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brady23

What are your thoughts on case-based learning?

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1 hour ago, brady23 said:

Just wondering what are your thoughts on case-based learning? For me personally, I'm not sure if it works for me.

It can be a great tool for reinforcing information, building on it, and applying it to real-world situations. Unfortunately, like any tool, it can be misused, and often is. Case-based learning requires an established baseline of knowledge among participants (which is often lacking) as well as access to resources (or preceptors) to help fill in any gaps in knowledge or to provide missing context (which is often lacking). Properly designed and utilized case-based learning can be very effective, but, like trying to put in a screw by using a hammer, it can't be used in all situations like many schools seems to want to do.

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17 minutes ago, ralk said:

 Properly designed and utilized case-based learning can be very effective, but, like trying to put in a screw by using a hammer, it can't be used in all situations like many schools seems to want to do.

Or to fulfill accreditation requirements...

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I personally really like it so far. I definitely feel like by the end of the last session (we have two per week on the same topic), I walk away feeling like I fully understand and know the topic quite well. You definitely need to put the work in beforehand to have the best experience, though, which for me entails doing research and making notes on the objectives for the session. Our tutors so far have been great with filling in any information we’re unsure of, and keeping the discussion on the right track/stimulating appropriate discussion. I actually wish we had more CBL and fewer lectures in our curriculum. :) 

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1 hour ago, ralk said:

It can be a great tool for reinforcing information, building on it, and applying it to real-world situations. Unfortunately, like any tool, it can be misused, and often is. Case-based learning requires an established baseline of knowledge among participants (which is often lacking) as well as access to resources (or preceptors) to help fill in any gaps in knowledge or to provide missing context (which is often lacking). Properly designed and utilized case-based learning can be very effective, but, like trying to put in a screw by using a hammer, it can't be used in all situations like many schools seems to want to do.

Yes, I agree! Like in my school, we don't have enough pre-requisite knowledge to answer the questions, so it's basically just googling answers to specific questions and splitting up the questions which doesn't seem to be effective imo. 

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I agree with @ralk in that the participants must have some baseline knowledge before the CBL becomes an effective learning tool. But many professions use CBL - law students use cases and learn how to apply doctrines and the law on specific scenarios, CPA students use cases and learn how to apply GAAP on specific financial accounting situations. CBL is THE leading way to help students grasp concepts in a more practical manner. It has its pitfalls, but certainly much more effective than didactic theoretical lectures, as a standalone.

When I was a law student, I found case preparedness very important. Not sure how translatable this is, but the instructors make an effort to connect what was learned in the unit thus far to what they have slated in as the case. So make sure you read the dry material (at least skim it) to have some familiarity. This made the difference for me and allowed me to use CBL in a more effective manner. 

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Sherbrooke is about 90% PBL with some rare lectures and I have to say that I love it. Being faced with a "patient" helps you get your thinking skills early on and even though you don't have the precise knowledge when it comes to treatments, diagnostics, investigations, etc., you still get the same reflexes such as thinking about possible causes (differential diagnostics) which allows you to think about ways to differentiate these causes (investigations) and then ways to act on these causes (treatments). Afterwards, reading the textbooks is a lot less dry as you can make link and think back about the case you're studying. All of these "Oh I wasn't so far off!" or "Wow, I really didn't get it the first time around!" moments help you remember the material as it adds a practical side.

Also, I am someone who absolutely cannot stand lectures and tends to fall asleep or start doing something else. With PBL, you can't do that during the courses and there format leaves you with a lot of freetime (about 10h of classes/week at Sherbrooke) so it's very easy to study when you know you'll be productive. For instance, my peak is early morning right out of bed and during the early afternoon. If I had to attend lectures from 8h30 to 11h30 and then from 13h to 16h, I'd be losing all of my productive time and be stuck studying during the evening when I can't get anything done. For me, that's another huge plus.

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I think it definitely has its advantages ^^ IF all the heavy lifting in a PBL curriculum has already been done (compiling notes, searching through texts, even translated ) by previous generations of students.  I also haven't been exposed to many really outstanding lecturers in med school which would convince me that it's a better way to go.  

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I was one of the few that preferred lectures b/c less of those were mandatory and thus could be perused at my own pace (read: 2x), as opposed to CBL/PBL where everyone was dragged along whether they were ready or not. I understand you're supposed to put in the work before the sessions for CBL, but even that results in loss of control over your schedule. The less mandatory things, the better.

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4 hours ago, Hanmari said:

I was one of the few that preferred lectures b/c less of those were mandatory and thus could be perused at my own pace (read: 2x), as opposed to CBL/PBL where everyone was dragged along whether they were ready or not. I understand you're supposed to put in the work before the sessions for CBL, but even that results in loss of control over your schedule. The less mandatory things, the better.

Couldn't agree more.  I don't need someone who read some obscure article to bring up an irrelevant point during PBL/CBL to waste my time. Tutors are hit or miss too, some are great, some are just terrible.

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I like to work through a case -- that way you learn an approach, which is what we will need in practice.

Working through a case can be done in lecture and can be just as good, if not better. As pre clerks, we have limited clinical knowledge and that makes these discussions in CBL/PBL sometimes inefficient and irrelevant, assuming that everybody comes prepared all the time, which already isn't realistic. 

TBL, on the other hand, I hate. It's regurgitating textbook chapters and review papers for a bunch of multiple choice questions. For me, it's all short term memory and I retain very little of it. The teamwork component is also not reflective of clinical practice. What would be clinically relevant is assigning roles to each member to work up a case, and that would actually be analogous to what happens in tumour boards.

 

 

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I find i don't like it, but that is largely because I only want to start prepping for the exams a few weeks before I have them. CBL requires being on top of the material basically as soon as you are being taught it, and between wanting to have some me time and prepping for clinical skills I just don't find it realistic.

I would love if instead in say a 4 week period between exams. In the first two weeks immediately preceding the exam in was basically just cramming all the content in, then third week was more of the non-medical courses on ethics, research etc. Then the week before the exam had all the CBL sessions packed in. That way you have them when everyone is prepping for the exam and it identifies weakness. 

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Yes, cases are definitely interesting and relevant. But like someone mentioned, tutors can be hit or miss, and it really depends on how much you prepare beforehand (tbh, most people don't prepare much because that requires a tremendous time commitment).

I think learning cases in lectures would be just as effective (ex: someone mentioning what this physical exam finding means), because I find a lot of the time, we just don't have enough knowledge to tackle the cases, and simply googling questions can only help us so much.

 

 

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12 hours ago, brady23 said:

Yes, cases are definitely interesting and relevant. But like someone mentioned, tutors can be hit or miss, and it really depends on how much you prepare beforehand (tbh, most people don't prepare much because that requires a tremendous time commitment).

I think learning cases in lectures would be just as effective (ex: someone mentioning what this physical exam finding means), because I find a lot of the time, we just don't have enough knowledge to tackle the cases, and simply googling questions can only help us so much.

 

I'm surprised that people are googling answers so heavily..  Aren't a certain number of references given?  Are more senior students who have been through the curriculum not handing down notes,.. etc?  

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I actually had an AMAZING tutor this week, where I felt like I was learning during CBL.

I think it's true what they say, the tutor you have makes a huge difference. 

Having a tutor explain to you each component of a CBC and how it relates to a pneumonia diagnosis is so much more helpful than simply presenting us with a CBC and saying these are her lab results. As first years, I feel like we don't have enough knowledge in interpreting these tests and having a tutor really streamlines it well.

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6 hours ago, calcan said:

I'm surprised that people are googling answers so heavily..  Aren't a certain number of references given?  Are more senior students who have been through the curriculum not handing down notes,.. etc?  

Not really. Most of the questions are very broad and vague, so the answer can go multiple ways. 

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The curriculum really has to be built around PBL for it to work. Unfortunately, from what you guys have written, it seems like most schools simply throw some PBL on top of all the other activities that are typical in an MD program so as to be able to say "Hey, we also have PBL!"

Things are very different in a purely PBL-based program where things have been this way for a long time like Sherbrooke (and McMaster as well?). For instance, most of the tutors I've had did their MD at Sherbrooke and therefore studied with the PBL method which means they knew how it worked before being tutors themselves and know what they like or don't like in a tutor. Also, the program has been this way for 30 years so many tutors have been doing these PBL tutorials for 20+ years and know them inside out and can easily guide students so they focus on the important stuff and avoid wasting time on small, useless details.

Honestly, from someone who's in love with PBL, your testimonies are unfortunate because they don't sound like what PBL should be like. Obviously, there are also students who prefer other methods and this is also perfectly understandable.

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I always felt it worked ok for some concepts and not for others?

Like its not so good for topics that require a lot of memorization--its really hard to learn anatomy, pharmacology, etc without exams.

I think it worked great for other topics.  The problem as others mentioned is that you need competent and invested tutors, and you need some background in advance (which may be best taught through lectures), and when this isn't present, I found it really unhelpful. 

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It's good for clinical medicine, but not good for basic sciences that are better/faster learned when an expert explains the concepts to you, rather than reading articles (where you've never heard of 2 out of every 3 words).

As mentioned by someone else, you need to have tutors that are available and experts of the material. I am currently at a school that only uses PBL, and it's really hard to clarify misunderstood concepts because of the lack of experts. It becomes an issue when a nephrologist is teaching you the MSK physical exam that he learned 1hour before class and one of the former PT students in your group is correcting their every move.

The perfect curriculum would have, at each block, a dedicated week of fundamentals (physiology, anatomy, etc.) from pre-recorded lectures by experts in the field (PhDs, or MD-PhDs) and the rest of the weeks would be clinical medicine learned through PBL and reading. 

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I hated PBL. Not effective learning for me at all. I don't want my drinking buddy from class explaining renal failure to me. I'd rather a nephrologist.

 

 Schools love it because they can throw any old tutor in there and not worry about scheduling the appropriate specialist. 

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4 hours ago, NLengr said:

I hated PBL. Not effective learning for me at all. I don't want my drinking buddy from class explaining renal failure to me. I'd rather a nephrologist.

 

 Schools love it because they can throw any old tutor in there and not worry about scheduling the appropriate specialist. 

Exactly. I learned to block out my ears during class, because 50% of the time, people (both students AND tutors) are saying incorrect information. I use class time as my "break time", using very little of my brain energy.

Many of my peers who actually listen in class ended up getting incorrect answers on the exams.

 

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4 hours ago, Med Life Crisis said:

Exactly. I learned to block out my ears during class, because 50% of the time, people (both students AND tutors) are saying incorrect information. I use class time as my "break time", using very little of my brain energy.

Many of my peers who actually listen in class ended up getting incorrect answers on the exams.

 

 

I don't like it either. I do agree with what was said above about tutors being experts in the field/subject and, unfortunately, that's rarely the case.

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