PBL Problems

[CodeRedDew]

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So my school holds a few required PBL classes every week and I get absolutely nothing out of it. Mainly because my session is full of students who have relatively extensive past medical experience (nurses, EMT, etc) and they're usually the only ones talking the entire session about terminology and differentials that I can't make any type of connections with. It's a complete waste of time because they're just spitting our information and I (along with a few of my other classmates) have no clue what they're talking about. And if I asked a question about every single detail that I didn't know about, which is practically everything since I'm only a first year, we'd never get through the session. I want to learn, but I just get discouraged when I don't know what the heck is going on. I make good grades, so it's not that I'm a slow learner or anything. I just don't have anywhere near the background knowledge as some of my classmates.

So I guess my question is, what can I do to make the best of this situation? I was already anti-PBL before these sessions even started and this is just making me hate it even more. Are there any books that can maybe teach me some basic clinical terminology and assessment? Something that isn't TOO advanced for a 1st year medical student.

Please excuse any errors as I typed this on my cell phone.

 

[alamo4]

A lot of times when I'm in a session where I don't know what is going on, whether its at a research conference, grand rounds, etc. if I don't feel like I can ask questions, I just start looking up things mentioned online on my laptop or phone. Especially if something is mentioned a few times, that's a sign it's worth figuring out what it is. Even if I don't understand most of what is being talked about, I can be learning.

 

[Pasmal]

I'm an M1 as well, but in a PBL-based curriculum.

What do they give you before the sessions? Do you know the overarching topic? You obviously wouldn't want to waste time researching stuff that won't be discussed, but if you know the topic then looking up the typical presentation, pathophys, ddx and treatment options shouldn't take more than 10-15 mins (or you could do it during the session as the previous poster suggested).

 

[CodeRedDew]

We aren't allowed to have our laptops or cellphones out nor are we given any information prior to the PBL session.

 

[mcloaf]

We aren't allowed to have our laptops or cellphones out nor are we given any information prior to the PBL session.

That sounds like the opposite of a learning experience.

 

[Porfirio]

Just go with the flow, pass your classes, and study for Step 1 when the time comes.

Edit:
If you want to get at least something out of it, take a paper and pen. Write down what the subject is, and what questions are being asked (do not waste your time on writing down answers - find those yourself). Then go to First Aid/Pathoma and learn about the topic. Heck, even Wikipedia is good.

 

[Brain Bucket]

What McLoaf said.

Also, I had a similar experience during M1. A few nurses/EMTs. I just took a lange cases/pretest with me and did Qs. So long as this isn't a large portion of your grade, you're not missing out on anything. Focus on your exams and the step. You'll outpace them all when it matters.

 

[CodeRedDew]

What McLoaf said.

Also, I had a similar experience during M1. A few nurses/EMTs. I just took a lange cases/pretest with me and did Qs. So long as this isn't a large portion of your grade, you're not missing out on anything. Focus on your exams and the step. You'll outpace them all when it matters.

Which Lange cases/pretest book did you use? I googled it and several popped up.

 

[Brain Bucket]

Oh, this wasn't for PBL, just for tests. At the time, I was reading:
http://www.amazon.com/Files-Physiology-Second-Edition-LANGE/dp/0071493743
http://www.amazon.com/Anatomy-Histology-Cell-Biology-Self-Assessment/dp/0071623434

Older editions, though. The point was, I was doing qs, primarily because it was too distracting to read a text, and while it's easy to space out while reading a text, it's easier to keep track of time if you're doing Qs. Suppose you've only done 3 and it's been 15 mins, you're like wtf, gotta get back.

 

[notbobtrustme]

I think that's PBL done wrong. We've had a smattering of PBL/small-group learning and the majority has actually been pretty decent. I came away with knowledge that I didn't have before.

However, this is all predicated on having a facilitator that know's whats up. Keeping the group on target, keeping the discussion moving forward and nipping side tracks in the bud.

 

[thefritz]

So my school holds a few required PBL classes every week and I get absolutely nothing out of it. Mainly because my session is full of students who have relatively extensive past medical experience (nurses, EMT, etc) and they're usually the only ones talking the entire session about terminology and differentials that I can't make any type of connections with. It's a complete waste of time because they're just spitting our information and I (along with a few of my other classmates) have no clue what they're talking about.

Wait, are you saying that PBLs are only about students arguing about who is the smartest? That maybe trying to be educated by your peers isn't as good as being instructed by an actual teacher and studying on your own? Blasphemy! Don't know you about all the RESEARCH behind team-based learning? You know, the research conducted by people with financial, political, and career interests in promoting such stuff? The research where they throw out evaluations turned in by unhappy students because they are 'unprofessional'?

Basically, if you are an introvert, GTFO. The goal of medical education has obviously been to turn us all into gregarious politician celebrity types rewarding those who are loudest, most popular, and can debate the best. Individual study and innovation is a thing of the past. I mean, nevermind that most technological advances of the modern era were pioneered by introverted individuals working alone (ok, so there were TWO Wright brothers). But imagine what all these people could have done if they had formed a committee and put their heads together! Surely there wouldn't have been bickering and compromise!

Ok, enough sarcasm. OP, I share your frustrations. Just get through it and ignore these academic idiots trying to kill the idea of the individual in America.

 

[thefritz]

We aren't allowed to have our laptops or cellphones out nor are we given any information prior to the PBL session.

I'm saddened to see that this anathema is continuing to infiltrate and poison the medical schools in this country. Are there any schools left that don't have this crap and don't treat their adult students like 2nd graders?

 

[Kahreek]

I bet they are just bouncing some medical lingo, just write the main subject on the notebook and study it laters, i can guarantee you with a 95% confidence you are not missing much.

 

[Apoplexy__]

We aren't allowed to have our laptops or cellphones out nor are we given any information prior to the PBL session.

This is horsesh*t. I think what Porfirio said about the paper and pen is a great idea; do that. It'll probably take just a handful of sessions of you looking up the terms and concepts that you wrote down for you to start to pick up on stuff.

Also, coming from a PBL-based curriculum, it gets better. Trust me, it sucked being an MS1 who didn't even know what a CBC was or the faintest idea what anything on an EKG meant, while having x-ray techs and EKG techs in my group. But I sublimated the hell out of that frustration and devoted myself to eventually surpassing those people relying on their past experiences. Now it's MS2, and those people who didn't realize that they'd eventually have to work as hard as everyone else are off on the sidelines. Having a phlebotomy certificate or nursing degree isn't going to help you explain immune-complex glomerulonephritis.

PS: Total douche move on the part of those people spouting off their expertise. What a way to ruin PBL. Even if you know every facet of every discussion, you don't just drown everyone out with your knowledge.

 

[link2swim06]

PBL is dumb. End of story.

 

[Pasmal]

PBL is dumb. End of story.

80%+ of med schools use it. But you're right, you have obviously figured out something they have not.

 

[link2swim06]

80%+ of med schools use it. But you're right, you have obviously figured out something they have not.

Yep it sounds good in theory...but it is a very low yield way of learning. Worse than most powerpoint lectures imo.

Many people would agree that doing questions is probably the most efficient, most long term way to retain information. Yet many courses (at least at my school) didn't have practice tests or if they did exist they were only 10 questions or so.

Why schools haven't adapted I have no idea.

 

[CherryRedDracul]

PBL is dumb. End of story.

They're good if they're run properly by a good facilitator. I learned quite a bit from the few my school has had. We also get material beforehand so we know what the case is about. OP describes PBL done wrong and it would be a good idea to mention the flaws in course evaluations.

 

[Wordead]

PBL, like mandatory lecture, is good for people who aren't able to learn by themselves. Frustrating for the self-motivated.

 

[tantacles]

PBL, like mandatory lecture, is good for people who aren't able to learn by themselves. Frustrating for the self-motivated.

Not uniformly, certainly. I've found many PBL sessions to be extremely helpful, particularly if I've looked at the scenario beforehand and am up to date in my studies. I'd say that PBL is great for solidifying information you've already had a first exposure to, especially when your lecturers are substandard, as I find my school's often are.

They're good if they're run properly by a good facilitator. I learned quite a bit from the few my school has had. We also get material beforehand so we know what the case is about. OP describes PBL done wrong and it would be a good idea to mention the flaws in course evaluations.

The course evaluations aren't the only way to solve this. At least at my school, course directors are extremely receptive to feedback given non-anonymously during a course. If you're professional and you're able to express your critiques coherently, you may be able to see change before you're done with your PBL.

 

[Laryngophed]

Lot of PBL hate up in here. I personally loved it and found that it was able to provide context for diseases and management decisions. Sure, by the end of the second year I was over having to do learning objectives and some of the presentations were "classic" and readily identified secondary to board prep, but I think it helped make the transition to the clerkships more natural, it gave me plenty of unstructured time when I could drive my own learning, and I was able to pick up a few hobbies and not neglect my family the first two years. Maybe I could have found those things in a traditional curriculum, but PBL worked well for me.

 

[Wordead]

Not uniformly, certainly. I've found many PBL sessions to be extremely helpful, particularly if I've looked at the scenario beforehand and am up to date in my studies. I'd say that PBL is great for solidifying information you've already had a first exposure to, especially when your lecturers are substandard, as I find my school's often are.

It might be helpful to an extent, but it took 200x as much time to get the same result, not to mention time wasted going to school. Our PBL sessions were 2 hrs; it would've taken me ~20 minutes by myself to learn the same info.

 

[notbobtrustme]

PBL is only worthwhile as an adjunct to lecture. We are like 95%+ lecture and 5% PBL and the little bits of PBL do help put some things into context and help solidify learning. However, if it were anything more than this, I'd kill myself.

 

[Mace1370]

Easy solution is to make PBLs non-mandatory. Will that ever happen? Ha!

 

[tantacles]

It might be helpful to an extent, but it took 200x as much time to get the same result, not to mention time wasted going to school. Our PBL sessions were 2 hrs; it would've taken me ~20 minutes by myself to learn the same info.

Many of the most useful PBL sessions I've had were ones where I've already learned the material, which is what I was trying to get at. The best PBLs, in my opinion, take a seemingly arcane case and give you a context for the diagnosis. I think it's fantastic that you're able to encode information quickly and retain it over an extended period of time, and I don't dispute that your ability to do that is profoundly beyond my own. Even for the self-motivated, however (though clearly not you), PBL can play an important role in the learning process; it's just another modality.

I think we're in agreement, though, that the hype about PBL clearly exaggerates its utility much of the time. I've been told an awful lot of the time during my history of education that people only retain 10% of what's said in a lecture, but there are certainly people, and I'm one of them, who can retain quite a bit of information given the right lecturer, level of attention, and topic.

 

[thefritz]

OP describes PBL done wrong and it would be a good idea to mention the flaws in course evaluations.

At my school, those evaluations would most likely get thrown out. A lot of schools are conducting "research" and have grants to study this PBL/TBL garbage. Student evaluations form a major metric in evaluating success and consequently the data is cherry picked.
An evaluation that says "I hated this ****ing class it is the biggest ****ing waste of time. Everybody here is *****s and they are throwing my tuition dollars down the drain with this horse**** and effectively making me a dumber physician" gets thrown out as "unprofessional." What is unprofessional or not is totally subjective. Is this unprofessional as well? "I disagree with the PBL concept and how it is being implemented at my school. I find the educational methods a major distraction and impediment to my studies. Here is why... etc." That would probably also get thrown out even though it is clearly not 'unprofessional' (the blanket term used for a no-no since we are children after all) as the first example.

TBL was literally just made up by a single guy and has been pitched as snake oil to all sorts of fields of education, where it has largely suffered the same failures: A minority of the people always ends up doing all of the work or all of the speaking. Same results, every time, no matter what discipline it's in. It's total garbage. The data is cherry picked to sell it. There is plenty of research out there showing how ineffective it is, but this research is never mentioned by the proponents of it -- again, they cherry pick the studies that support it, which have cherry-picked data that form their conclusions. At my school, we literally were forced to write negative comments about our team members. It was not acceptable to write "student X did a great job and I have nothing negative to say" Whether or not this was true, we were instructed to explicitly write a critical comment in order to receive a passing grade. The unstated assumption was "if you truthfully have nothing negative to say about your teammates, you will need to make something up in order to receive a passing grade." Why? Well, it's a key part of the "process."

It's appalling and this post is drudging up terrible memories.

 

[mcloaf]

80%+ of med schools use it. But you're right, you have obviously figured out something they have not.

I'm not sure this is a very informative statistic without knowing to what degree it's used in various programs. We have it once a week and it's fine, but while that session I guess puts us in the 80% that use it I'd hardly say it's a big part of my learning on a weekly basis.

 

[Laryngophed]

I suppose all of the PBL hate here comes from places where PBL isn't the primary learning tool in the curriculum. At my school, PBL is about all that is truly mandatory (aside from the intro to basic medical skills course), whereas lectures are optional. We have about 12 hours of mandated PBL times (roughly, though some groups move faster than others, some slower, and most groups generally require less time second year) and that allows for self-study, in addition to completion of learning objectives. The school has a graph that shows Step 1 scores tracked from before the shift to a nearly complete PBL curriculum (roughly what it is now) and there is an interesting correlation demonstrating a jump in the scores after the implementation of PBL. But that opens the doors for the naysayers who will decry anything published by a school, and the arguments about whether or not Step 1 matters (as a tool to evaluate a school's efficacy in medical education) and whether or not the curriculum plays any role in the scores achieved at the school.

 

[Pasmal]

I'm not sure this is a very informative statistic without knowing to what degree it's used in various programs. We have it once a week and it's fine, but while that session I guess puts us in the 80% that use it I'd hardly say it's a big part of my learning on a weekly basis.

It's informative in the sense that it's unlikely that 80% of medical schools would waste even an hour per week on something that they didn't feel was important/valuable.

 

[Wordead]

Many of the most useful PBL sessions I've had were ones where I've already learned the material, which is what I was trying to get at. The best PBLs, in my opinion, take a seemingly arcane case and give you a context for the diagnosis. I think it's fantastic that you're able to encode information quickly and retain it over an extended period of time, and I don't dispute that your ability to do that is profoundly beyond my own. Even for the self-motivated, however (though clearly not you), PBL can play an important role in the learning process; it's just another modality.

I think we're in agreement, though, that the hype about PBL clearly exaggerates its utility much of the time. I've been told an awful lot of the time during my history of education that people only retain 10% of what's said in a lecture, but there are certainly people, and I'm one of them, who can retain quite a bit of information given the right lecturer, level of attention, and topic.

I'm actually terrible at learning information long term and need several iterations to get it into long term information; which is why I hate mandatory things that I get a lot less out of.

 

[thefritz]

he school has a graph that shows Step 1 scores tracked from before the shift to a nearly complete PBL curriculum (roughly what it is now) and there is an interesting correlation demonstrating a jump in the scores after the implementation of PBL. But that opens the doors for the naysayers who will decry anything published by a school, and the arguments about whether or not Step 1 matters (as a tool to evaluate a school's efficacy in medical education) and whether or not the curriculum plays any role in the scores achieved at the school.

Yes, exactly. LOL at a school trying to sell PBL with a bump in a graph the year PBL was implemented. This is ******ed on so many levels:
1. The school is supposed to teach you how to conduct proper research and analyze data, yet they expect you to believe that a single data point proves a correlation? LOL
2. Typically when schools do changes like this, they heavily screen applicants to make sure they will do exceedingly well. This means bumping up GPA and MCAT criteria for interviewing, interviewing more candidates, and accepting more candidates to fill the class with higher caliber students. Often scholarships are even extended. In recent years, brand new medical schools are offering full tuition scholarships and landing some really weird first classes with 40+ MCATers all around. Deans and administration make changes like this to the curriculum in order to make their mark and bolster their professional career (which almost always involves something beyond dean of medical school). Once they get enough data to prove how great they were (these chart bumps) they move on. It's a political game.
3. The average step 1 score has been going up steadily.
4. Statistics are spun to make this look good. For example, people who fail don't have the failing score counted, only the 2nd score. If there is a bimodal distribution (indicating that only students who did outside prep courses and extensive self study did well), this isn't reflected by an average score.
5. Is anybody really stupid enough to believe that anything you learn in a PBL session will be of benefit on a timed binge-and-purge rote memorization exam like step 1? An exam where how well you do is measured by how many hours you can lock yourself in a room alone and memorize? Imagine trying to study for Step 1 using only PBL in groups. Just imagine that.

This is one of the dumbest things I have ever read. Seriously? Come here and do PBL and you'll do better on step 1? Seriously?

 

[KnuxNole]

It's informative in the sense that it's unlikely that 80% of medical schools would waste even an hour per week on something that they didn't feel was important/valuable.

They think it's important, but a lot of students sure as hell don't

 

[CodeRedDew]

The point is, as others have mentioned. is that PBL is incredibly inefficient.

 

[Pasmal]

The point is, as others have mentioned. is that PBL is incredibly inefficient.

It's only as inefficient as the students in the group make it.

 

[Brain Bucket]

It's only as inefficient as the person supervising the group makes it.

Corrected it for you.

Sent from my GT-N7100 using Tapatalk

 

[Pasmal]

They're both limiting factors.

That said, from my experience a facilitator who doesn't know much about a case won't significantly inhibit your group's progress if the students know their stuff and are able to cover topics efficiently. I understand your experience may be different (I'm not sure what exact role facilitators play in your PBL setting), but our facilitators generally give us control and don't chime in unless they need to/we get completely stuck, so we can generally get through the material pretty fast if we come prepared (our PBL cases are 3-4 days x 3 hrs/day so we study the material ahead of time and then discuss it and apply it to the clinical findings in group).

 

[Chir0nex]

It also depends on what the aim of the PBL course is though. Trying to learn material for the first time in that setting seems miserable, especially since there are so many leaning styles. However, I do think PBL can be effective at teaching proper group dynamics while reinforcing clinical situations. It is really hard to speak to PBL as a whole, since I think PBL means very different things at different schools.

As to the original situation, I would speak to your facilitator or preceptor. Hopefully, they will start going through the terminology and diagnosis for the entire group (or even better, have the people with more knowledge explain it to the group). At least at my school, it does not matter how many cases you get through, so there was no problem taking a while to have someone explain concepts, though obviously they may be different for you.

 

[KnuxNole]

Just out of curiosity(and probably a dumb question), what happens if you are in a group where none of the students do any reading? Does that mean that nobody learns anything?

 

[Akali]

We aren't allowed to have our laptops or cellphones out nor are we given any information prior to the PBL session.

Jesus. How horrifying.

Small group learning is stupid. Just give me the facilitators answers and I can learn it myself at LEAST twice as fast and definitely in a much better way that is tailored to how I best learn things.

It's informative in the sense that it's unlikely that 80% of medical schools would waste even an hour per week on something that they didn't feel was important/valuable.

Isn't it just because LCME forces them to do it?

 

[001100010010011]

PBL is purely inefficient. You need to ask your course director to allow you to access UptoDate, Pubmed, and other electronic sources. Your experience sounds like an atrocious waste of your time.

 

[Pasmal]

PBL is purely inefficient. You need to ask your course director to allow you to access UptoDate, Pubmed, and other electronic sources. Your experience sounds like an atrocious waste of your time.

I love how often people complain about how "inefficient" PBL is.

Sure, it's inefficient at lower order learning (gaining knowledge), but if you're at a school that has even a half-decent PBL set-up then most of that learning is self-directed and occurs on your own time in-between sessions. PBL is about higher-order learning that will make you a better physician as opposed to just drinking from the fire hose for two years to maximize your boards. You aren't really losing that much time and you're gaining valuable skills. If you don't have time to study in med school with the little PBL most of you are required to do (my school is PBL-based), then it is truly a miracle that year-after-year, students here are able to get good board scores and graduate on time.

 

[notbobtrustme]

It's informative in the sense that it's unlikely that 80% of medical schools would waste even an hour per week on something that they didn't feel was important/valuable.

hahahahahahahahahahahahahahahahahahahahahahahahahahahahhahahahahahahahahahahahaahahahahahahahaha

 

[CodeRedDew]

I love how often people complain about how "inefficient" PBL is.

Sure, it's inefficient at lower order learning (gaining knowledge), but if you're at a school that has even a half-decent PBL set-up then most of that learning is self-directed and occurs on your own time in-between sessions. PBL is about higher-order learning that will make you a better physician as opposed to just drinking from the fire hose for two years to maximize your boards. You aren't really losing that much time and you're gaining valuable skills. If you don't have time to study in med school with the little PBL most of you are required to do (my school is PBL-based), then it is truly a miracle that year-after-year, students here are able to get good board scores and graduate on time.

So tell me why I can't obtain this self-directed and higher-ordered learning from being in a non-PBL curriculum.

PBL is a waste of time. No matter how you look at it, it is INCREDIBLY inefficient. As others have said, what you get out of a 2 hour PBL session can be learned in 30 minutes using a book, the internet, and some good youtube videos.

 

[Wordead]

I love how often people complain about how "inefficient" PBL is.

Sure, it's inefficient at lower order learning (gaining knowledge), but if you're at a school that has even a half-decent PBL set-up then most of that learning is self-directed and occurs on your own time in-between sessions. PBL is about higher-order learning that will make you a better physician as opposed to just drinking from the fire hose for two years to maximize your boards. You aren't really losing that much time and you're gaining valuable skills. If you don't have time to study in med school with the little PBL most of you are required to do (my school is PBL-based), then it is truly a miracle that year-after-year, students here are able to get good board scores and graduate on time.

What in your MS1 opinion makes a better physician? What "higher order learning" are you referring to?

Not mocking, totally serious.

 

[thefritz]

Just out of curiosity(and probably a dumb question), what happens if you are in a group where none of the students do any reading? Does that mean that nobody learns anything?

I would estimate 10% of the class did the full readings. I would estimate <40% did ANY readings.
If the administration didn't expect this from PBL, they are stupid. That's the way it always goes with any sort of group/team project. One guy ends up doing all the work. It's why team efforts like this aren't fair. The honest guy has to work harder and the lazy bums get to pass without having to do anything. Doesn't anybody remember this from middle school? Surely we were all the smart ones in our classes making the science fair posters while our teammates were home playing N64.

 

[Chrissisissi]

It can be frustrating and is definitely not for everyone but it does work. Different strokes for different folks.

 

[KnuxNole]

I would estimate 10% of the class did the full readings. I would estimate <40% did ANY readings.
If the administration didn't expect this from PBL, they are stupid. That's the way it always goes with any sort of group/team project. One guy ends up doing all the work. It's why team efforts like this aren't fair. The honest guy has to work harder and the lazy bums get to pass without having to do anything. Doesn't anybody remember this from middle school? Surely we were all the smart ones in our classes making the science fair posters while our teammates were home playing N64.

That's what I gather from PBHell. Some people like to falsely believe everyone in your group will be hard working, high achieving motivated people for some reason. When in reality, 1-2 peeps do all the work and the rest can just sit back and passively learn. Which isn't that bad, after all, one person like Pasmal can carry the team, everyone else listens, and they all rock Step 1 😀

And I'll confess. I was one of the middle school kids who spent time painting the project while one kid came up all the ideas :O

 

[Pasmal]

What in your MS1 opinion makes a better physician? What "higher order learning" are you referring to?

Not mocking, totally serious.

My "MS1 opinion"? Let's spend time discussing the issue and not implying circumstantial ad hominems. Trying searching "problem-based learning" on Wikipedia and researching supporting evidence before you bash it. "Higher order" is in reference to Bloom's Taxonomy.