PBL: Problem Based Learning
A new quickly spreading method of study to reinforce concepts. This method is one of the main highlights of the LECOM SODM that separate it from almost every other school. You MUST grasp this concept prior to interviewing and starting school.
In short, PBL is a method of learning in which self directed study and interactive group case study trains a student to think and act like a doctor. At LECOM it is used to prepare student for the boards starting in D1 year and ending before boards are taken.
What does the PBL group study setting look like?
In a PBL "session" you are in a group of typically 8-10 people (switching every semester) with one staff facilitator. The facilitator is not present to teach you anything at all. They are simply there to make sure you discuss all the concepts that are supposed to be obtained from the "case" that you are working on that day. They keep you on track so that you spend more time of topics that are more relevant to the case/boards and move you along when you dwell on something that is not quite as important. They also give you the actual case details to solve the case but do not explain them, that is for you to figure out.
Who is the facilitator?
The facilitator can be any staff member in the school. They are not there to teach you anything but to just provide information about the case that was given to them. They could be an anatomy professor, biochemistry professor, or they can be someone who has no educational teaching background whatsoever.
What is the point of PBL? How is it different from normal learning?
The point of PBL is to actively engage in learning material rather than memorizing powerpoints. Traditionally, you are taught a subject such as physiology in a classroom with powerpoints and a lecturer spews out fact after fact and you glaze over it, chug it after it after class with minimal context, regurgitate it for the exam, and then forget it shortly after because you have not really applied it.
In PBL, you are given a REAL past hospital case and are trying to solve the case by learning the different concepts and mechanisms that could be involved. You are actively searching and making connections therefore reinforcing the concepts in your mind. You are also discussing these findings with your group members because everyone has a different background and knows more about certain subjects than others.
In a typical PBL case you will hit multiple subjects such as Anatomy, Biochemistry, Immunology, Pharmocology, and Physiology all at once so that connections are made between subjects.
Do you have specific roles in your PBL group?
The PBL session begins with assigning roles. The reason for this is that everyone MUST be involved for you to get through the case effectively.
Roles include (and will vary based on institution):
Writer (writes on white board)
Typer (types all information discussed for later review)
Reader (reads all information displayed from the case out loud)
Everyone else (including those above): contributes to discussion to solve the case
These roles will be switched every session. Some groups opt out from having a writer if the facilitator allows.
If there are no Powerpoints, how am I supposed to know the information to solve a case?
When you begin a PBL case, you will quickly realize that there are lots of things that you do not know. It is up to you to look up the topics that are not familiar within the textbooks that are given to you. Our textbooks are online in a database and so if we come across the topic of "RAAS mechanism" for example, I can search it within my various textbooks to found out what it does and why it is important and then explain it to my group. The topics and concepts you will need to understand will become clear as you go through the PBL case. The details within the case lead you towards certain concepts, for example a case with left sided heart pain with a provided ABG test is likely wanting you to learn about heart function/anatomy, respiratory function/anatomy, medications that work on the heart/lungs + their mechanisms, and bicarbonate buffers/acidosis (ABG test, etc). You are discovering what various mechanisms/medications are and presenting them to your group.
How do you solve a PBL case?
The case begins by the facilitator opening the case file on the computer in the PBL room. It is displayed on a giant TV screen in the room. These files are not accessible outside of class which is why good notes are important via the typer and writer roles.
The facilitator will start by saying something along the lines of "Pt named John Smith arrives to the Emergency Room complaining of left arm pain with associated numbness."
At this point PBL discussion begins. The group must work together to piece together information and learn concepts to figure out what is wrong with John Smith.
The group can ask the facilitator questions as if it were an actual doctor/patient interaction such as:
How you ever been hospitalized before?
What medications are you on?
What is your family history?
What do you do for work?
As you solve more cases you will begin to think like a doctor and ask the right questions. The facilitator will respond with information that they have been given about the case. They may have answers to all your questions or they might not.
After asking questions, the facilitator will display more and more pieces of information on the screen. You may get a full list of symptoms, social history, family history, medications, occupation, etc and using this you will discuss with your group about possible differential diagnosis and mechanisms that are occurring.
You will then order tests. You must know what tests should be ordered and if you dont you will need to figure it out by looking through textbooks and/or the internet. After coming up with possible tests, the facilitator will show the actual tests that were done on the patient and what the results were.
At this point you must know what the tests are, what they look for, and what they are telling you about the patient. If you dont, look it up!
After tests are given and you understand the concepts behind them, You will come up with a diagnosis and treatment plan. After finishing, the facilitator will reveal the diagnosis and actual treatment plan that was given the to the real patient.
PBL Cases are designed to expose you to information, tests, and mechanisms that are foreign to you so that you will actively look them up, understand them, and discuss them.
The goal of PBL is NOT to solve the case but to UNDERSTAND the concepts and mechanisms behind the case. You are not graded based on figuring out the diagnosis.
What is an example of a PBL session?
F: Facilitator (acts as patient)
G: Group (acts as doctor)
C: Concepts (things you are to learn from the case)
F: Pt presents with left arm pain with associated numbness
G: How long has this pain occurred? What medications are you on? Are you a smoker? What do you do for work? Have you ever been hospitalized before?
C: Symptoms and their associated organs/mechanisms
F: I have had this pain for two days. I am on Amplodipine. I am a smoker. I have been hospitalized in the past for heart attack.
G: Possible differential diagnosis could be MI (heart attack), stroke, Pneumonia, viral infection, cancer, bronchitis, etc
C: Medications and their mechanisms, modifying factors
F: "Releases full list of symptoms, social history, family history"
G: If there are any symptoms that are not familiar or wording that is not understood, group will look them up in textbooks or internet or group member with knowledge of that concept can explain.
You will begin to add or remove possible diagnoses based on results.
F: Shows physical exam and vital that were done to patient
G: Continues to add possible causes based on physical exam. If there are any unfamiliar test "Homans sign positive" or "Abnormal S1/S2 sinus rhythm" you will look these up
Group begins to brainstorm tests that could be done
C: Heart rhythm, physical exam findings and their meanings
F: "What tests would you like to run?"
G: CBC, BMP, Troponin, chest xray, EKG, ABG, CT scan. You can look up tests that can be run on chest or whatever you are concerned with
F: Releases test that were actually done on patient at the hospital
G: Analyzes test results and understands reasoning behind each test with mechanisms and modifying factors.
F: "What do you think the diagnosis is what what treatment would you like to prescribe?"
G: Pt has Penumonia and should be started on anti-biotic with regular bronchodilating B2 antagonist medications.
F: Releases actual diagnosis and treatment plan that was done for patient
G: analyzes treatment plan, medications, and mechanisms involved
This process seems quick but it will actually take 2-3 PBL sessions because you are learning all the new tests, modifying factors, medications, and general concepts as you go.
The group at the end of this case has likely learned:
1. Heart phyiology
2. Lung Phyiology
3. Heart medications (Pharmacology) and their mechanisms
4. Lung and Heart tests and their mechanisms
5. New physical exams tests and lab tests and their meanings
REMEMBER: Every test, symptom, and concept in the case is there for a reason. They are all connected to boards topics, so if you understand all pieces of the case, you have nailed down many concepts that will help you on the boards.
What happens after a PBL session?
After a PBL session the group will discuss topics that they struggled with and will discuss at the beginning of next PBL session. For example, if one of the tests was an EKG, and no one knew about heart rhythms, they can discuss abnormalities in heart rhythms together during the next session. Also, PBL chapters will be assigned for reading. During the course of the case you will utilize many of your textbooks and will take the chapters that you used the most to "assign" them for the PBL test.
PBL sounds hard. All the concepts you mentioned are foreign to me. Can I do it?
Yes you can. On day one you will be hard pressed to find a student that knows what sinus rhythm and an abnormal ABG test means but over time you will learn all the signs and symptoms, tests, physical exam findings, medications, and possible diagnoses and they will come naturally. The reason they make you ask questions or order tests prior to revealing what was actually done to the patient is so that you will get into the habit of knowing what to ask and what to order and connect it to the organs of the body. After about 2-3 cases you will be spewing out questions, tests, and diagnoses like you've been a doctor for ten year. Every case will teach you new tests, terminology, medications, and diagnoses.
How is PBL graded?
So like mentioned before. You will be using textbooks to find information to solve cases. Your group will come to a consensus as to what chapters were most used and important and you will assign these for your PBL exam. Your group may assign different chapters than another group so within your class there will be a different exam for every group.
Grades also come from participation in the PBL sessions (25%).
Questions for the exam will come out of the chapters assigned as well as major topics from the cases.
For each exam you will have approximately 20-30 chapters assigned with a total of 150 questions.
Each case will take about 2-3 PBL sessions because to go through this process take quite a bit of time so for each exam you may have between 5-8 cases.
What do PBL exam questions look like?
As stated before, PBL is to help you understand the major concepts that are on the board exams. And since you are reading 20+ chapters of textbooks and have 150 questions that come out to less than 10 questions per chapters so that questions will never be super specific but will cover major topics and crucial points.
Do you enjoy PBL?
I LOVE PBL because I feel as though I am truly learning the material. If you show me what an ABG test or an LFT panel does on a powerpoint I will likely forget 2 months after the test but after learning it through PBL I am confident I will know how to interpret them in ten years from now if I ever needed to. The same goes with all the concepts that are learned. I also love to teach others concepts that I know a lot about because it strengthens my knowledge. Also we tend to dwell on things that are actually important for practicing dentistry. We learn all the subjects for boards but a lot of times we will dwell on medications and mechanisms that will actually be at play with the medications and procedures that you do in a dental office.
I hope this clears up the confusion about PBL and I will continue to add and edit this as you guys have questions.