# PBL Vs. Didactic curriculum

Discussion in 'Pre-Medical - MD' started by chury, Dec 28, 1999.

1. ### chury Member

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Is it true that students who follow didactic curriculum score better on USMLE's than

If that is true,then why? To me this does
not make any sense since USMLE is very case-based, incorporating many different disciplines and problem-solving techniques.

3. ### Ian Wong Member

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Dec 5, 1999
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Hello,

I guess the answers you receive regarding this question might influence your decision in regards to attending a PBL-based medical school in Australia.

Here's my two cents. Please keep in mind this is just one person's opinion from a single medical school after a scant four months in a didactic/PBL hybrid curriculum.

Pure didactic curriculums tend to score very highly in standardized tests where rote memorization and raw knowledge of facts is emphasized. Since I haven't, and likely won't write the USMLE, I'll use the MCAT as a baseline reference as a "standardized test."

Take the physics section of the MCAT as an example. It really isn't necessary to do much more for that section of the exam, than to memorize the formulas, and have some rudimentary idea of where and when they should be applied. Combine this with the ability to read and interpret graphs and tables, and you should score respectably.

Standardized tests love to test nit-picky facts. It's really easy to design a multiple choice test that examines your memorization capacity, and very difficult to design a multiple choice exam that really forces you to think and reason.

You may consider this my idea of didactic learning. Cram and puke. Memorize and regurgitate. The key is to stuff many facts into your brain, and to spit them back out onto the exam paper accordingly.

The other end of the spectrum deals with actually *understanding* the physics concepts. Why is torque completely different than work, when both are equal to F*D. (F is force, D is displacement)?

Can you derive the formula for gravity?
F=GMm/R^2

Do you understand it? What other formulas can I prove using this one?

This is the essence of PBL. Take a case, and meticulously dissect it into its anatomical and physiological components, using the combined knowledge of the other seven class-mates in your group, each of whom was smart enough to get into med school.

The problem with pure-PBL curriculums is that often, you'll encounter a case where no one in the group has a solid enough background to provide a starting-point for discussion.

We recently had a case in pharmacology PBL where the entire group was composed of Biology/Microbiology/Arts students. No one had a clue about Phase 1 + 2 detoxification enzymes. No one had any idea of why the patient, who had overdosed on phenytoin in combination with alcohol, was unconscious. No one had ever seen a dose-response curve before. No one could tell the difference between efficacy and potency.

Not only had we never seen the concepts, we didn't even have the *language* to understand the problem.

It wasn't until the lecture afterwards (we use a hybrid system at UBC) that our group had enough of a foundation to re-attack that particular case.

In addition, since each case takes a week to fully discuss, it's inevitable that you're going to miss out, and not cover a multitude of diseases and medical conditions, simply because you don't have the time.

Contrast this to the didactic curriculum where the prof hands out a wad of lecture notes, and then assigns you to read chapters from 2-3 textbooks. You'll get far better coverage of information that way. Unfortunately, since you cram that knowledge in, a great deal of it tends to be forgotten very rapidly.

If you look at Canadian medical schools, as far as I know, there are currently only two schools out of the sixteen total that are fully PBL (U of Calgary, and McMaster U). Only one school (U of Saskatchewan) is fully didactic.

Every other school is PBL/didactic hybrid.

Ian
www.geocities.com/mdpremie

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