nervous about PBL curriculum

[pjr28]

I will be going to Cornell med next year, but am really nervous about the PBL curriculumn. Can any current med students at a school with a PBL curriculumn share their experiences with it? Thanks so much.

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[aphistis]

We do PBL at IUSD. For us, it's a major PITA just because the faculty tutors make us proceed so slowly and deliberately, but it's easy money on exams.

 

[DW]

http://forums.studentdoctor.net/showthread.php?s=&threadid=102884&highlight=cornell

 

[Seaglass]

You either like PBL or you don't. I will say that for all the painful studying PBL is great at organizing information so that you can recall it later, instead of memorizing->forgetting like most people do to get through the tests. I am in the process of writing a paper right now on educational theory and PBL and I will summarize it by saying that if you treat PBL like the immersion style it is designed to facilitate you will be a step ahead of lecture trained third years come clerkship time.

Our school has lecture and a significant amount of PBL and I hated PBL when I did it but now the material from PBL is the only stuff I remember.

Also, after third year the majority of your learning will be in a case based format regardless of where you go (you learn by reading about your patients). So suck it up and do it. It's good for you.

Casey, MSIV

 

[Gleevec]

Im glad someone thought it was helpful. I had thought it sounded like a good way to learn and retain information long-term, but everyone in med school was telling me its a waste of time (almost as bad as dissections). It seems a lot better than looking at books, but then again, what do I know. If it was that bad, I would hope med schools wouldn't be actively implementing it into their curricula.

Originally posted by cg1155
You either like PBL or you don't. I will say that for all the painful studying PBL is great at organizing information so that you can recall it later, instead of memorizing->forgetting like most people do to get through the tests. I am in the process of writing a paper right now on educational theory and PBL and I will summarize it by saying that if you treat PBL like the immersion style it is designed to facilitate you will be a step ahead of lecture trained third years come clerkship time.

Our school has lecture and a significant amount of PBL and I hated PBL when I did it but now the material from PBL is the only stuff I remember.

Also, after third year the majority of your learning will be in a case based format regardless of where you go (you learn by reading about your patients). So suck it up and do it. It's good for you.

Casey, MSIV

 

[WatchingWaiting]

Actually, PBL is a horrible fad that in twenty years will be looked back on as, "What the Hell were we thinking?" Something like whole-word phonics a couple of decades ago. The reality is most first year med students are in a position of severe ignorance of the knowledge required to be a practicing physician. The process of getting to be a a competent physician, first and foremost, requires acquiring the ENORMOUS corpus of knowledge to actually be able to understand what's happening with your patients and how to help them.

The reason PBL is a joke and an absurdity is that it assumes that the reason first year med students aren't able to provide quality care and have a dazed-and-confused look when confronting actual medical problems is that their critical reasoning, independent research, forming effective interpersonal relationship skills are lacking or need development. This is 100% wrong! The problem is primarily one of ignorance and needing to learn a whole lot of terminology, drugs, and pathologies. AFTER the big picture material and general understanding has been acquired, PBL is a wonderful idea. But, guess what, third year, fourth year, and your three to seven years of residency have been structured as basically "PBL" for the last century of medical education. Once you have the big-picture knowledge of anatomy, physiology, and pathology acquired in the first two years, it makes a lot of sense to learn through cases, but, until then, PBL is inefficient as a Hell and also annoying as Hell. Instead of learning how some drug or physiological process works through a concise lecture or reading lecture notes, followed by student sitting and thinking about it, you get to learn how it works by independently researching it through pub med or having a presentation by one of your classmates. This takes four times as long, and is generally quite annoying. You also get these infuriating in-class sessions were you get six people basically trying to guess how some drug or process works when there is a definitive answer that can be imparted in thirty seconds of reading a lecture note on it.

The one good thing that has occurred with the wave of curriculum reform that brought in PBL is that it has been accompanied by a large-scale reduction in class time, which is, overall, a very good time. If you give PhDs a lot of time, they will fill it with all kinds of minutiae and random details. So, reduction of class time and emphasis on giving you the time to study the relevant material yourself outside of class is a good thing. But, emphasizing sitting in groups of six or eight blind mice trying to flail towards knowledge in little seminars is a terrible, terrible experience.

In short, there is no shortcut to acquiring knowledge.

 

[Seaglass]

Actually, PBL is a horrible fad that in twenty years will be looked back on as, "What the Hell were we thinking?"

I doubt it. It accurately reflects the evolution of the current understanding about how we learn information.

The process of getting to be a a competent physician, first and foremost, requires acquiring the ENORMOUS corpus of knowledge to actually be able to understand what's happening with your patients and how to help them.

Exactly. Now you can memorize and then forget this information, or you can build memory patterns that will help you to recall it in relevant clinical situations. Case is designed to facilitate the latter.

The reason PBL is a joke and an absurdity is that it assumes that the reason first year med students aren't able to provide quality care and have a dazed-and-confused look when confronting actual medical problems is that their critical reasoning, independent research, forming effective interpersonal relationship skills are lacking or need development.

With all due respect, you clearly do not understand the goal of case, or it has been improperly explained to you. We do not do case to develop our social skills. The theoretical reasons for doing case are many and complex. Suffice it to say that research has shown that case is superior to lecture in informaiton retention.

PBL is inefficient as a Hell and also annoying as Hell.

As this is an opinion I can't really argue with it but I would say that most students would agree. Most students are independant types that hate the forced group dynamic. However it is much more efficient than lecture when you compare the amount of retained information compared to lecture.

Instead of learning how some drug or physiological process works through a concise lecture or reading lecture notes, followed by student sitting and thinking about it, you get to learn how it works by independently researching it through pub med or having a presentation by one of your classmates.

The problem is that people don't remember the lectures past the tests. If you research the info yourself it reinforces that information beyond just "hearing" it. If your case consists of your classmates just telling each other the info instead of discussing it then it really isn't better than lecture.

In short, there is no shortcut to acquiring knowledge.

Obviously I disagree.

And besides which STEP 1 IS CASE BASED FORMAT. That's right, the questions are presented as cases with 2 step answers. So case preapres you for Step 1.

If you want to go into more depth then I'm perfectly willing to do that.

Casey

 

[Buck Strong]

PBL sucks, in my opinion. I think time could be better spent either in a traditional lecture, or by just letting my study in the library. I can list a ton of reasons why I don't like PBL, but i'm sure someone who loves PBL can refute every one of those reasons, because they're purely my opinions, not backed by any facts or figures. However, our school's step one average has dropped as lecture hours have fallen in favor of more PBL hours, including over a dozen failing step one last year. If i had to do it over again, i'd probably go somewhere where PBL hasn't been implemented, but if this trend continues, few schools will remain PBL free. Thanks for listening.

 

[courtyard]

Most schools that do have PBL usually have lectures as well.
I will be attending soon, so i don't know what it is like to study in pbl fashion, but in combination, I am feel that it would be effective way to learn for me. Lecture would provide factual knowledge, and pbl would reinforce the knowledge by applying it in a context.

I am not sure if there are actually schools that are truly 100% pbl from day one.

 

[Da Vinci2]

PBL was painful for me. I don't think it lived up to its promise. It may be useful if your curriculum structured it so its at the end of your preclinical years, when you have the information and can figure things out. Its otherwise a waste since you just don't have the knowedge base to do PBL in preclinical years. I think it should function more as an adjunct to a curriculum, instead of the core of a curriculum as PBL will not provide you with the kind of knowledge you need to perform well on step 1.

 

[moo]

PBL is a waste of time. They don't even test us on the material in it, so nobody studies it. The only good thing about it is that we get drastically reduced lecture time.

 

[edfig99]

i had a great time with it...thought it prepared me well for the floors. passed the boards with no problems whatsoever (didn't study for them either). felt pretty grounded for residency.

lectures though at times useful, really are a poor learning format. they have been shown time and time again to not really lead to good information retention, nor do they change habits/behaviors, yet not so oddly enough, they are the preferred learning method by physicians (this was in a recent study looking at different methods of providing CME - continuing medical education - to physicians).

interactive learning, with opportunity for self study is the way to go...in a systems based fashion.

i still use all my pbl skills now as an attending. it ain't all bs. medicine is a LOT more than about getting tested.

 

[pjr28]

Thank you everyone for your great insights

 

[Entei]

There are lots of people here saying that PBL is a waste of time, but you know what? Nine times out of ten, lecture is a waste of time too. There is no substitue for sitting down with a book and memorizing all the stupid details that you need to know. At least a little PBL sounds like a lot more fun than just falling asleep in lecture, but it's all a moot point because any second that you don't spend in the library ultimately becomes a waste of time.

 

[Jalby]

I've had one real experience with PBL, and I hated it. It sucks having to learn something for the first time from other students who read it out of a book. It does prepare you for the third year, but it definately isn't helpfull for the boards per say. One person above said the USMLE is PBL, which is just wrong. It's called vinettes. PBL is group activities.

That being said, my schooling in class is done in 2 weeks and I will have 8 weeks of PBL learning, but all of the stuff is what we have learned before or building on the stuff. That probably will help us for the wards to get used to that, but right now I'm voting against PBL when used for learning the infomation for the first time.

 

[moo]

I agree with Jalby, just because it's vignettes does not mean it's a clinically oriented exam. You can still test the basic science concepts disguised in a vignette.

 

[Buck Strong]

Yeah, i think our step 1 scores have dropped about 10-15 points in the past 5 years, but our step 2 scores are up. Unfortunately, step 1 counts a whole hell of a lot more than step 2. Recently, I've decided to blow off PBL, maybe spend an hour on it per night, and focus on just memorizing textbooks and lecture notes...not ideal, but I'll be damned if my step 1 sucks

 

[DW]

Originally posted by Entei
There are lots of people here saying that PBL is a waste of time, but you know what? Nine times out of ten, lecture is a waste of time too. There is no substitue for sitting down with a book and memorizing all the stupid details that you need to know.

along with dissections in anatomy lab and looking at histo slides on a microscope

 

[Jalby]

Originally posted by DW
along with dissections in anatomy lab and looking at histo slides on a microscope

You still use microscopes??? That was one of things I was so glad about when I got to school, that we didn't need microscopes. Everything is now projected onto a large screen or online. Sooooo nice.

 

[Habari]

this is my take:

i don't do lectures, never did in college - and haven't found a reason to thus far in med school. and while i curse the existance of pbl when i have to be in small group at 8am - it is one of the very few times in med school that i feel like i put a modicum of thought into what i'm doing. when i goto our preceptor every week and see patients, i can actually follow diagnostic tests/values and have some behind the logic of patient management in situations i haven't formally learned through lecture.

efficiency of learning/information transfer using this method? low; perhaps the lowest of all activities in med school. maybe one of the random clinical vignettes our preceptors impart will be on the boards. probably not. but like going to preceptor each week and talking to patients - which is also a low information transfer activity, you get something else out of it.

i am not a committed proselytizer of pbl. don't know if having gone through pbl will convert into an advantage in the future - i sort of doubt it. people in other curriculums who are tenacious and socially aware will recoup any purported deficit.

again, it depends, in part, if the process of your education is important to you; for others, on the other hand, the 'end game' [i.e. residency match, fellowship, career] is of main concern. to each their own. pbl, in some ways, makes me feel a bit more engaged, and like my mind isn't completely atrophying away during this acculturation process.

 

[DW]

Originally posted by Jalby
You still use microscopes??? That was one of things I was so glad about when I got to school, that we didn't need microscopes. Everything is now projected onto a large screen or online. Sooooo nice.

ostensibly we are still using microscope, although all the critical images are online. very few people bother brining their microscopes to lab...and our histo professors wonder why

 

[Seaglass]

To the OP: I think you can see what I was saying, that the majority of students don't like PBL due to the time/work committment and reluctance to change learning habits that were successful for them in undergrad (memorizing). Unfortunately you simply cannot memorize and retain the amount of information learned in the first two years of medical school. You have to find a way to learn it.

Its otherwise a waste since you just don't have the knowedge base to do PBL in preclinical years.

PBL is about aquiring the knowledge base, if you already had it there wouldn't be a point!

PBL is a waste of time. They don't even test us on the material in it, so nobody studies it.

This is one of the main problems with the application of PBL in curricula. Tests seem to universally still favor lecture based material, which is a shame, because PBL really is good preparation for Step 1 questions.

There is no substitue for sitting down with a book and memorizing all the stupid details that you need to know.

Actually there is (PBL) since you can't retain what you memorize as it is.

Recently, I've decided to blow off PBL, maybe spend an hour on it per night, and focus on just memorizing textbooks and lecture notes..

Hmm, I wonder if this has anything to do with declining Step 1 scores? The problem isn't PBL people, it's too much free time. When our school (Penn State) started PBL they had the PBL track and the lecture track. At the end of the trial period (3 years) the Step 1 scores and clinical shelf scores were compared. The groups were statistically equivalent on Step 1 and PBL trained students were statistically superior on the floors. The main problem with PBL is that students who don't like it short-cut the process by 1) not doing the work and having the answers handed to them the next day by other students (for this student PBL will be no better than lecture since the knowledge aquisition process is the same) and 2) splitting up learning objectives instead of everyone looking everything up.

I agree with Jalby, just because it's vignettes does not mean it's a clinically oriented exam. You can still test the basic science concepts disguised in a vignette.

I didn't say Step 1 is clinical but it is presented in case format. Coincidentally, PBL is presented in case format. Hopefully, by the end of your ms2 year you should know how to walk through a case and evaluate it as a result of PBL. If your PBL is well done then learning objectives will include biochemical, pharmacological, physio, micro, etc. that will be heavily represented on Step 1. I know that in our cases students are expected to research and present the pathophys, normal phys, pharm, etc. for cases in year 1.

The boundaries of "what you need to know" are very fuzzy in PBL.

This is by design. Good facilitators should keep you from wasting time.

Also, the signal to noise ratio can be a bit low because you end up hearing a fair amount of erroneous information from classmates.

Also by design. Hopefully you then discuss why things are "wrong" and come to a deeper understanding of the material.

Because information is coming from all directions at once, I find it difficult to maintain organized notes in a PBL curriculum.

A good facilitator will help with this too.

 

[8744]

Originally posted by WatchingWaiting
Actually, PBL is a horrible fad that in twenty years will be looked back on as, "What the Hell were we thinking?" Something like whole-word phonics a couple of decades ago. The reality is most first year med students are in a position of severe ignorance of the knowledge required to be a practicing physician. The process of getting to be a a competent physician, first and foremost, requires acquiring the ENORMOUS corpus of knowledge to actually be able to understand what's happening with your patients and how to help them.

The reason PBL is a joke and an absurdity is that it assumes that the reason first year med students aren't able to provide quality care and have a dazed-and-confused look when confronting actual medical problems is that their critical reasoning, independent research, forming effective interpersonal relationship skills are lacking or need development. This is 100% wrong! The problem is primarily one of ignorance and needing to learn a whole lot of terminology, drugs, and pathologies. AFTER the big picture material and general understanding has been acquired, PBL is a wonderful idea. But, guess what, third year, fourth year, and your three to seven years of residency have been structured as basically "PBL" for the last century of medical education. Once you have the big-picture knowledge of anatomy, physiology, and pathology acquired in the first two years, it makes a lot of sense to learn through cases, but, until then, PBL is inefficient as a Hell and also annoying as Hell. Instead of learning how some drug or physiological process works through a concise lecture or reading lecture notes, followed by student sitting and thinking about it, you get to learn how it works by independently researching it through pub med or having a presentation by one of your classmates. This takes four times as long, and is generally quite annoying. You also get these infuriating in-class sessions were you get six people basically trying to guess how some drug or process works when there is a definitive answer that can be imparted in thirty seconds of reading a lecture note on it.

The one good thing that has occurred with the wave of curriculum reform that brought in PBL is that it has been accompanied by a large-scale reduction in class time, which is, overall, a very good time. If you give PhDs a lot of time, they will fill it with all kinds of minutiae and random details. So, reduction of class time and emphasis on giving you the time to study the relevant material yourself outside of class is a good thing. But, emphasizing sitting in groups of six or eight blind mice trying to flail towards knowledge in little seminars is a terrible, terrible experience.

In short, there is no shortcut to acquiring knowledge.

Amen, buddy. On a more visceral level, if you're going to learn the material yourself why bother with the first two years of medical school? Might as well make it a correspondence course.

My school is mostly lecture based, praise Bhudda, but we dabbled a bit in PBL. I really hated those pointless hours of group learning, especially since most of what we learned in any given session could have been condensed down onto an index card which I could read in about five seconds.

I agree completely. Third and fourth year are all "PBL" but at least you have a knowledge base from which to operate. First week of first year we had a "PBL" session and most of us just sat looking stoopud. Not hard when when you literally don't know anything.

And, being something of a PBL-slacker I always did the bare minimum when it came to PBL assignments. I used "Google" not Pub-med, and only researched enough to cover my ass. At least with lectures you know what you have to study and for how long.

Another thing I dislike about PBL is that it brings out the tiger in gunners. You will never really hear me complain about gunners except as it relates to PBL when they can have a direct impact on my life. As in, for example, asking useless and often self-aggrandizing questions towards the end of a session which only serve to prolong the agony. At least in lecture you can implement the "ten-minute" rule.

(No questions in the last ten minutes of lecture. If you have some burning desire for a more detailed explanation of a difficult concept then by all means wait until I am safely out of the lecture hall and on my way home.)

 

[Entei]

Originally posted by cg1155
Actually there is (PBL) since you can't retain what you memorize as it is.

I go to a lecture-based school, but we have PBL sessions every once in a while. Now, maybe the lectures have made me slow and stupid, or maybe I'm a nimrod unfit for the practice of medicine, but I have never magically retained all the important information that was presented at one of our small group sessions. Sure, big picture stuff sticks, but the stupid details have to be drilled again and again at home. This... isn't that different from a good lecture, really.

 

[Jalby]

Originally posted by cg1155
Unfortunately you simply cannot memorize and retain the amount of information learned in the first two years of medical school.

I disagree. I believe this is one of those urban legends that has been passed down by pre-meds. You can memorize, and most people do, the amount of information to do well on the boards.

 

[indianboy]

Amen, buddy. On a more visceral level, if you're going to learn the material yourself why bother with the first two years of medical school? Might as well make it a correspondence course.

God knows I would if i could. Look let's face it: If you are engaged and find the academics of med school challenging, consider harnassing free cycles of your considerable brain power to contribute to the SETI project. Don't get me wrong, the goal of fashioning college gradutes into pliant cogs is an admirable one, no matter the curriculum.

Hope that Helps

P 'Would you like fries with that?' ShankOut

 

[DW]

Originally posted by indianboy
God knows I would if i could. Look let's face it: If you are engaged and find the academics of med school challenging, consider harnassing free cycles of your considerable brain power to contribute to the SETI project. Don't get me wrong, the goal of fashioning college gradutes into pliant cogs is an admirable one, no matter the curriculum.

Hope that Helps

P 'Would you like fries with that?' ShankOut

oh man, thats classic