A PBL Primer for Future Med Students

Group of three medical students in a problem-based curriculum.

Your hand aches, fingers on the verge of cramping as you continue clutching your pen, jotting down page after page of notes as quickly as the professor can dryly convey his or her knowledge. A hundred notebooks rustle as the cell biology lecture stretches into its second hour. Your back and neck are screaming for a stretch break, but there is no break because in ten minutes, you’ve got to hustle to your pharmacology lecture.

Is this how you envision spending your four years as a medical student?

Intro: Why PBL?

If you think a good portion medical school exclusively consists of eight-hour days spent in a series of long, crowded lectures delivered in monotone by grey-haired professors, think again. Some U.S. medical schools have updated their programs with the hopes of turning out physicians that are not only well-rounded, knowledgeable, and caring, but also self-starting, creative, and excellent at taking initiative. To achieve this goal, some medical schools supplement or even replace the same old lecture-based learning with a teaching style called problem-based learning (PBL).

How Does PBL Work?

PBL was and still is a fairly radical concept: small groups of 6-10 students working with a faculty-appointed team leader, following patient care on a case-by-case basis. The team leader, who serves only as a discussion facilitator, is not always an expert in the material covered. Students challenge each other to solve problems in a constructive manner and identify learning issues for further independent and/or group study.




The medical cases studied are based on actual patients, and the students receive the case info much the same way a physician would: During the course of a month, students get new pages of patient information each week. For example, at the first meeting, students receive the patient’s name, age, sex, and initial medical complaints.

The group discusses what other information they require for a valid diagnosis; each week, the subsequent pages provide data such as medical history, laboratory test results, and other symptoms. The object is not to determine the correct diagnosis, but rather to help students develop skills toward becoming self-directed, independent, critical thinkers while working in a team environment.

The Pros

In PBL, learning is no longer passive, and there’s no more rote memorization of thousands of scientific and medical facts! Instead, students enthusiastically learn the rudimentary medical sciences through challenging clinical situations that better prepare them for their third-year clinical clerkships.

What about grades? Your grade usually depends on three things: 1) test scores covering the basic sciences: gross anatomy, cell biology, physiology and histology; 2) your team leader’s evaluations; and 3) peer evaluations. The faculty team leader and your peers base their evaluations on your performance as a team player, professional behavior, preparation, and learning skills.

The Cons

So, what’s the downside to PBL? Well, for one thing, gaining admission into PBL programs can be very competitive. Medical schools cannot afford to run this type of program for all of their interested students. Admission is sometimes determined via lottery selection, but at other schools, your GPA may be the determining factor.

Another downside: it requires heaps of self-discipline, self-motivation, self-evaluation and highly organized work flow skills. There really is no outline of material you’re going to cover (i.e. a formal syllabus) or knowledge evaluation checkpoints (i.e. mid-terms). It’s more or less up to you to decide your education path and requires significant independent research.

Is PBL Right for You?

PBL is not for everyone. Not all students thrive under the pressure of having to learn so much of the sciences on their own. It’s the ideal format for students who are comfortable with ambiguity while learning, learn best through reading and discussion, are flexible, and have the discipline to learn independently. If that doesn’t describe your learning style, you might be better off sticking to the lecture format.

One med student, Amy, had this to say about her PBL experience:

“I loved it because it gave me some patient contact from day one and that’s why I went to med school in the first place. Also, I enjoyed the flexible schedule and learning at my own pace.”

Another student, Joanne, left after a year of PBL for a lecture-based curriculum:

“I needed the structure and enforced discipline that midterms, deadlines, and finals create. When I had the freedom of independent study, I procrastinated until the night before exams and almost flunked out of school,” she says.

Conclusion

A number of med schools have integrated a PBL-type curriculum. While most schools have a hybrid format, combining PBL with some lecture courses (Ohio State University, Georgetown, and UCLA, to name a few), some schools, like the University of Hawaii’s John A. Burns Medical School and Lake Erie College of Osteopathic Medicine (LECOM) – Bradenton, FL campus, are exclusively PBL.

If at first glance you’re intrigued by this innovative learning style, please do your homework and make sure that this format suits you. Ask friends attending medical school, your med committee advisor, professors at your school, or search for scholarly articles on the topic, such as this PBL meta analysis (PDF), from The Interdisciplinary Journal of Problem-based Learning.




One last thing: Try to relax and remember that your four years in medical school are meant to be enjoyable as well as educational. The best doctors are not only smart but creative, caring, and compassionate. However you get there, good luck and we wish you every success on your road to becoming a doctor.

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