are pretty green to the process.

I think that would actually be kind of interesting though.

 

[SpecterGT260]

Bad grasp of what troll means considering I have a legitimate reason for saying that which I just explained.

troll gets misused to an alarming degree on this forum. Usually it is the pre-meds who assign it to anyone who disagrees with them. 😕

 

[SpecterGT260]

I think that would actually be kind of interesting though.

what would be interesting? It is a standard medschool PBL. With a couple of exceptions the PAs participate in our 2nd and 3rd years. Some of their stuff is watered down a little.

 

[deleted6669]

we wouldn't focus on vent management and A-lines.

we didn't do that in pbl. that was just my example of the value of learning things from others in medicine, sorry if I was unclear. our pbl's were all case based, starting easy and getting harder. a case regarding chest pain might involve a ddx that included pulmonary embolism which would involve discussion of risk factors, wells criteria, perc criteria, virchow's triad, etc and lead into diagnostic and treatment options, etc.

 

[calvnandhobbs68]

what would be interesting? It is a standard medschool PBL. With a couple of exceptions the PAs participate in our 2nd and 3rd years. Some of their stuff is watered down a little.

Having PAs in the groups. Just to have someone besides all med students there I guess. We don't have any of that but there's no PA school here sooo that would be the reason lol.

 

[calvnandhobbs68]

we didn't do that in pbl. that was just my example of the value of learning things from others in medicine, sorry if I was unclear. our pbl's were all case based, starting easy and getting harder. a case regarding chest pain might involve a ddx that included pulmonary embolism which would involve discussion of risk factors, wells criteria, perc criteria, virchow's triad, etc and lead into diagnostic and treatment options, etc.

Ah got it I thought you were saying that was in your PBL.

 

[SpecterGT260]

Having PAs in the groups. Just to have someone besides all med students there I guess. We don't have any of that but there's no PA school here sooo that would be the reason lol.

I think many/most PA schools are associated with medical schools and work this way in many places.

 

[deleted6669]

I think many/most PA schools are associated with medical schools and work this way in many places.

yup, there are varying degrees of overlap. at some programs pa's take all their courses with med students, at some a few courses, and at some none(but often taught by same instructors). you guys obvioulsy get a lot more basic med. sci.
our first yr has some of your first yr and a lot of your 2nd yr.
our 2nd yr overlaps closely with the ms3 yr which is why the current bridge program at lecom credits pa's with a full clinical yr.

 

[SpecterGT260]

bridge program?

 

[deleted6669]

bridge program?

http://lecom.edu/college-medicine.php/Accelerated-Physician-Assistant-Pathway-APAP/49/2205/612/2395
the first class are now ms2's and doing very well when compared to traditional track students. ( I have a friend in the program). half the class had to sign on as primary care track applicants, the other half can apply to match into anything.
the program is all of ms1 and ms2 with a hybrid clinical year.

 

[munchymanRX]

My school has drunk the TBL kool-aid, and they're foisting it on the poor underclassmen. My year got a pass, but now they're going full force. Where is the evidence that TBL/PBL is any better? What are the goals? Do they think that students will retain better? If so, there are much better methods for that (spaced repetition). Do they think we'll work better together? That's questionable. I think it actually creates more tension than it relieves. Do school just want to try to distinguish themselves and justify their existence (and 50K pricetag) in the age of low cost online education (e.g. pathoma, gunnertraining, etc.)? I think so. That's ultimately what they're trying to do. They need to have a reason to justify charging so much money, and dragging students through hours of "teaching" is how they do it. I know that's really cynical, but seeing what I've seen here at my school, I realize how relentless these admins and instructors are to push throw their system. It's ideological.

They don't have to justify their 50k pricetags. We are paying for the degree. An MD or DO allows us to receive real training. You learn how to be a doctor in residency.

I think the rest of the world has it right with their 5-6 year curriculums. You don't need a college degree for this stuff. It just adds unnecessary time and expense to the process.