"Small groups don't work"

[Frank Nutter]

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http://www.ncbi.nlm.nih.gov/pubmed/17457072

Interesting article overall, especially this part

Small Groups Don’t Work
The commitment to tutored small-group activity accounts not only for most of the cost and logistical difficulties of PBL, but it is also the basis for an unacceptable variability in the student experience, a general low level of discourse, and an inherent conflict with the professed principle of self-directed learning.

Anyone who has ever used small-group teaching has heard student feedback that “small groups don’t work” because of inevitable differences in ability, motivation, and grading practices among tutors. One might argue that the variability could be countered with instruments to assess tutor effectiveness and programs for faculty development,16 but all this adds to the costs, and there is no assurance of a successful outcome. Seeking solutions to the problems with small-group dynamics in PBL seems to be spawning an industry among educationalists.17–19 The need for some perspective on group work as a means to an end rather than an end in itself has been discussed.20,21

The sophistication of discussion in an educational exercise is limited by the knowledge of the participants. Slavin,22 an articulate proponent of small-group teaching, discusses the potential cognitive advantages of collaboration with peers. Slavin states that students can benefit either in the role of tutor through the opportunity to elaborate ideas, or in the role of tutee, guided by a more capable peer who is likely operating within one’s “zone of proximal development” (Vygotsky’s term 23 to describe the trajectory of potential growth from a student’s current lower level of competence under the guidance of someone more accomplished). Allowing some assumptions about positive group dynamics and shared motivation, there is some initial appeal to this vision of a group potentially achieving more in the cognitive realm than any individual could accomplish alone. The problem is that the zone of proximal development among peers is very small, but the world of ideas in medicine is very large. The student centeredness of the small-group process (which, in “pure” PBL, includes allowing students to set the agenda of study issues) tends toward an amateurish and dissipated experience that can never get beyond the students’ own resources. Schmidt 24 suggests that students need at least some minimum level of structure, and that if it is not provided by prior knowledge or cues as to what to focus on from the environment of the exercise, students will look to tutors. Unfortunately, in the multiple small-group setup, content expertise among tutors will be the exception rather than the rule,25 and thus there is no one authoritative to turn to for expert insight. Even the most committed proponent of PBL would be hard pressed to defend the position that this setup leads to a high-level, realistic discussion of medical issues. Transcripts of actual discussions in PBL group that proponents select as examples of “effective collaboration” speak for themselves.26

Finally, there is the question of whether mandatory small-group participation is appropriate at this level of education and how it can be reconciled with the idea of self-directed learning. Tennant (summarized by Miflin 27) observes that among adult learners, a fundamental tension exists between the “ethic of individualism and the spirit of collectivism” and that this tension threatens to undermine the small-group process. The spirit of collectivism is captured in Slavin’s “motivational perspective” on small-group success, which requires that shared goals and social cohesiveness drive the process.22 One might legitimately ask to what extent this is realistic in medical school. The ethic of individualism, which could include respect for personal preference for independent modes of study, seems incompatible with a system where grades depend on participation in small-group activities. At some fundamental level, PBL is at odds with itself on this point. Proponents vacillate between the idea that students should find their own solutions and the idea that group work is the only legitimate venue for learning. Colliver has commented on the “loose” reasoning that justifies this stand on group work, a reasoning that seems to equate the idea that knowledge is a social construct with the conclusion that learning necessarily involves social (small-group) interaction.28

 

[fiznat]

Or, to sum up:

had to, sorry haha. Interesting article though. I avoided PBL for similar, albeit not so well articulated reasons. Thanks for posting!

 

[KinasePro]

Here's a snippet from my interview day at an infamously PBL-focused med school.

Admissions cheerleader during the morning spiel: After moving to our new, innovative PBL curriculum, our students now learn to think like clinicians much earlier. They are comfortable solving problems and their transition into the clinic has never been easier herpa derp Flexner report hurr durr 1910 blah blah

(later that day)

Me (to Clinical Faculty Interviewer): So in your experience, has the new curriculum helped ease your students' transition into the clinic? Do you see a change in their "thinking" relative to the old cirriculum [heavily lecture-based]?

Faculty: No, I wouldn't say it has changed anything. The students still face the same challenges when transitioning to the clinic, in both the new and old curriculum's. I'd say it hasn't changed their thinking at all, it's [PBL] really just a different style of teaching.


Conclusion: PBL = hype to dazzle pre-meds

 

[Votaku]

Take a look at the author:

Acad Med. 2007 May;82(5):479-85.
Viewpoint: leaving the "empty glass" of problem-based learning behind: new assumptions and a revised model for case study in preclinical medical education.

Shanley PF.

Source

State University of New York Upstate Medical University College of Medicine, Syracuse, New York 13210, USA. [email protected]


While I agree with the quoted assessment, keep in mind that this is the man that has himself been the subject of vehement criticism from Upstate students for several years now for his own unique method of teaching. I believe it is his quizzes that were the focus of the Upstate cheating scandal several months ago, and therefore the school's current recommendation for probation and subsequent resignation of Chancellor, and the embarrassment that followed.


The fact that he's saw fit to write publications on effective teaching methods is rich in irony Admittedly, this was published in '07, long before those happy times, but I would take any of his recommendations for improvements with a grain of salt...

 

[theubiquinator]

While I agree with the quoted assessment, keep in mind that this is the man that has himself been the subject of vehement criticism from Upstate students for several years now for his own unique method of teaching. I believe it is his quizzes that were the focus of the Upstate cheating scandal several months ago, and therefore the school's current recommendation for probation and subsequent resignation of Chancellor, and the embarrassment that followed.

I guess you believed wrong then. Criticism is mostly from a vociferous minority, the actual reputation is having glowing course evals every year.

MLC wasn't mentioned in the LCME's recommendations. In fact it was cited as being the primary fulfillment of their active learning requirement.

 

[Lbgem]

I was a fan of PBL until I had to do it.

 

[Votaku]

I guess you believed wrong then. Criticism is mostly from a vociferous minority, the actual reputation is having glowing course evals every year.

MLC wasn't mentioned in the LCME's recommendations. In fact it was cited as being the primary fulfillment of their active learning requirement.

The fact that 100 out of 140 people were caught cheating speaks to significant flaws in the MLC course. I don't know the exact numbers for or against his course, but all the students I spoke with when I was interviewing there were very cagey regarding this subject, and even the ones who were for it and cited their bump in USMLE scores seemed to have reservations.

Regarding the LCME, their comments regarding the school certainly indicate that there was some issues with the curriculum that concerned them, and the scandal was not left out.

 

[Masticate3Xaday]

This vid cracks me up every time because it is so true:

http://www.youtube.com/watch?v=un4ULrgVYMY

 

[Lbgem]

This vid cracks me up every time because it is so true:

http://www.youtube.com/watch?v=un4ULrgVYMY

LOL. Favorite line: I don't need to study. I'm Asian.

 

[theubiquinator]

The fact that 100 out of 140 people were caught cheating speaks to significant flaws in the MLC course. I don't know the exact numbers for or against his course, but all the students I spoke with when I was interviewing there were very cagey regarding this subject, and even the ones who were for it and cited their bump in USMLE scores seemed to have reservations.

Regarding the LCME, their comments regarding the school certainly indicate that there was some issues with the curriculum that concerned them, and the scandal was not left out.

MLCIII, taken by 4th years, half of whom are either on away rotations or in Binghamton, is much different from I and II taken by first and second years. Their quizzes had to be online, they had to drive back for class, it was pretty unrealistic, and "cheating" was made exceedingly easy. That's why it happened, not because anyone was unprofessional and not because MLCI or II were bad courses.

 

[D elegans]

This vid cracks me up every time because it is so true:

http://www.youtube.com/watch?v=un4ULrgVYMY

Hahaha, while I admit I've drunk the PBL Kool-Aid, this video was hilarious 👍

 

[newdoc2013]

Here's a snippet from my interview day at an infamously PBL-focused med school.

Admissions cheerleader during the morning spiel: After moving to our new, innovative PBL curriculum, our students now learn to think like clinicians much earlier. They are comfortable solving problems and their transition into the clinic has never been easier herpa derp Flexner report hurr durr 1910 blah blah

(later that day)

Me (to Clinical Faculty Interviewer): So in your experience, has the new curriculum helped ease your students' transition into the clinic? Do you see a change in their "thinking" relative to the old cirriculum [heavily lecture-based]?

Faculty: No, I wouldn't say it has changed anything. The students still face the same challenges when transitioning to the clinic, in both the new and old curriculum's. I'd say it hasn't changed their thinking at all, it's [PBL] really just a different style of teaching.


Conclusion: PBL = hype to dazzle pre-meds

dear kinase pro, sounds like you're talking about CWRU here. let me be clear, PBL is effective if you buy into it. if you dont, you wont learn a thing.

in my personal experience, it was more engaging than sitting in lecture. I am very happy with my PBL experience.

 

[SlickNickMD]

I like learn and study the way I make love, by my goddam self😎

 

[bamtuba]

Quote from professor this week in class: "well, the whole idea behind lectures is just to make the reading you could do on your own more interesting."

PBL, for me, is kind of like this without the need to take up a professor's time.

We could all just learn this material on our own, except for clinical time obviously, but it's just too hard to justify charging tuition to people if they can just stay home and learn things on their own using BRS Physiology and Robbins.

 

[Beta Cell]

Quote from professor this week in class: "well, the whole idea behind lectures is just to make the reading you could do on your own more interesting."

PBL, for me, is kind of like this without the need to take up a professor's time.

We could all just learn this material on our own, except for clinical time obviously, but it's just too hard to justify charging tuition to people if they can just stay home and learn things on their own using BRS Physiology and Robbins.

That's idiotic. I still end up having to read or re-review the slides anyway, so does everyone else. Lectures complement the reading, they don't replace it.

 

[startswithb]

This is why you go to a school with PBL, lectures, and plenty of time to self-study. 😎

 

[KinasePro]

let me be clear, PBL is effective if you buy into it. if you dont, you wont learn a thing.

I agree, I'm sure it works great for those who are 100% invested. I just don't like when it's sold as a ground-breaking innovation that will change the way you think about medicine, especially to pre-meds who largely don't know any better. Heck, it sounded great to me until I prodded faculty and M3's/M4's about their perspectives.

When something sounds like "hype," it probably is.

Quote from professor this week in class: "well, the whole idea behind lectures is just to make the reading you could do on your own more interesting."

I'm glad our professors don't think like this. Our lectures are the distillate... you need to know everything that's presented, at the bare minimum. The reading is meant to fill-in the gaps or provide a deeper understanding, but you could be highly competent if you only studied the lectures alone. IMO, it's the most efficient way to learn.

 

[bamtuba]

That's idiotic. I still end up having to read or re-review the slides anyway, so does everyone else. Lectures complement the reading, they don't replace it.

Yeah, one guy's thoughts on lectures, but for some classes it has been pretty true. Bad teaching (though it's been pretty rare at my school) can waste a ton of time for all involved.

I'm glad our professors don't think like this. Our lectures are the distillate... you need to know everything that's presented, at the bare minimum. The reading is meant to fill-in the gaps or provide a deeper understanding, but you could be highly competent if you only studied the lectures alone. IMO, it's the most efficient way to learn.

Totally agree some lectures definitely help get things done quicker than doing it on your own. Glad you get what you need from your lecture time.

 

[VisionaryTics]

dear kinase pro, sounds like you're talking about CWRU here. let me be clear, PBL is effective if you buy into it. if you dont, you wont learn a thing.

in my personal experience, it was more engaging than sitting in lecture. I am very happy with my PBL experience.

To be fair, every school in the country with PBL probably hears the same hype. It's a buzzword that the LCME glommed on to, so we're having it shoved down our throats.

Our PBL sessions are worthwhile about 50% of the time, just like our lectures. They're no better or worse. I think a mix of both is ideal.

 

[KnuxNole]

The thing about PBL I find weird from what I hear is students teaching others and a preceptor just handing out topics. Of course you can't learn much from students, If I learned pathology and physio from classmates, I probably would have bombed Step 1, simply because we are all clueless, unless they took a class about it. I also feel like we have to learn about it first BEFORE doing any group cases, cause then it's wasting time and sleep/free time.

i dunno, it could work for some, but I'm glad for the standard lecture style. We still have to read on our own, but I feel PBL needs someone to teach us and not hope the students would be able to explain topics to others. Cause I can anticpiate a lot of people might not do the "HW" or put minimal effort and make group topics not as good cause 5 out of 9 people didn't read and thus makes talking about something less stellar.

 

[startswithb]

The thing about PBL I find weird from what I hear is students teaching others and a preceptor just handing out topics. Of course you can't learn much from students, If I learned pathology and physio from classmates, I probably would have bombed Step 1, simply because we are all clueless, unless they took a class about it. I also feel like we have to learn about it first BEFORE doing any group cases, cause then it's wasting time and sleep/free time.

i dunno, it could work for some, but I'm glad for the standard lecture style. We still have to read on our own, but I feel PBL needs someone to teach us and not hope the students would be able to explain topics to others. Cause I can anticpiate a lot of people might not do the "HW" or put minimal effort and make group topics not as good cause 5 out of 9 people didn't read and thus makes talking about something less stellar.

At least at our school, we each (about 7 students/group) study the same topics and then go over them together in group 3 times/week for about 2-3 hours. No one is literally teaching another student medicine. The discussion is more of a clarification of topics or generating new questions to then study again in detail. Another big part of PBL is self-directed learning where we have to use resources we find on our own to learn from, rather than being spoon-fed the information. (I've heard that some schools just memorize a gigantic packet of information? How boring!) Also, starting from a patient presentation and then working backwards to learn the pathology, then normal physiology, and pertinent basic sciences is simply a more fun, engaging way to learn in my opinion. Each PBL case is then ended by a presentation from a faculty member or local MD to ensure everyone is getting the correct information. We also have several optional lectures by basic science faculty for those auditory learners. So, in essence, our PBL curriculum has several checks and balances in place to ensure that we ARE getting all the material we'll need to learn and prepare for STEP 1.

 

[KinasePro]

At least at our school, we each (about 7 students/group) study the same topics and then go over them together in group 3 times/week for about 2-3 hours. No one is literally teaching another student medicine. The discussion is more of a clarification of topics or generating new questions to then study again in detail. Another big part of PBL is self-directed learning where we have to use resources we find on our own to learn from, rather than being spoon-fed the information. (I've heard that some schools just memorize a gigantic packet of information? How boring!) Also, starting from a patient presentation and then working backwards to learn the pathology, then normal physiology, and pertinent basic sciences is simply a more fun, engaging way to learn in my opinion. Each PBL case is then ended by a presentation from a faculty member or local MD to ensure everyone is getting the correct information. We also have several optional lectures by basic science faculty for those auditory learners. So, in essence, our PBL curriculum has several checks and balances in place to ensure that we ARE getting all the material we'll need to learn and prepare for STEP 1.

I never really understood why the lecture format is always described as "spoon-feeding" on SDN. With the amount of information we're required to learn, there's really no difference between learning cardiac physiology from Guyton in the library w/ a PBL outline vs learning cardiac physiology from a physiologist in a lecture hall. Guyton spoon-feeds you in the library, and Dr. Whatshisface spoon-feeds you in the lecture hall.

 

[startswithb]

I never really understood why the lecture format is always described as "spoon-feeding" on SDN. With the amount of information we're required to learn, there's really no difference between learning cardiac physiology from Guyton in the library w/ a PBL outline vs learning cardiac physiology from a physiologist in a lecture hall. Guyton spoon-feeds you in the library, and Dr. Whatshisface spoon-feeds you in the lecture hall.

I see your point, but what I was referring to is having pre-made study guides to just memorize from. In that case one wouldn't even need lectures or books.

 

[FIREitUP]

To be fair, every school in the country with PBL probably hears the same hype. It's a buzzword that the LCME glommed on to, so we're having it shoved down our throats.

Our PBL sessions are worthwhile about 50% of the time, just like our lectures. They're no better or worse. I think a mix of both is ideal.

50%? Damn that's high.

 

[newdoc2013]

To be fair, every school in the country with PBL probably hears the same hype. It's a buzzword that the LCME glommed on to, so we're having it shoved down our throats.

Our PBL sessions are worthwhile about 50% of the time, just like our lectures. They're no better or worse. I think a mix of both is ideal.

true, but i still liked it more than sitting in lecture.

 

[D elegans]

I have never gotten much out of lecture (my fault; I just cannot pay attention to a presentation unless it's wildly engaging), so moving to a PBL curriculum has been wonderful for me. I think success with PBL is dependent upon your learning style and whether or not your enjoy the game. One way of learning the material isn't necessarily superior to another.

 

[Substance]

PBL sux

 

[Samoa]

Frankly, I wish they would just assign learning objectives, suggest a textbook, and then have weekly Q&A sessions, so we can get clarification on whatever we don't understand. Before tests, the sessions would be daily for a couple of weeks.

That's pretty much what most of my class did anyway, so let's just drop the pretense. Everybody wins.

 

[Wolverines83]

I have never gotten much out of lecture (my fault; I just cannot pay attention to a presentation unless it's wildly engaging), so moving to a PBL curriculum has been wonderful for me. I think success with PBL is dependent upon your learning style and whether or not your enjoy the game. One way of learning the material isn't necessarily superior to another.

There it is. It all comes down to different strokes for different folks. If you like lecture and find that time valuable, PBL does in fact suck, for you. If you hate lecture and learn better by reading on your own and then discussing it, then maybe PBL is good, for you.

But to say one style is better or cranks out superior physicians over the other is a bit drastic to me.

 

[hot sauce]

One way of learning the material isn't necessarily superior to another.

Perhaps. But I think that some teaching methods are superior to others.

 

[Frank Nutter]

Quote from professor this week in class: "well, the whole idea behind lectures is just to make the reading you could do on your own more interesting."

PBL, for me, is kind of like this without the need to take up a professor's time.

We could all just learn this material on our own, except for clinical time obviously, but it's just too hard to justify charging tuition to people if they can just stay home and learn things on their own using BRS Physiology and Robbins.

Since it involves a greater faculty:student ratio, without much resultant additional benefit, wouldn't PBL/small groups be an even worse use of professors' time? That is actually the biggest knock against PBL from the article, that it is a misuse of faculty expertise and a waste of resources.

 

[bamtuba]

Since it involves a greater faculty:student ratio, without much resultant additional benefit, wouldn't PBL/small groups be an even worse use of professors' time? That is actually the biggest knock against PBL from the article, that it is a misuse of faculty expertise and a waste of resources.

I was referring to groups that are peer only. We have groups of 6-10 with one physician each as well as the peer only model. Really wasn't referring to the article though it was an interesting read.

 

[medicalmatins]

A friend of mine went to LECOM. They have a system that sounds like it works. Students can choose whether they want to learn by lectures or take a bunch of PBL. The two groups get the same material (and lectures are open to the PBLers) but they choose how they learn.

 

[digitlnoize]

LECOM-B 4th year here. We do all PBL (as you probably know).

There are many different types and styles of PBL. These can be pretty much divided into two main camps: Guided and Non-Guided. I did Guided PBL during my organic chemistry class in undergrad and loved it. We do Non-guided at LECOM-B (which basically means we work through the clinical case almost entirely on our own, with only a "facilitator" (professor) there to help out if we get stuck or miss something big). My guided Orgo class had "worksheets" and exercises that taught the material...

Anyways, my experience has been that PBL, if done correctly, works very, very well. Our board scores have been outstanding for every year our school has operated, except year 1, when they were still working out the kinks. Since then, we've been #1 or #2 every year in our board pass rates and our class averages have been WAY above the mean, and well above our competitors. Obviously, these are averages, but for the most part, everyone does very well.

PBL really CAN work, but it has to be implemented correctly. I've been lucky enough to have taken part in 2 PBL curriculums that were well designed and implemented correctly. I've had friends who were much less fortunate...and "PBL" obviously didn't work for them. Not all PBL is created equal. Also, it's not for everyone, although pretty much everyone who tried did ok at LECOM-B.

 

[FIREitUP]

LECOM-B 4th year here. We do all PBL (as you probably know).

There are many different types and styles of PBL. These can be pretty much divided into two main camps: Guided and Non-Guided. I did Guided PBL during my organic chemistry class in undergrad and loved it. We do Non-guided at LECOM-B (which basically means we work through the clinical case almost entirely on our own, with only a "facilitator" (professor) there to help out if we get stuck or miss something big). My guided Orgo class had "worksheets" and exercises that taught the material...

Anyways, my experience has been that PBL, if done correctly, works very, very well. Our board scores have been outstanding for every year our school has operated, except year 1, when they were still working out the kinks. Since then, we've been #1 or #2 every year in our board pass rates and our class averages have been WAY above the mean, and well above our competitors. Obviously, these are averages, but for the most part, everyone does very well.

PBL really CAN work, but it has to be implemented correctly. I've been lucky enough to have taken part in 2 PBL curriculums that were well designed and implemented correctly. I've had friends who were much less fortunate...and "PBL" obviously didn't work for them. Not all PBL is created equal. Also, it's not for everyone, although pretty much everyone who tried did ok at LECOM-B.

o rly?

 

[digitlnoize]

o rly?

rly. srsly. 4 rl. 2legit2quit.

 

[MossPoh]

Yup, it is all in how it is done. Facilitators need to be trained in the methods to actually facilitate. Too often they take a grad student or random phd, throw them in the room and say "facilitate!" Also, it takes a degree of ownership and buying in by the students. You have to study and prepare as if you are going to teach people and have a little bit of fear you will look like the stupid one. Our PBL sessions tended to be epically long time sucks where everybody walked in just wanting to get the hell out before it started.

Undergrad was PBL for me and it worked great.

 

[Rex 876]

I was a fan of PBL until I had to do it.

 

[ALFI]

in australia we use CBL (case base learning.) all material is introduced at appropriate timing so if we're focussing on say DKA all the info we need to start the case we will be given and then we'll gradually be given more and more.

 

[Law2Doc]

PBL is one of those things that only works if done well and if the participants are invested in the results. I've seen it work and seen it fail miserably either on the faculty side or on the student side. I think it's a teaching/learning opportunity that can work with the right faculty leader and for a small subset of students. But as it stands now, I'd agree it's not a great selling point. Either the faculty member is just going through the motions, or the students aren't interested in exploring issues and just want to read books on their own that will help them pass their tests, and see forced small group time ( or any mandatory attendance, actually) as "doing their time". You can probably make better clinicians this way, but you'd have to break down a lot of deep set "this is how i learn best" attitudes and demonstrate that it's in fact higher yield for tests (if thats even the case) before there would be adequate buy in.

 

[mtc1019]

I would have preferred the traditional route, but figured PBL might be interesting too. I heard that PBL meant more time to study on one's own (which incidentally, is false after one figures in all of the time spent on completing mandatory minutiae or attending required sessions).

A prior post noted the "checks in place" to ensure a good PBL experience. Fortunately for her, she likely has a good tutor, as not all tutors are created the same. I believe that this is about half the problem with PBL: lack of standardization across various tutors and their groups. If a student ends up with the bad fortune to have an inept tutor - especially during the first year, when a student might not initially recognize or know what to do in this situation - well, good luck with the basic sciences (*especially* if your undergrad major wasn't heavy on these subjects - let this be a warning to you PBL virgins!)...

Also, as to the proposed benefits of finding our own sources of information (the prior poster wrote of the future bad effects of "being spoon fed information"), I would argue it's a huge inefficiency to have to find our own sources within an academic setting already short of time (i.e., "medical school located in Anywhere, USA"), especially given the backdrop of a generation of students who are arguably the most adept (and each year, increasingly so) at sifting through information vs. any other previous generation that has completed medical school. Then, once you find those sources, if your tutor has more interest in picking his nose than fostering insightful discussion, how does a student ascertain the appropriate depth to delve into the info? Three hours or 30 spent on the urea cycle? Lastly, as to the quality of the sources of information that group members cited, I found myself frequently pondering during student monologues whether we would be awarded a diploma from WikiDoc upon graduation. Just because students are sourcing their own info, doesn't mean it's a *good* thing...

I think that we should let let Step 1 scores be the judge. Anyone have the info on this?

In any case, I'm going to keep on supporting PBL. Why? Because if all else fails, I've got a Plan B: I'm opening up a med school in the Sahara (or maybe Siberia? I'm still deciding). I figure that all I need are some copies of Robbins, a few dead bodies (easy to find in either locale, methinks), and some large club bouncers to mediate arguments between/among (not-so-large-but-overly-aggressive) 1st-year med students. I can almost smell the Benjamins.
😉

 

[Law2Doc]

...

I think that we should let let Step 1 scores be the judge. Anyone have the info on this?
...
😉

no such publicly available info exists for this, and increasingly the powers that be are becoming more and more uncomfortable with Step I being used to "judge" anything. This test was initially designed simply to offer some minimum standards, not meant as a yardstick to determine who is "better" at medicine. Which is why there has been so much push in past years to combine Steps and move them out of residency decisions by giving them later. Nobody believes that the IMG who spends 6 months studying for each of the Steps and rocks them is a better doctor than the US allo grad who spends four weeks studying for it and scores 10 points lower. It's not an aptitude test and never was designed to provide a higher is better algorithm. So no, let's not suggest step I be the judge.

 

[CatFactorial]

I'm a fan of PBL insomuch as it refers to qbanks, not these asinine group exercises. The material isn't conceptually difficult enough to require collaboration.

I wish the LCME would stop watching Dead Poets Society and leave me the hell alone.

 

[FIREitUP]

I'm a fan of PBL insomuch as it refers to qbanks, not these asinine group exercises. The material isn't conceptually difficult enough to require collaboration.

I wish the LCME would stop watching Dead Poets Society and leave me the hell alone.

No truer words have ever been uttered (or typed).

 

[ErgoSum]

frankly, i wish they would just assign learning objectives, suggest a textbook, and then have weekly q&a sessions, so we can get clarification on whatever we don't understand. Before tests, the sessions would be daily for a couple of weeks.

That's pretty much what most of my class did anyway, so let's just drop the pretense. Everybody wins.

+10

 

[bamtuba]

no such publicly available info exists for this, and increasingly the powers that be are becoming more and more uncomfortable with Step I being used to "judge" anything. This test was initially designed simply to offer some minimum standards, not meant as a yardstick to determine who is "better" at medicine. Which is why there has been so much push in past years to combine Steps and move them out of residency decisions by giving them later. Nobody believes that the IMG who spends 6 months studying for each of the Steps and rocks them is a better doctor than the US allo grad who spends four weeks studying for it and scores 10 points lower. It's not an aptitude test and never was designed to provide a higher is better algorithm. So no, let's not suggest step I be the judge.

👍

...though we should all still try to do our best I suppose...

 

[mtc1019]

Unfortunately, the test still decides fates.

I'm not talking about an official research project - I'm just looking for some way of measuring educational philosophies against each other for the purpose of a studentdoctor.net forum discussion. That being said, given there are no better-controlled barometers to assessing the merits of an educational philosophy, plus the benefit of Step 1 being given to essentially all US medical students completing similar coursework in roughly the same time period, it is a rather perfect assessor of how well students learn the relevant basic science information. After all, the USMLE is concerned w/ensuring that it turns out physicians who know the high-yield material (albeit, along with some esoteric facts).

Third and 4th years would not be included in this study: we're assessing the better mechanism for learning the basic sciences, not who is the better clinician. Clinical skills would require pt feedback and many other subjective measures. It could be argued that many times, such scores (hypothetical and with the intent of assessing pt satisfaction and clinical skills) are decided before the prospective provider reaches his 10th birthday.

Unfortunately, we'll likely never see any real data on PBL vs. traditional learning methods; hence, my interest in a back-of-the-envelope analysis of Step 1 scores at various institutions. Traditional programs aren't going to waste the time to prove that they are still the superior learning method*, and PBL programs have everything to gain by "finessing" - or worse, "cherry-picking" - data and statistical methodologies to prove the merits of its ascribed educational philosophies.

I wish it were only Dead Poets Society and Kumbayah mentalities driving this. Unfortunately, once an institution and its administrators have adhered too strongly to a theory and gone too far down the rabbit hole, it's a difficult and pride-swallowing exercise to admit when even small things aren't working, as academic faculty and administrators are not generally known for their "pride-swallowing" abilities.

*I am not necessarily saying that traditional schools are claiming to be superior, so no one go getting his or her undies in a bunch...

 

[Valadi]

Unfortunately, the test still decides fates.

I'm not talking about an official research project - I'm just looking for some way of measuring educational philosophies against each other for the purpose of a studentdoctor.net forum discussion. That being said, given there are no better-controlled barometers to assessing the merits of an educational philosophy, plus the benefit of Step 1 being given to essentially all US medical students completing similar coursework in roughly the same time period, it is a rather perfect assessor of how well students learn the relevant basic science information. After all, the USMLE is concerned w/ensuring that it turns out physicians who know the high-yield material (albeit, along with some esoteric facts).

Third and 4th years would not be included in this study: we're assessing the better mechanism for learning the basic sciences, not who is the better clinician. Clinical skills would require pt feedback and many other subjective measures. It could be argued that many times, such scores (hypothetical and with the intent of assessing pt satisfaction and clinical skills) are decided before the prospective provider reaches his 10th birthday.

Unfortunately, we'll likely never see any real data on PBL vs. traditional learning methods; hence, my interest in a back-of-the-envelope analysis of Step 1 scores at various institutions. Traditional programs aren't going to waste the time to prove that they are still the superior learning method*, and PBL programs have everything to gain by "finessing" - or worse, "cherry-picking" - data and statistical methodologies to prove the merits of its ascribed educational philosophies.

I wish it were only Dead Poets Society and Kumbayah mentalities driving this. Unfortunately, once an institution and its administrators have adhered too strongly to a theory and gone too far down the rabbit hole, it's a difficult and pride-swallowing exercise to admit when even small things aren't working, as academic faculty and administrators are not generally known for their "pride-swallowing" abilities.

*I am not necessarily saying that traditional schools are claiming to be superior, so no one go getting his or her undies in a bunch...

There are actually a couple studies examining different teaching models and their effectiveness. I've posted links to them on another thread about med schools and step 1 score. You can pubmed them yourself, though.

The conclusion was that teaching method (pbl v didactics, etc) did not influence step scores among schools. Among schools, even geographic location had a bigger influence on scores than teaching style. Having sessions with 4th year students teaching underclassment, though, has been significantly associated with boosted scores (I can imagine why; we're close to it enough to know the game, but far enough removed to cut through the bull****).

I wish the idea put forth by samoa is what we had. I think that would have been ideal. PBL without preceptors leads to a ridiculous game of trying not to step on people's toes, blindly trusting peers who may not be accurate in their information, and having the conversation degenerate into playtime. With a preceptor, you're hit or miss for a great learning experience or a waste of your 2 hours.

Edit: Found the post: http://forums.studentdoctor.net/showthread.php?p=11828428#post11828428

 

[Valadi]

Another option would be to have Goljan make lectures for everything and use those as lectures across the country 😀

 

[Brotoss]

I actually enjoy TBL because I really love wasting my time.