PBL - what is it REALLY like?

[The Law]

Hey guys,

 

I think we should have a thread here for this topic.

I have heard so many rumours surrounding PBL, as have many others on this forum... "Oh my gosh, how can you learn medicine if it's all PBL"... "It's hard to find direction... you don't know how well you are doing"... etc etc.

 

I was hoping some of you Mac students could just tell us what the program is like. Is it true that you have almost no lecture? What do you find are the pros and cons of having a large component of the program being PBL? Do you find that it puts you at any disadvantage/disadvantage? Any other topics that you think are important, please discuss those too!

 

Thanks for your feedback!

[rubberoduck]

let's clear up some myths:

1. "no lecture" - we DO have lectures, about twice a week, usually 2-3 hours each. they're meant to be introductory and are fairly manageable

2. PBL - basically, you get a case around the topic of concern (i.e. a 50yo woman comes to the c,linic presents with moon face, plethora, supraclavicular fat pad, fat hump on the back, hyperglycemic, pitting edema, shows elevated overnight 24hr urine glucocorticoid level. given DST shows 50% reduction in GC. diagnosed with cushing's syndrome). As a group you form the objectives (ie DEPICT cushings, learn the HPA axis, etc).

3. "no test" - that is mostly true. we don't have any real numerical evaluation that would go on our transcript, but we are being evaluated by our tutors, and we have a "test" called the concept application exercise at the end of every unit (each unit is 8-9wks, long ones are 15wks).

 

Advantage: lots of time outside of class to do whatever you want, though most people use it to do horizontal electives or study. Early clinical exposure is a big plus. We also have weekly clinical skills sessions in the hospital where we see real patients (and this starts right away in first year). We have the option to do horizontal electives in whatever we like. The program is only 3 years so we can earn more income!

 

Disadvantage: not enough lectures. Qualities of lectures can vary, but we still learn a lot on our own, and clinical experience really helps reinforce what we learn in class, and see the relevance of them.

[Left and Leaving]

Oh my gosh, how can you learn medicine if it's all PBL"... "It's hard to find direction... you don't know how well you are doing"... etc etc.

 

Honestly, it really depends on the individual. If you are comfortable with doing your own work with little direction, it's fine. And believe me, you DO know how well (or not) you are doing on basically a daily basis. We have evals constantly and you can tell pretty quickly if you aren't working as hard as your peers when you take up cases in tutorial. In that way it's great - you can fairly accurately gauge how you measure up to your classmates based on the level you're at in tutorial. As for finding direction - can you use the internet? (think more reputable sites like Up to Date, MD Consult etc) Can you read a text book? If you answered yes to these questions, you can do PBL.

 

Also - keep in mind you have a tutor who is usually a clinician or a PhD with tons of experience. They will step in if you are way off base or not learning the objectives that the powers that be set out for you to learn based on a certain case.

 

Learning medicine is learning medicine, whether you do it sitting in lecture or in small group tutorials.

 

Is it true that you have almost no lecture?

 

Basically. We have lecture from 8:30-11:20 Monday and Friday, and some Wednesdays we have anatomy lectures or another random lecture thrown in there.

 

What do you find are the pros and cons of having a large component of the program being PBL? Do you find that it puts you at any disadvantage/disadvantage?

 

I assume you meant advantage/disadvantage - personally PBL and small group sessions work great for me. I did a Masters degree before med school so I was really used to working on my own. I know some of my classmates struggled a bit at the start but I think its safe to say you will settle down into the routine pretty quickly. It does take a certain amount of motivation because you are doing work all the time. Which I think is an advantage - I am constantly working as compared to studying only in the weeks before a test. There are always disadvantages, but again I think these are more related to the person - you only get out of PBL what you put in - so if you do less work then your classmates, it will show. Whereas with a lecture based school, you are all given the same info (but even then it depends on how much you study, right?).

 

Any other topics that you think are important, please discuss those too!

 

Honestly like I've said many times, PBL being good or bad is so dependant on each person, as well as your group, your tutor, the subject matter etc.

Don't be scared of PBL though! If anything if gives you great connections with doctors (your tutors - I've already had a couple say they'd write me great CaRMS letters!).

[TBJ1]

Thanks for the feedback!

 

Could you provide some insight on these horizontal electives? Do you just shadow a physician around for a few hours a week or do you play a more active role (even in the first year of med schoo)?

[The Law]

Great posts guys.

 

So pretty much, you guys cover the same material as the other schools, but you do it through the objectives you guys come up with in tutorials? Then you guys present the objectives in the tutorial a while later?

 

I assume you meant advantage/disadvantage

 

Haha yeah those are the words I was looking for!

[rubberoduck]

Re PBL

I agree. I think the amount of learning done in PBL is dependent on the invidual, which is why Mac is looking for people who are self-motivated because there's no real evaluation to penalize the people who don't do work. However, your patients will end up suffering as the result of your incompetence. Frankly if you're inherently dependent on external motivation, even if you get past the interview, this is not the school for you. There's hardly any competition here. the adv is a friendly, congenial atmosphere, the disadv is that you're not pressured to learn. everyone in my class are basically driven by the fear that they will not learn enough to do their patients justice, and they study very hard as a result.

 

Re: horizontal elective

basically, as long as a doctor is willing to take you in, you can go anywhere (except ICU, and certain specialties where they stipulate that you have to complete a certain level of training to participate). the level of participation is determined by you and your preceptor (doctor). i know people who got to suture wounds and do digital rectal exams in their first week. most of us get to interview patients and present to the doctor before he/she sees them. it's a terrific learning experience, and you can go to places and see things that you might not even see in rotation. it's also great because there's no committment. you can do as little as a day and as long as you like (with permission from the doctor).

[Jennifer_Dickens]

This post is coming 13 years after the original, but it's never too late.

The biggest problem with McMaster is the discrepancy between what they preach and what they practice. They claim to stand out because they accept more mature and unconventional students with non-science backgrounds. But if you take a look at their admissions trends over the last 5 - 7 years, you'll notice that they've fallen back into the baseline habit of being like every other medical school: Accept science students straight out of undergraduate programs. The advantage of that is having more uniform and monolithic classes with energetic, idealistic and motivated students. The administration also faces less resistance and novel ideas, i.e. the student body is easier to control and manipulate. The disadvantage comes in the fact that medicine remains stagnant and deprived of true innovation.

Re: PBL, itself, I noticed two major problems while working my way through McMaster's program:

1.) The school claims to be open to discussion and differing ideas, but in practice it's quite intolerant of original thinking. Tuesday mornings are dedicated to "Professional Competencies", which is essentially comprised of lectures dealing with the soft side of medicine: Ethics, law, spirituality, culture, etc. Over time, I noticed that the lectures and resources that were made available to us were extremely biased, one-sided and poor. We had an ER doc give us a lecture on ethics and tell us that there basically was no definition of ethics; a very ignorant statement that ignores at least 2,000 years of philosophy and political science. Our lectures on abortion stressed its absolute necessity but did not touch upon the possible complications that could come as a result. We had a lecture on Indigenous culture that resulted in a student being publically berated in the auditorium after he asked a question that was in line with our learning objectives; people were deadpan and pale as snow when that was happening. It was terrifying. Our Dean publically apologized to everyone EXCEPT for that student. 

And because McMaster's become so biased and intolerant of original thinking, that's why they're moving away from more mature and unconventional students; they want younger people who more or less all think the same and will agree unanimously with a one-sided opinion.

2.) One comment in this thread mentioned that the tutors for the medical PBL tutorials are experienced clinicians or PhDs, which leads one to logically assume that groups will always receive the best possible teaching. That's grossly inaccurate. I saw countless instances in which the tutor was a family physician and discouraged learners from getting caught up in the nitty gritty details. Meanwhile, these were students who were future medical geneticists, internists, and pathologists who wanted to better understand the biochemistry behind clinical presentations. This also contributes to the fact that a lot of these tutors aren't properly trained in education and sometimes make poor/lazy teachers. Quite a few students who asked for guidance were invited to "go and read around it", rather than being recommended specific sources and chapters that would be good starting points. I had quite a few intelligent classmates who agreed that the PBL process should have been more gradual: Make it more didactically heavy in the beginning, teach people HOW to teach themselves, and then gradually ease up.