Problem Based Learning

[DoctorAck]

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I was considering looking into medical schools that offer a problem based learning curriculum. I've gone to an AMSA conference in Boston where at Harvard Medical School I've sat in on a mock problem based learning session, and I've that you learn medicine from a clinical approach from day one, as opposed to waiting until your third year for clinical rotations. Does anyone know more about this? Such as the pros/cons to PBL as opposed to the lecture/discussion curriculum? Anyone know anyone who has taken the PBL approach and what they think of it? Thanks

 

[robotsonic]

PBL seemed like a great idea to me when I was applying to med school. Now I'm a fourth year at one of those PBL schools. For me, unfortunately, PBL was often a huge waste of time. I've heard that PBL differs from school to school, but where I went (I keep this anonymous, but it's a good school) it was an hour and a half, 3 times a week. We would do one case per week - you get a bit of information the first day, you discuss it, then you split up the topics that you will present at the next meeting. There are certain things that you learn really well in PBL, because you had to spend a lot of time researching to figure it out. While this is somewhat useful in teaching you how to search through the medical literature, it is extremely inefficient. And a lot of what you end up discussing is clinically irrelevant, especially when you have to struggle to come up with more topics for discussion and then spend an hour on the histopathology of some rare genetic disorder that you will never see. I think this stems from the fact that when you are in your first and second year, you don't actually know what is clinically relevant and what isn't, and although there was always a faculty member in the group with us to guide us, the faculty often were not all that good at it.

I wish now that we had just spent that time in lecture or in small group discussions of case studies (for example, going over 3 cases in an hour, unlike 1 case beaten to death over a week).

So overall, PBL sucked. The only real benefit I see is learning how to search the medical literature. Some argue that it helps you learn to work with colleagues, but I don't think so. The wards teach you that.

 

[herrf]

i certainly agree that pbl learning probably differs with each school. I know that the university of Hawaii has been using the pbl system for over ten years. I've talked with doctors and current medical school students who all love it. they say that pbl is not for everyone and those who prefer more lecture and need that discipline will not do well in a pbl. i had my misgivings about it before until i went to a mock session. the success of the pbl system is dependent on the students if people don't pulll their weight, the group will fail.

 

[NehsNairb]

from what i've heard, pbl involves a lot more work. as mentioned befored, you do have to research quite a bit on your own just to figure out what you should study. in lecture based curriculum, they just tell you to study this and study that. i dont think there's a real benefit to pbl since you end learning the same amout of stuff. i personally would prefer lecture-based just because i like to know i can cut certain classes if i want to.

 

[robotsonic]

i had my misgivings about it before until i went to a mock session.

Dude, you can't know what it is like from a mock session. The mock sessions I had were all pretty cool, too, because you think to yourself, "Wow, this is the kind of clinical reasoning that real doctors do! Awesome!" But no, in reality doctors actually DON'T spend 3 hours diagnosing myasthenia gravis. While I might have thought PBL was boring when I was doing it in first and second years, it wasn't really until my third year that I realized how truly useless it was. In third year you realize that the clinical reasoning involved is not what is done in PBL (at least at my school).

But don't believe me. Go try it for yourself. 🙄

 

[Ypo.]

You guys are really really scaring me. I have PBL next year. I already think that lectures are a waste of time! 😱

 

[gary5]

Here's a highly oversimplified description: In lecture-based learning, they tell you what the diseases are. In PBL, they ask you what the diseases are.

 

[hsperson]

I'm having a hard time deciding whether i want to go to a pbl school or a lecture school. My experience in undergrad so far has been that I don't even need lectures, nor can I tolerate them. I find large lectures painfully boring while I enjoy the discussion that small classes allow. I thrive in a self-guided learning environment. I read the text religiously, hold study groups and perform well; all without lectures. I really can't stand lectures, and I would think that this would mean a pbl school would be better for me. But I've heard so many bad things about pbl. I've heard it is often a waste of time, it is often unfocused, misguided etc. That said, I cringe whenever I hear med students talk about, "Oh, I just skip lectures when I don't feel like going. They're just so boring. Instead, I read the text."
Thus, I just don't know if lecture or pbl would be best for me even given my aversion to lectures. Should it even make a difference; it's the clinical years that really matter right? Or should I still be concerned with the preclinical years' structure for the sake of finding a structure that is engaging rather than boring? Any comments? Also, can anyone provide a list of pbl schools and lecture schools? Thanks.

 

[tigress]

I also preferred discussion courses in college. That is, for humanities. I know very well that I'd be miserable in a mainly PBL curriculum. I think it's probably a good experience to get a dose of PBL, but I certainly wouldn't want my entire curriculum to be PBL. I really think that the pre-clinical years are all about learning a large amount of information. You learn how to apply that in a clinical setting mostly in 3rd and 4th years and in residency (with hopefully an introduction to that in 2nd year). And in my opinion the best way to learn information is to have somebody tell you, "Here, this is what you need to know. Now learn it." That's what happens in lectures, not PBL.

 

[robotsonic]

... That said, I cringe whenever I hear med students talk about, "Oh, I just skip lectures when I don't feel like going. They're just so boring. Instead, I read the text."
Thus, I just don't know if lecture or pbl would be best for me even given my aversion to lectures.

The good thing about lectures is that you CAN skip them if you want to. At my school, PBL attendance is mandatory, so you cannot skip. If you find out that you hate it and you aren't learning anything, oh well, you still have to participate in it.

Remember that it is not just lectures all day vs. PBL with no lectures. My school has lectures and small group sessions. I really like learning in small groups, I just don't like PBL. I loved most of the small group sessions we had that were not PBL.

But anyway, I'm just a cynical fourth year; don't let me scare you away from PBL if you still have idealistic views on it.

 

[robotsonic]

I also preferred discussion courses in college. That is, for humanities. I know very well that I'd be miserable in a mainly PBL curriculum. I think it's probably a good experience to get a dose of PBL, but I certainly wouldn't want my entire curriculum to be PBL. I really think that the pre-clinical years are all about learning a large amount of information. You learn how to apply that in a clinical setting mostly in 3rd and 4th years and in residency (with hopefully an introduction to that in 2nd year). And in my opinion the best way to learn information is to have somebody tell you, "Here, this is what you need to know. Now learn it." That's what happens in lectures, not PBL.

Thanks, tigress, nicely said. I think sometimes people forget that medicine in the first two years is all about memorizing large quantities of information. It doesn't make sense to sit around with a group of students who are as clueless as you are and discuss which issues you think are important and you should study, because you are often wrong about what is important and you waste valuable memorizing time. 🙂

 

[tigress]

Well, I just want to add that I have spoken to a bunch of students in Drexel's PIL program (which is completely PBL) who are VERY happy with the curriculum. But I personally know I would hate it. I just don't think I'd learn what I need to know.

 

[tkdusb]

When I was applying for schools, I thought PBL would be a strong point. But after actually having been to interviews and talked to students about it, I'm definitely concerned about it. I know that it personally won't fit my style of learning very well. If by some freak accident I get into Cornell, I don't know if I'll even go now (because it's so PBL heavy). It used to be my #1 choice by a mile, and it's definitely the most prestigious school I've applied to, but the whole PBL thing just seems er.. not great.

 

[chandelantern]

Northwestern is pretty darn proud of their PBL curriculum, which sounds very similar to the 2nd poster's curriculum who didn't name their school. Based on my interview experience their (they do a mock PBL session) and doing some other research on it, I don't feel PBL meets my learning style. Our physics program is taught like a PBL curriculum...where your whole time is spent in lab groups with other students who are as clueless as you and you have to figure out what is happening, why it's happening, and what significance it has. It's guided by a TA, so if you have a good one, it's a much better experience. Otherwise you are never told the correct answers or methodology of thinking and are subsequently tested on material you didn't even know about! I HATED physics because of this and did really bad when it came to the physics on the MCATs because our course avoided giving us equations, etc and encouraged us to think conceptually...sometimes you do need to do some memorization.

I agree with Tigeress in that some PBL sessions occassionally are cool, to suppliment the lecture and dense book material with real applicable cases, but a curriculum based primarily on PBL would frustrate the he11 out of me.

 

[BlahtoThis]

PBL will not make you a better doctor, it will not improve your board scores, and it will not make your clinical reasoning better. Also, if you go to a school with grades, especially with SHELF exams, PBL's become the most useless things in the world and go on the back-burner to studying for the exams.

However, PBL's are definitely more fun than lectures and much more interactive. They're definitely more engaging intellectually. Also, they do offer you a fun project to do from time to time (go out, figure this out and come back and tell me what you think).

People decide on a college all the time based on how interactive classes are and how much of an intellectual exchange there is. I don't see a problem in choosing a medical school based on this. BUT don't just start thinking that you'll be a better doctor because you're in a GASP PBL curriculum or that you can do better on exams, because you probably won't.

 

[anon-y-mouse]

I think I'd love to go to a school with both ends covered... lecture and PBL at the same time, mainly lecture. That way, everything that's essential gets covered, but we still get a flavor of solving problems using the tools we have. I don't like how PBL doesn't arm students with information: it forces them to seek it out and learn FROM it... I think it is much more relevant to teach diseases, etc. and then give students problems with clinical correlates. A few PBL sessions a week, maybe.

 

[nicholasblonde]

I recently spoke with the former director of the office of medical education at my state's public medical school. She was pretty much ousted from her position because the school was switching to PBL, which allowed the school to cut the basic science faculty by 25%. After my discussion with her, I think we should all, as medical students, question whether PBL is what's best for the SCHOOL (financially), or what is best for US. She also cited a research study which showed that PBL students have higher anxiety and stress levels, on average, than students at more traditional and systems-based schools (though I've heard my state school say the exact opposite thing about their PBL curriculum, in attempting to market it to undergraduate students and applicants).

With PBL, the school, in effect, gets to charge us the same amount while shifting more of the work on us. Instead of paying a lecturer to prepare those handouts, presentations, and a syllabus, PBL requires US to do those same things. Isn't that what we're paying for? I could handle it if I were paying in-state tuition...but if I'm going to pay private tuition rates, I expect more from my professors than just sitting in a room and listening to us make fools of ourselves, instead of actually teaching us something.

Just think of the cost savings, and time savings (for the remaining faculty) a school gains when they decide that they will just let us spend OUR time finding our own way, rather than spending THEIR time leading us in the right direction. I'm glad I have a spot at a traditional curriculum school, and I hope to get into a few more.

 

[BlahtoThis]

I recently spoke with the former director of the office of medical education at my state's public medical school. She was pretty much ousted from her position because the school was switching to PBL, which allowed the school to cut the basic science faculty by 25%. After my discussion with her, I think we should all, as medical students, question whether PBL is what's best for the SCHOOL (financially), or what is best for US.

With PBL, the school, in effect, gets to charge us the same amount while shifting more of the work on us. Instead of paying a lecturer to prepare those handouts, presentations, and a syllabus, PBL requires US to do those same things. Isn't that what we're paying for? I could handle it if I were paying in-state tuition...but if I'm going to pay private tuition rates, I expect more from my professors than just sitting in a room and listening to us make fools of ourselves, instead of actually teaching us something.

Just think of the cost savings, and time savings (for the remaining faculty) a school gains when they decide that they will just let us spend OUR time finding our own way, rather than spending THEIR time leading us in the right direction. I'm glad I have a spot at a traditional curriculum school, and I hope to get into a few more.

I think it's unfair to solely place it on financial issues. This enters into it, don't get me wrong, but everybody changes education for this reason. There's also less bedside teaching than there used to be.

LCME accreditation rules for medical schools required a relative reduction in hours dedicated to lecture. PBL offers a nice way to reduce lecture hours but still have structured learning. Most of medical learning is independent anyway (you'll have to take exams every several years for the rest of your medical life and will have to study for most of them on your own).

Either way you just deal. It's really a question of what makes you more comfortable or what you enjoy.

 

[sanford_w/o_son]

I recently spoke with the former director of the office of medical education at my state's public medical school. She was pretty much ousted from her position because the school was switching to PBL, which allowed the school to cut the basic science faculty by 25%. After my discussion with her, I think we should all, as medical students, question whether PBL is what's best for the SCHOOL (financially), or what is best for US. She also cited a research study which showed that PBL students have higher anxiety and stress levels, on average, than students at more traditional and systems-based schools (though I've heard my state school say the exact opposite thing about their PBL curriculum, in attempting to market it to undergraduate students and applicants).

With PBL, the school, in effect, gets to charge us the same amount while shifting more of the work on us. Instead of paying a lecturer to prepare those handouts, presentations, and a syllabus, PBL requires US to do those same things. Isn't that what we're paying for? I could handle it if I were paying in-state tuition...but if I'm going to pay private tuition rates, I expect more from my professors than just sitting in a room and listening to us make fools of ourselves, instead of actually teaching us something.

Just think of the cost savings, and time savings (for the remaining faculty) a school gains when they decide that they will just let us spend OUR time finding our own way, rather than spending THEIR time leading us in the right direction. I'm glad I have a spot at a traditional curriculum school, and I hope to get into a few more.

right on. let's not be such idealistic pre-meds that we forget that even humans in the medical field often do things with self-interested ulterior motives. no school using pbl is going to tell you it sux.

 

[snobored18]

Maybe I missed something but I don't think there is a single school out there that is 100% PBL. I know the University of Missouri-Columbia was the school that first instituted a PBL based curriculum but first years still have lectures and still take standard shelf exams to get them ready for the boards. However, they try and force people to apply the lecture material and other resources (clinical faculty and primary literature) to solve each weeks case. I admit it is kind strange to be tested by being given a real case, but I completely disagree about the stuff the previous posters have said. This is what you MIGHT face...yes of course if you are in a lifestyle specialty this **** doesn't matter but those who are really getting their hands dirty might see a child with myasthenia gravis come through and knowing that the ice cube test is a painless way to figure rule out MG might come in handy...as are the 15-20 other potential diseases you examined as an objective. I think at least for Mizzou's curriculum the strength of the curriculum is in the numbers. Here is a school that has an entering class with average MCATs and GPAs lower than the matriculant average yet consistently produces above average board scores...Also if PBL is so bad like the previous posters why are more and more schools integrating it into the curriculum or completely revising to a more integrative PBL curriculum.

 

[robotsonic]

I completely disagree about the stuff the previous posters have said. This is what you MIGHT face...yes of course if you are in a lifestyle specialty this **** doesn't matter but those who are really getting their hands dirty might see a child with myasthenia gravis come through and knowing that the ice cube test is a painless way to figure rule out MG might come in handy...

A lifestyle specialty? Are you referring to me? I'm now interviewing for general surgery - hardly a lifestyle specialty!

Another problem with PBL that your example reminds me of: you often don't learn the most common aspects of a disorder, because if the case is an atypical presentation, you will remember that atypical case and may never learn the "typical." Myasthenia gravis, for example, does not often occur in children; it's usually in the third or fourth decade, more common in women. Did you do a case with a child with MG and assume that was the norm? Also, the "ice pack test" has been questioned as a valid test - it's probably the same as letting the person rest the eye for a few minutes and then open again, as rest improves MG and the cold probably doesn't make it to the relevant eye muscles anyway.

Plus, although myasthenia gravis might seem like the most important disease after you've studied it all week, you realize later that there are a ton of important diseases that you need to know, and you really can't spend too much time on each one, especially not in MS1 and 2.

 

[doublepeak]

Maybe I missed something but I don't think there is a single school out there that is 100% PBL. I know the University of Missouri-Columbia was the school that first instituted a PBL based curriculum but first years still have lectures and still take standard shelf exams to get them ready for the boards. However, they try and force people to apply the lecture material and other resources (clinical faculty and primary literature) to solve each weeks case. I admit it is kind strange to be tested by being given a real case, but I completely disagree about the stuff the previous posters have said. This is what you MIGHT face...yes of course if you are in a lifestyle specialty this **** doesn't matter but those who are really getting their hands dirty might see a child with myasthenia gravis come through and knowing that the ice cube test is a painless way to figure rule out MG might come in handy...as are the 15-20 other potential diseases you examined as an objective. I think at least for Mizzou's curriculum the strength of the curriculum is in the numbers. Here is a school that has an entering class with average MCATs and GPAs lower than the matriculant average yet consistently produces above average board scores...Also if PBL is so bad like the previous posters why are more and more schools integrating it into the curriculum or completely revising to a more integrative PBL curriculum.

The UCB-UCSF JMP is completely PBL. It is a three year program that combines PBL and you get a masters degree in medical sciences in a field of your choice. I really liked the PBL there. That being said, I cannot really fathom learning mostly everything in huge lectures because I hated them most in undergrad. They stressed that their program (especially the PBL) was not for everyone - which I can not agree with more. PBL is a personal preference. It takes a certain kind of person to want to always be active in ALL class sessions. If you don't like PBL then you don't like it and that is fine; however, that does not mean that others wouldn't excel in it.

 

[DrBowtie]

It seems that all schools are starting to implement some PBL into their curriculum as its the "buzz word" right now.

 

[BlahtoThis]

All I have to say is your attitudes may (or may not) change when you actually GO THROUGH medical school. And, just so you know, oftentimes people who did average or below in college or high school do amazingly well in medical school because they either are scared and study insanely or were better suited to memorization than to other forms of learning.

In response to snobored, a LOT of medical schools that are below the mean for medical schools (i.e., not top 63) put out average board scores that are above the mean. How is this possible? Well, you have about as many foreign medical grads coming into this country trying to take the USMLE's as American medical grads. Many do insanely better because they have to. Most really don't because they aren't accustomed to the American medical style of learning. And remember, in college your entire 4 yrs or so aren't aimed towards the MCAT's. Also, in medical school, your entire first 2 years are geared towards gathering knowledge geares towards the USMLE Step 1. It's like if you were a math major in college, took only math classes, and then had board exams covering all of math at the end - bunch of very varied fields with many connections between them.

That said, I don't feel PBL should be the final judge for where you're going to medical school.

The following factors matter a LOT more:
1) how well known is the school? (this has an impact on residency matching)
2) how good are the research opportunities? (this has a huge impact down the road)
3) how involved are the medical faculty?
4) how well known are the medical faculty that are involved? (i.e., letters from well-known people will get you more than in the door to great residencies)
5) how willing is the administration to "go to bat" for its student. For example, the students at one school told me that the program director in internal medicine will call the place they are most interested in even before interviews go out.

You'll do well on Step 1 if you study enough. But if you think PBL is the reason you do well or will make you a better doctor, then you're in for a rude awakening. The reason to go for it is because that's the style you like.

And there are also very good reasons for moving to a PBL. Medical knowledge is extraordinary in its breadth. No amount of lectures can suffice to teach everything. How you do on Step 1 will largely depend on you and your studying for it. Everything else in the first 2 years is to try and gear you so you at least have seen most of the knowledge you need. At least in a PBL the faculty can get a better feel of you in terms of how you think and also hear you speak and see you interact while you're seeing many pieces of what you need (and maybe suddenly encountering the rest when using a review book or a textbook for the SHELF).

Okay I'm done and off this board now. 😛

 

[deuist]

This article summarizes the new teaching paradigm Not-My-Problem-Based Learning