Why is PBL hated so much?

[begoood95]

PBL, TBL, or whatever it's called, there seems to be a lot of hate directed towards this teaching method. Why? I don't have any experience with it, but after reading up on it, it doesn't seem that bad.

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[sullen-burger]

PBL, TBL, or whatever it's called, there seems to be a lot of hate directed towards this teaching method. Why? I don't have any experience with it, but after reading up on it, it doesn't seem that bad.

This is news to me. I didn't know that PBL even got hate :/

 

[Lawpy]

Supposedly because the time devoted to mandatory PBL sessions can be better used to watching lectures at home in your own pace and doing important activities like productive research.

 

[Lawpy]

PBL and TBL are different things with confusingly similar names.

I'm not sure exactly how PBL works because my school doesn't have it.

But here's how TBL goes:
1) Read an article or study a previous lecture.
2) Take a super short individual quiz on it in the morning.
3) Take the same quiz with your group members.
4) Do two hours of "application exercises" where you're basically working through cases and answering questions related to the reading with your group members.

It's moderately annoying because the reading can feel a little like busy work sometimes, which is probably where the hate comes from. My school only does it a 1-2 times a month max, which is manageable. It's usually pretty relevant to the exam and/or a situation we'd encounter on rotations, and I do notice I usually don't need to spend as much time studying the topics on TBL. So I complain about it a lot, but in reality it's not THAT bad. I can definitely see how it would be super annoying if you had to do it all the time, though.

Here's a suggestion for all schools to employ: get rid of random preclinical education methods and just allow students to watch lectures from home. Lecture attendance is optional. TBL, PBL, whatever odd scheme is eliminated. And preclinical grades are unranked pass/fail.

I think the above could be useful. @Goro always says med students are adult learners so they can teach themselves what they need to know and ask professors for help wherever needed. Doing various preclinical education schemes seems pointless when Step 1 and clinical education matter so much more.

 

[cresume]

I think it can really depend on the school you go to.

At my school, it is full of people wanting to show off how they can google some random, unimportant fact about the subject we are talking about in hopes of to impressing the professor, and so we get off track and waste 2 hours.

Honestly, it could be good, but I wouldn't count on it given that you are going to have quite a few of those in every med school class.

 

[sullen-burger]

This paper has a comparison of problem versus team based learning:


http://www.ceesvandervleuten.com/ap...g_No_combine_the_best_of_both_worlds_2014.pdf

 

[bannie22]

Its a big waste of time that reduces the amount of teaching that faculty actually have to do.
If you do PBL twice a week, you are spending ~2 hours preparing a 20min presentation. Then spending 3-4 hours in a group session discussing the presentation. Two times a week.
That is 12 hours a week. Can you learn that material in half the time? Most likely.

So it is just very inefficient. Also, there is no flexibility unlike lectures where some might choose not to attend, whereas PBL restricts the learner's preference.

 

[begoood95]

@Lawper @cj_cregg @bannie22 @cresume

So, basically, it seems like the frustration stems from having to spend much more time on material you'd otherwise spend less time on... which is understandable, especially if you're doing PBL twice a week at a total of 12 hours. Most people would definitely be able to understand the material in much less time.

However, (it seems like) we're all assuming that the introduction of P/TBL was justified by its alleged learning benefits -- i.e., that it may be more efficient. I don't think the administrators in-charge of curriculums across the U.S. are stupid, so maybe we're looking at it the wrong way; that is, I'm saying that there's perhaps a different reason T/PBL is used.

Maybe, it's used because it emphasizes the team-based problem solving/critical thinking necessary in the "real world," where in a hospital (or any other medical institution), the physician is one part of a team that needs to work as a cohesive whole in order to provide efficient care. Looking at it from that perspective, it seems to make a little more sense: you're forced to discuss cases, materials, and etc. with your peers, such that a "team" atmosphere is emphasized, and your skills operating in such an environment are homed -- rather than the isolated study skills required when watching a lecture and taking notes.

I think we'd all agree that, in general, T/PBL is less efficient at gross-understanding of materials. But, I could see a real benefit in "forcing" medical students to cooperate in their learning, and in solving case studies.

 

[Goro]

Some people still need to hear what is important, and context sometimes is lost in a video.

There is no single right way of teaching, but the "sage on the stage" is not one of the best.

There IS evidence that TBL works. It's not some random method.

Here's a suggestion for all schools to employ: get rid of random preclinical education methods and just allow students to watch lectures from home. Lecture attendance is optional. TBL, PBL, whatever odd scheme is eliminated. And preclinical grades are unranked pass/fail.

I think the above could be useful. @Goro always says med students are adult learners so they can teach themselves what they need to know and ask professors for help wherever needed. Doing various preclinical education schemes seems pointless when Step 1 and clinical education matter so much more.

 

[Lawpy]

@Lawper @cj_cregg @bannie22 @cresume

So, basically, it seems like the frustration stems from having to spend much more time on material you'd otherwise spend less time on... which is understandable, especially if you're doing PBL twice a week at a total of 12 hours. Most people would definitely be able to understand the material in much less time.

However, (it seems like) we're all assuming that the introduction of P/TBL was justified by its alleged learning benefits -- i.e., that it may be more efficient. I don't think the administrators in-charge of curriculums across the U.S. are stupid, so maybe we're looking at it the wrong way; that is, I'm saying that there's perhaps a different reason T/PBL is used.

Maybe, it's used because it emphasizes the team-based problem solving/critical thinking necessary in the "real world," where in a hospital (or any other medical institution), the physician is one part of a team that needs to work as a cohesive whole in order to provide efficient care. Looking at it from that perspective, it seems to make a little more sense: you're forced to discuss cases, materials, and etc. with your peers, such that a "team" atmosphere is emphasized, and your skills operating in such an environment are homed -- rather than the isolated study skills required when watching a lecture and taking notes.

I think we'd all agree that, in general, T/PBL is less efficient at gross-understanding of materials. But, I could see a real benefit in "forcing" medical students to cooperate in their learning, and in solving case studies.

Just make TBL/PBL optional. Students who want to attend them are feel free to do so.

Some people still need to hear what is important, and context sometimes is lost in a video.

There is no single right way of teaching, but the "sage on the stage" is not one of the best.

There IS evidence that TBL works. It's not some random method.

Lectures are optional though so they are welcome to attend if they want to. I just don't see the reason for mandatory lectures, mandatory PBL/TBL etc. Medical students are adults. Let them do what they want to succeed and do well in their classes and on Step 1.

 

[begoood95]

Just make TBL/PBL optional. Students who want to attend them are feel free to do so.

If preclinical years are true P/F, then I'd predict a slight decrease in the number of people who attend, but still enough to continue the T/PBL program.

If preclinical years are ranked in any way, I'd bet that attendance would plummet to near zero, because it's probably (1) annoying for students to change their studying habits and therefore (2) they'll want to stick to the traditional method of learning -- no matter the evidence that it may be more efficient. The administrators wanting to push T/PBL at such an institution would probably not do this (make it optional), because it'd render their efforts wasted.

 

[Lawpy]

If preclinical years are true P/F, then I'd predict a slight decrease in the number of people who attend, but still enough to continue the T/PBL program.

If preclinical years are ranked in any way, I'd bet that attendance would plummet to near zero, because it's probably (1) annoying for students to change their studying habits and therefore (2) they'll want to stick to the traditional method of learning -- no matter the evidence that it may be more efficient. The administrators wanting to push T/PBL at such an institution would probably not do this (make it optional), because it'd render their efforts wasted.

And yet another reason to make preclinical grades unranked P/F.

 

[begoood95]

And yet another reason to make preclinical grades unranked P/F.

Yup.

How wonderful would it be if the LCME made it a requirement for accreditation to be true P/F in preclinical years? Very.

 

[P0ke]

TBL and PBL are gonna vary widely from school to school. PBL at my SMP school meant researching some sort of disease and applying what we learn to a certain case and each of us making a brief presentation, with basic scienice tie-ins like biochemistry. TBL was a cluster**** of gunners trying to impress the professors with how smart they are (it didn't help that extra credit was given to teams who were correct, so everyone was fighting to be heard by the profs). At my current school PBL is where we are given a case and try to figure out what they have, and TBL is pretty much non-existent. I think schools just throw these labels onto some vaguely-defined activity to meet LCME standards, or to say "hey, we do this thing that apparently works, according to research".

 

[tessellations]

I'm no med student, but my undergrad has really been pushing TBL on us and has built some fancy new classrooms for this purpose.

I am not really a huge fan, but I think it works when it's done right. I personally think that TBL is not the place for learning concepts. Instead, it should be used to reinforce ideas and to apply them. It can be a huge waste of time, especially if like me, you learn better by cranking through the material on your own. I went to a biochemistry TBL class faithfully one semester and got nothing out of the TBL sessions. Most of my learning came from looking at the power points after class at home. The team work was just stressful since you'd lose points for getting questions wrong in class (as well as on the homework). Another class, though, was great because it was focused on applying what we knew as biochemistry majors to the outside world. That worked well because it was light on content and heavy on application.

 

[Med Ed]

Here's a suggestion for all schools to employ: get rid of random preclinical education methods and just allow students to watch lectures from home.

However, (it seems like) we're all assuming that the introduction of P/TBL was justified by its alleged learning benefits -- i.e., that it may be more efficient. I don't think the administrators in-charge of curriculums across the U.S. are stupid, so maybe we're looking at it the wrong way; that is, I'm saying that there's perhaps a different reason T/PBL is used.

Couple things.

LCME standard 6.3: Self-Directed and Life-Long Learning
The faculty of a medical school ensure that the medical curriculum includes self-directed learning experiences and time for independent study to allow medical students to develop the skills of lifelong learning. Self-directed learning involves medical students’ self-assessment of learning needs; independent identification, analysis, and synthesis of relevant information; and appraisal of the credibility of information sources.

PBL and TBL are both curricular elements that fulfill this standard. PBL is actually resource-intensive from the school's perspective, TBL less so. The easiest thing for us to do is lecture, but schools that have gotten in accreditation trouble over this usually respond by pushing lecture to less than 50% of scheduled curricular time while adopting some type of active learning pedagogy.

A common misconception about the BL's is that they are intended to be "efficient" as a means of knowledge acquisition. They are not. We are fully aware that the time honored spoonfeed-cram-purge method is the gold standard for nailing those MCQ exams. But between the internet and smartphones the desire to have students maintain transient mental databases of medical facts is arguably obsolete. Nowadays the game is application, and learning to apply is a messy, some might say inefficient, process. While there is still controversy in the PBL literature about its effects, a Harvard MD/PhD student summed up the pro- argument in a paper published last year:

"In essence, students are taught to use information that can be easily obtained by scholarly searches to understand and propose solutions for complex problems for which there be no current solution. I have been very satisfied with the decreased emphasis on memorizing minutiae that can be easily searched and the increased emphasis on thinking in various dimensions."

For anyone who just can't stand the thought of any of this, and simply wants two years of nearly uninterrupted time to prep for Step 1, I hear there are some lovely institutions south of Florida that will let you do just that.

 

[begoood95]

Couple things.

LCME standard 6.3: Self-Directed and Life-Long Learning
The faculty of a medical school ensure that the medical curriculum includes self-directed learning experiences and time for independent study to allow medical students to develop the skills of lifelong learning. Self-directed learning involves medical students’ self-assessment of learning needs; independent identification, analysis, and synthesis of relevant information; and appraisal of the credibility of information sources.

PBL and TBL are both curricular elements that fulfill this standard. PBL is actually resource-intensive from the school's perspective, TBL less so. The easiest thing for us to do is lecture, but schools that have gotten in accreditation trouble over this usually respond by pushing lecture to less than 50% of scheduled curricular time while adopting some type of active learning pedagogy.

A common misconception about the BL's is that they are intended to be "efficient" as a means of knowledge acquisition. They are not. We are fully aware that the time honored spoonfeed-cram-purge method is the gold standard for nailing those MCQ exams. But between the internet and smartphones the desire to have students maintain transient mental databases of medical facts is arguably obsolete. Nowadays the game is application, and learning to apply is a messy, some might say inefficient, process. While there is still controversy in the PBL literature about its effects, a Harvard student summed up the pro- argument in a paper published last year:

"In essence, students are taught to use information that can be easily obtained by scholarly searches to understand and propose solutions for complex problems for which there may be no current solution. I have been very satisfied with the decreased emphasis on memorizing minutiae that can be easily searched and the increased emphasis on thinking in various dimensions."

For anyone who simply can't stand the thought of any of this, and simply wants two years of nearly uninterrupted time to prep for Step 1, I hear there are some lovely institutions south of Florida that will let you do just that.

Like you said, between the internet and smartphones, it seems redundant -- and a waste of student/faculty resources -- to emphasize the memorization of minutiae that were perhaps useful "back then," but are much less so today. Can you point me in the direction of any other papers on the BL's? It's actually very interesting to me, and I'd love to read more about it.

On a related note, I've experienced the "flipped-classroom" in a number of science courses and humanities, and I thought it was perfect. As long as you keep up with the material, class time is so much more productive. You're able to focus on questions you may have had from the reading; the professor is free to carry out a more "open" discussion of the material, rather than the uni-directional, traditional lecture; and, as @Goro said above, the learning was much more active. I may be in the minority (I also haven't experienced the BL's in medical school... because I'm not there yet), but I liked wrestling with the material with other classmates. You turn an otherwise monotonous biology lecture into a discussion about research techniques you could use to investigate X, or try to figure out what would happen if you did X to Y... it was just much more enjoyable than lectures from powerpoints.

I hope this trend continues. We've been learning the same way for decades, and I think a change is warranted.

 

[Lawpy]

Couple things.

LCME standard 6.3: Self-Directed and Life-Long Learning
The faculty of a medical school ensure that the medical curriculum includes self-directed learning experiences and time for independent study to allow medical students to develop the skills of lifelong learning. Self-directed learning involves medical students’ self-assessment of learning needs; independent identification, analysis, and synthesis of relevant information; and appraisal of the credibility of information sources.

PBL and TBL are both curricular elements that fulfill this standard. PBL is actually resource-intensive from the school's perspective, TBL less so. The easiest thing for us to do is lecture, but schools that have gotten in accreditation trouble over this usually respond by pushing lecture to less than 50% of scheduled curricular time while adopting some type of active learning pedagogy.

A common misconception about the BL's is that they are intended to be "efficient" as a means of knowledge acquisition. They are not. We are fully aware that the time honored spoonfeed-cram-purge method is the gold standard for nailing those MCQ exams. But between the internet and smartphones the desire to have students maintain transient mental databases of medical facts is arguably obsolete. Nowadays the game is application, and learning to apply is a messy, some might say inefficient, process. While there is still controversy in the PBL literature about its effects, a Harvard MD/PhD student summed up the pro- argument in a paper published last year:

"In essence, students are taught to use information that can be easily obtained by scholarly searches to understand and propose solutions for complex problems for which there be no current solution. I have been very satisfied with the decreased emphasis on memorizing minutiae that can be easily searched and the increased emphasis on thinking in various dimensions."

For anyone who just can't stand the thought of any of this, and simply wants two years of nearly uninterrupted time to prep for Step 1, I hear there are some lovely institutions south of Florida that will let you do just that.

Why not just make PBL/TBL optional? Why does it have to be mandatory? The advantages of problem solving are matched or even outweighed by disadvantages of inefficiency. Unless schools uniformly and completely switch to unranked P/F preclinical grading, TBL/PBL will look like a major waste of time.

The MD/PhD student who wrote that paper in favor of PBL is from a school that uses unranked P/F grading. If grades are no longer the focus for doing well, more attention can be given to alternative learning strategies like PBL and huge benefits can be reaped.

 

[mistafab]

I like my TBL sessions enough - but I think the premise is stupid.

Med schools recruit and sift through applicants to choose smart, hardworking, ethical, and constantly-learning students. Then, they pretend they have to teach us how to be ethical and life-long learning. Those are literally two things they saw in us in the first place.

I understand my school does it because the accrediting agency says so - I still can vent that the recruitment bias sifts out the baddies. The bad seeds that make it through are not helped by these sessions - it is just more work for the rest of us.

It is like no child left behind, where most kids were not left ahead.

 

[BigRedBeta]

It's a bit old but this video sums it up perfectly

 

[efle]

It is like no child left behind, where most kids were not left ahead.

This would be my objection too, you end up setting the pace for the group instead of the individual. Bad news for the faster people.

 

[begoood95]

This would be my objection too, you end up setting the pace for the group instead of the individual. Bad news for the faster people.

Again, while annoying, I think that's something we have to live with. That "fast" person is suffering because they're annoyed of the slow pace -- I get that. But that's not the point of T/PBL, it seems.

The faster learner should then turn to those who are slower, and help them, and practice skills other than mastery of the subject material.

 

[Med Ed]

Like you said, between the internet and smartphones, it seems redundant -- and a waste of student/faculty resources -- to emphasize the memorization of minutiae that were perhaps useful "back then," but are much less so today. Can you point me in the direction of any other papers on the BL's? It's actually very interesting to me, and I'd love to read more about it.

Start with Pubmed.

Search terms "problem based learning PBL" yield 1,362 results. Search terms "team based learning TBL" yield 165 results.

The team-based learning collaborative: Home - Team-Based Learning Collaborative

 

[FindersFee5]

Here's a suggestion for all schools to employ: get rid of random preclinical education methods and just allow students to watch lectures from home. Lecture attendance is optional. TBL, PBL, whatever odd scheme is eliminated. And preclinical grades are unranked pass/fail.

I think the above could be useful. @Goro always says med students are adult learners so they can teach themselves what they need to know and ask professors for help wherever needed. Doing various preclinical education schemes seems pointless when Step 1 and clinical education matter so much more.

This is basically what pritzker is doing. Apparently the research on whether those other techniques was actually helpful was inconclusive at best.

 

[efle]

Wasn't there some major paper about PBL that found like, no effect on pass rates and a change in avg step 1 of a few points? I want to say based on U of Missouri?

 

[Med Ed]

Why not just make PBL/TBL optional? Why does it have to be mandatory?

Doing so would get the school cited over standard 6.3. Also, if you're the dean of academic affairs, it's also somewhat problematic to determine that a particular teaching methodology has value, then spend many hours developing a curriculum around it, then hire and train faculty to carry it out, then reserve the space to pull it off, and then pin the success of the whole endeavor on the desire of students to show up.

 

[Med Ed]

Wasn't there some major paper about PBL that found like, no effect on pass rates and a change in avg step 1 of a few points? I want to say based on U of Missouri?

You are probably referring to the 2006 Academic Medicine paper by Hoffman et al.

"CONCLUSIONS:
The PBL curricular changes implemented with the graduating class of 1997 resulted in higher performances on USMLEs and improved evaluations from residency program directors. These changes better prepare graduates with knowledge and skills needed to practice within a complex health care system. Outcomes reported here support the investment of financial and human resources in our PBL curriculum."

 

[Med Ed]

Med schools recruit and sift through applicants to choose smart, hardworking, ethical, and constantly-learning students. Then, they pretend they have to teach us how to be ethical and life-long learning. Those are literally two things they saw in us in the first place.

You're right, you guys really have it all figured out. To a person, your minds are like steel traps, your attitudes and behaviors beyond reproach. I don't know why we don't just hand out the diplomas at the end of orientation.

 

[Lawpy]

Doing so would get the school cited over standard 6.3. Also, if you're the dean of academic affairs, it's also somewhat problematic to determine that a particular teaching methodology has value, then spend many hours developing a curriculum around it, then hire and train faculty to carry it out, then reserve the space to pull it off, and then pin the success of the whole endeavor on the desire of students to show up.

How do students at top schools, especially at Yale with its hands free Yale System, do so well on classes, dominate Step 1, excel clinical years and have astounding residency match success? Why can't we just extend whatever those schools are doing right for all schools?

 

[efle]

You are probably referring to the 2006 Academic Medicine paper by Hoffman et al.

"CONCLUSIONS:
The PBL curricular changes implemented with the graduating class of 1997 resulted in higher performances on USMLEs and improved evaluations from residency program directors. These changes better prepare graduates with knowledge and skills needed to practice within a complex health care system. Outcomes reported here support the investment of financial and human resources in our PBL curriculum."

Yep this was the one. Such bizarre results for step score after the change - alternating between a giant +10 jump and n.s. between years? Huh.

 

[Med Ed]

How do students at top schools, especially at Yale with its hands free Yale System, do so well on classes, dominate Step 1, excel clinical years and have astounding residency match success? Why can't we just extend whatever those schools are doing right for all schools?

There is no one-size-fits-all curriculum. In the case of Yale, their 10th percentile MCAT is above the national average for all matriculants. They also have a long-established culture that pushes their students. You can't make a wish and hope to recreate that just anywhere.

 

[Lawpy]

There is no one-size-fits-all curriculum. In the case of Yale, their 10th percentile MCAT is above the national average for all matriculants. They also have a long-established culture that pushes their students. You can't make a wish and hope to recreate that just anywhere.

Well that's depressing. I really wasn't expecting differences in preclinical curricula hinging on differences in student body and motivation. That really changes things in a school-specific manner.

 

[Goro]

Something you are also refusing to accept that different people have different learning styles. And no, there is no way to select for a single learning style.

Well that's depressing. I really wasn't expecting differences in preclinical curricula hinging on differences in student body and motivation. That really changes things in a school-specific manner.

 

[Lawpy]

Something you are also refusing to accept that different people have different learning styles. And no, there is no way to see t for a sine learning style.

That can be dealt with by making lectures optional. People who want to hear, feel stuff, whatever can attend lectures if they want. The other stuff like PBL apparently is school specific that supposedly top schools have no problem making it optional or less frequent due to the high quality of their student body.

 

[efle]

That can be dealt with by making lectures optional. People who want to hear, feel stuff, whatever can attend lectures if they want. The other stuff like PBL apparently is school specific that supposedly top schools have no problem making it optional or less frequent due to the high quality of their student body.

PBL is still mandatory at top schools. The trend for top schools is just to have pass/fail optional lecture

 

[Lawpy]

PBL is still mandatory at top schools. The trend for top schools is just to have pass/fail optional lecture

Is it less frequent than other schools that employ them?

 

[Kkshake]

I'm interviewing at a PBL school, and personally everything I read about it I love and I do truly think it'll be perfect for my learning style. I hate the traditional approach. But we'll see, I could be completely wrong, it just sounds like it's more application based rather than memorization based learning. I honestly think it depends on the individual and their learning styles though so don't let what other people personally feel about the curriculum deter you if it sounds like it would be a good fit.

 

[begoood95]

Why not just make PBL/TBL optional? Why does it have to be mandatory? The advantages of problem solving are matched or even outweighed by disadvantages of inefficiency. Unless schools uniformly and completely switch to unranked P/F preclinical grading, TBL/PBL will look like a major waste of time.

The MD/PhD student who wrote that paper in favor of PBL is from a school that uses unranked P/F grading. If grades are no longer the focus for doing well, more attention can be given to alternative learning strategies like PBL and huge benefits can be reaped.

That can be dealt with by making lectures optional. People who want to hear, feel stuff, whatever can attend lectures if they want. The other stuff like PBL apparently is school specific that supposedly top schools have no problem making it optional or less frequent due to the high quality of their student body.

This has nothing to do with the thread, but I have a feeling you lean libertarian politically, based on your faith on people succeeding when left up to their own device... lol, I do not have as much faith. I think, sometimes -- even medical students (gasp!) -- don't know what's best for them, and as annoying as it may be, if the literature are generally positive about the BL's, I see no reason not to make it mandatory.

 

[mistafab]

Even if data comes out showing that hours invested in the medical ethics resulted in fewer malpractice suits, better patient outcomes, or any measure of success - it is biased in that there has been an increased push for recruiting ethical students in the first place. The increased adoption of MMI, for example, give schools ways to assess ethics that were not present in earlier generations of doctor. I'd like to add, that by measuring more, you are increasing the bias of recruitment of medical students, which can impact the future of doctoring in many, probably unforeseen ways.

For example, it is found that the MMI process in the first place is associated with certain personality traits, like extroversion and agreeableness for example (Does applicant personality influence multiple mini-interview performance and medical school acceptance offers? - PubMed - NCBI) or even conscientiousness (Associations between the big five personality factors and multiple mini-interviews. - PubMed - NCBI). What the data doesn't show however, is that this data you collect is at all related to logical reasoning ability or cognitive performance. What about great surgeons now that are snippy and short with people? What about great thinkers, not talkers, that enter med school with a vision for contributing to new therapies? These personality types are sifted out from the process and not granted admission due to the entry bias you all have introduced.

So maybe I grimace about these ethics sessions. So what? How many times a week would you like to spend an hour reading about:

Dr. John Hancock hated his patient Lucita Hernandes. "Why doesn't she just speak English better?" He thought. People shouldn't come to the United States if they don't care enough to learn the language. She was really sick today, but Dr. Hancock was frustrated that he couldn't figure out what she was saying. He approached his secretary and asked if they could call Lucita's family for help. "They aren't answering the phone," the secretary said. If you were Dr. Hancock, what would you do? How did Mr. Hancock contribute to Lucita's problem?

I also refute your claim that my mind is like a steel trap. Why? Because deal with it, that's why.

You're right, you guys really have it all figured out. To a person, your minds are like steel traps, your attitudes and behaviors beyond reproach. I don't know why we don't just hand out the diplomas at the end of orientation.

 

[Lawpy]

This has nothing to do with the thread, but I have a feeling you lean libertarian politically, based on your faith on people succeeding when left up to their own device... lol, I do not have as much faith. I think, sometimes -- even medical students (gasp!) -- don't know what's best for them, and as annoying as it may be, if the literature are generally positive about the BL's, I see no reason not to make it mandatory.

You're right. Maybe i'm just too optimistic and believe medical students are adults capable of self-learning and are intrinsically motivated. However from what I'm reading in this thread, PBL/TBL is becoming increasingly adopted by more medical schools. And even top schools have required PBL sessions.

Maybe it's for the better. I could see mandatory PBLs combined with optional lectures and unranked P/F grading being a very useful curriculum capable of producing very fruitful results come clinical years and residency. Active learning is always a good thing and a productive use of the time (and tuition spent/debt taken).

 

[ohioguy]

PBL, TBL, or whatever it's called, there seems to be a lot of hate directed towards this teaching method. Why? I don't have any experience with it, but after reading up on it, it doesn't seem that bad.

Personally, I thought PBL was useful. It kind of mimics what you would do on the wards in terms of teamwork.

TBL on the other hand... just picture 160+ students in a crammed lecture room spilling out onto the stairs, with each team leader holding out a stupid flag pole with some random country, and anyone in the room having the power to ask any dumb question for as long as they want.

 

[Lawpy]

Personally, I thought PBL was useful. It kind of mimics what you would do on the wards in terms of teamwork.

TBL on the other hand... just picture 160+ students in a crammed lecture room spilling out onto the stairs, with each team leader holding out a stupid flag pole with some random country, and anyone in the room having the power to ask any dumb question for as long as they want.

would you say TBL is far worse than a mandatory lecture attendance?

 

[ohioguy]

would you say TBL is far worse than a mandatory lecture attendance?

At least at my school, TBL was every once in a blue moon so it was bearable. It was mostly optional lecture and some PBL.

Mandatory lecture attendance would be the worst of the worst. We had one course director make his class required attendance and it was the most hated preclinical course by far.

 

[begoood95]

You're right. Maybe i'm just too optimistic and believe medical students are adults capable of self-learning and are intrinsically motivated. However from what I'm reading in this thread, PBL/TBL is becoming increasingly adopted by more medical schools. And even top schools have required PBL sessions.

Maybe it's for the better. I could see mandatory PBLs combined with optional lectures and unranked P/F grading being a very useful curriculum capable of producing very fruitful results come clinical years and residency. Active learning is always a good thing and a productive use of the time (and tuition spent/debt taken).

Being a hyper left-leaning individual myself, I've gotten into too many debates with libertarians and the like to not spot one in the wild .

Anyways, the bolded is where I see the future of medical education and agree with you (well, I think the future holds that plus a greater emphasis on or inclusion of the sociological model of health and illness... but alas, that's a topic to save for another time). I think medical administrators or those in charge of curricula will necessarily have to make lectures optional -- PBL is in a sense the antithesis to the lecture-based pedagogy, and they take time. Making both mandatory, I think, would be too much of a time-suck.

Of course, US medical schools have in the past and are still churning out great physicians, in spite of many programs still holding on to ranked grading and more traditional teaching methods (lectures, two years of pre-clinical training, etc.). However, it's becoming increasingly evident that a change to flipped classrooms, T/PBL, or other, revised teaching methods is warranted.

Even if data comes out showing that hours invested in the medical ethics resulted in fewer malpractice suits, better patient outcomes, or any measure of success - it is biased in that there has been an increased push for recruiting ethical students in the first place. The increased adoption of MMI, for example, give schools ways to assess ethics that were not present in earlier generations of doctor. I'd like to add, that by measuring more, you are increasing the bias of recruitment of medical students, which can impact the future of doctoring in many, probably unforeseen ways.

...What about great surgeons now that are snippy and short with people? What about great thinkers, not talkers, that enter med school with a vision for contributing to new therapies? These personality types are sifted out from the process and not granted admission due to the entry bias you all have introduced.

So maybe I grimace about these ethics sessions. So what? How many times a week would you like to spend an hour reading about:

Dr. John Hancock hated his patient Lucita Hernandes. "Why doesn't she just speak English better?" He thought. People shouldn't come to the United States if they don't care enough to learn the language. She was really sick today, but Dr. Hancock was frustrated that he couldn't figure out what she was saying. He approached his secretary and asked if they could call Lucita's family for help. "They aren't answering the phone," the secretary said. If you were Dr. Hancock, what would you do? How did Mr. Hancock contribute to Lucita's problem? ...

Of course committees' evaluation methods are biased, they're human, and literally everything we ever do is going to be "tinged" by our biases. But that doesn't make it an inherently wrong or ineffective method by any stretch of the imagination. As is evident from other threads floating around SDN currently, while many schools adopt a "holistic" review paradigm, they still value academic performance over virtually all other measures (and that's not a bad thing, I think; medical school is hard, and they're justified in refusing to invest in someone who might not stand up to the rigor). I highly, highly, highly doubt that "great surgeons" or "great thinkers" are denied a medical education by virtue of MMI's, or holistic review practices. Time and time again, medical schools select, educate, and create incredible physicians -- I don't think that trend is declining at all, and if anything, it's rising at an increasing rate.

Also, any institutional changes we make will have unforeseen consequences. That's the nature of life. Our futures are unpredictable, but that doesn't justify inaction -- especially if current data show benefits. Those ethical dilemmas you cringe at are issues that physicians might deal with, and it's important that we select people prepared to handle them. If you don't like dealing with them, that's not a problem! You'll likely end up in a speciality that doesn't result in such interactions, and that's perfectly fine. No measure of aptitude and competency is perfect, but to argue against change because of a possibility -- one of low likelihood no less -- of weeding out a specific subset of people is myopic at best.

Clichés exist because, most of the times, they're true. The oft-quoted sayings, "doctors are more than scientists," or "physicians need better communication skills" aren't just fluff. These new teaching and interview styles are meant to address these issues. If they don't work, then we'll have to find another way, and move on -- but we won't know until we try.

Whew. Okay, rant over. I'll be back later tonight; this thread has been awesome. Don't stop the discussion! ✌

 

[Lawpy]

At least at my school, TBL was every once in a blue moon so it was bearable. It was mostly optional lecture and some PBL.

Mandatory lecture attendance would be the worst of the worst. We had one course director make his class required attendance and it was the most hated preclinical course by far.

Right but what if your school had weekly (or worse, daily) mandatory TBL sessions? Just trying to compare which is the worst among mandatory PBL, mandatory TBL, and mandatory lecture.

 

[ohioguy]

Right but what if your school had weekly (or worse, daily) mandatory TBL sessions? Just trying to compare which is the worst among mandatory PBL, mandatory TBL, and mandatory lecture.

all things equal it would be mandatory TBL by far

 

[Lawpy]

all things equal it would be mandatory TBL by far

So all things being equal, PBL > lecture > TBL? Was PBL very helpful for preparing for clinical years? Not just the teamwork aspect but working actively to understand and solve various case studies.

 

[Med Ed]

Well that's depressing. I really wasn't expecting differences in preclinical curricula hinging on differences in student body and motivation. That really changes things in a school-specific manner.

I would simply offer caution in extrapolating what happens at the elite institutions to everyone else.

 

[Goro]

It depends upon the student, but overall, TBL has data backing up that it improves retention.

So all things being equal, PBL > lecture > TBL? Was PBL very helpful for preparing for clinical years? Not just the teamwork aspect but working actively to understand and solve various case studies.

 

[Med Ed]

Of course, US medical schools have in the past and are still churning out great physicians, in spite of many programs still holding on to ranked grading and more traditional teaching methods (lectures, two years of pre-clinical training, etc.). However, it's becoming increasingly evident that a change to flipped classrooms, T/PBL, or other, revised teaching methods is warranted.

PBL has been in medical education since 1969. Over the past 40+ years it been adopted, modified, and sometimes dropped by many schools. In fact, one of the difficulties in doing research on PBL's effectiveness, particularly with meta-analysis, is that no two schools run it exactly the same way. To my knowledge there is currently only one medical school that retains a "pure" PBL curriculum with no lectures. That is SIU. Everyone else uses some flavor of a hybrid model, where students spend some time in class, some time in small group, some time in a doctor's office, and some time talking about their feelings. It gives everyone things to love and hate, which is about as much as anyone can ask for.