problem-based learning

[Guest BBB]

Does any one know exactly how the problem-based learning works? Inputs from current medical students will be fantastic.

[Guest summervirus]

Hiya, I actually touched on this in another post. It's the third message on that page.

 

But, to elaborate, the course coordinators try to integrate PBL with the material that is presented in lecture. I'll give you an example: when we first started learning respiratory/pulmonary medicine, our first PBL case was about a patient that had a large mass in the upper right lobe of the lung that was so big that it squished one of the inlets to the heart (superior vena cava syndrome). The class is divided up into groups of around 12 students and one facilitator. The role of the facilitator is not really to contribute to the discussion or problem-solving process, but rather to give "hints" to make sure that we (students) don't run off in the wrong direction when we approach a case.

 

So, as a group, we approached this particular case by thinking of various learning objectives. These would include things like learning the relevant anatomy (e.g. the lung, heart, and surrounding structures), reading up on the basic physiology, knowing the most common cancers that are seen in the lung, understanding how to manage/treat such a patient, etc. Also, for each case, the course coordinator also gives a set of learning objectives that he/she wants all the students to achieve. In this case, the whole point of the PBL case is to become familiar with the anatomy of the lung and to appreciate how respiratory medicine can affect other body systems and our health.

 

Although each group might cover slightly different things and each student comes away learning something a bit different, the core objectives are achieved by everyone. In the end, however, what appears on the exam is what was expected from the core objectives so everyone has a fair chance. Things that people wish to pursue in their own groups (stuff like management of lung cancers, for example) will eventually be covered in lectures anyway. In the end, everyone is on a level playing field. Make sense?

 

Hope this helps you understand what goes on.

[Guest summervirus]

Oh yeah, there's one more thing I forgot to mention in my last post; PBL cases usually carry on for more than one day. Typically, on the first day, the group members read the case, clear up any questions about terminology/wording, suggest possible ways to approach the problem, and assign learning objectives to each person.

 

Then, everyone goes home and does his/her own resesarch. Afterwards (typically a day or two later), the group meets again and we teach each other what we learned. So, for example, if I was assigned to read up on "causes of lung cancer" and someone else in my group was assigned to "management of lung cancer," we would take turns teaching each other what we learned. Then, as a group, we collaborate to reach a consensus on what to do with the patient. (There's usually guiding questions that go along with each case... stuff like, "What is the prognosis for Mr. Smith?" that can only be answered if you did the appropriate readings).

[Guest fox]

Hey summervirus

So are the PBL sessions integrated into class time or do we have to meet at night? How often will we be involved in these sessions?

[Guest summervirus]

Hewwo,

 

PBL is always held during scheduled class time. It's usually held first thing in the morning or first thing after lunch. But, the times are flexible. There were a number of times during the year when my group agreed to either reschedule or cancel PBL, usually because we would finish the assigned cases early and we didn't need to spend two extra days sitting around, staring at each other. I don't think anyone ever met at night.

 

PBL doesn't really work too well for the basic science blocks (like Intro and Triple I block). But, it's actually pretty fun for the clinical blocks. The amount of time you spend in PBL varies during the school year.

 

During Intro block, you're introduced to PBL. I think it was held around 2-3 times a week. You're with the same group throughout the block.

 

Then, in Triple I block, there are small group sessions that are kinda pseudo-PBL. I think these were only once a week (thank goodness). You're put into new groups and presented with cases that are kinda clinical... but not really... it's really basic science stuff. And, it's not really self-directed learning. Most of the students complained that it was really a mini-lecture where the facilitators would take over and talk for an hour...

 

Things get better in Endocrinology block. Again, you're put into new small groups... and it's pseudo-PBL again around once to twice a week. But, at least you get to see real patients and actually interact with them. There's also opportunity to take a look a some paper cases but we typically needed the facilitators to solve them for us... :\

 

Finally, in Cardio-Pulmonary-Renal block, you get to see real PBL again and in new groups. It's usually held around three times a week. It's structured just like Intro block. But, it's a lot more fun in CPR: by this time, you'll know who your classmates are; you have gotten a feel for medicine; you actually know a bit about what you're doing (I recall how happy I was to feel slightly less retarded at that time); and, all your cases are clinical!

 

I heard that the 2nd year blocks all have "real" PBL.

 

Oh, and just to remove any confusion about what I mean by basic sciences and clinical cases... when I refer to "basic sciences" cases, I'm speaking of vignettes like, "What is the bacterial etiology of toxic shock syndrome?" Clinical cases, on the other hand, require students to integrate their knowledge of the basic sciences and apply them to a practical situation. They are typically presented like, "Little 5-year old Betty-Sue comes to see you in your office with complaints of a sudden onset of headache, fever, non-productive cough, and sore throat that began two days ago. What laboratory tests should you consider ordering?"

[Guest summervirus]

This is in response to BBB's question from another thread.

 

Oops. Sorry, I didn't mean to say that PBL is based on lecture material. What I intended to say is that there is a lot of crossover between PBL and lecture material. PBL is intended to supplement our learning and often extends past what is presented in lecture.

 

At the UofA, the subjects and cases in PBL are timed so that they are presented slightly before lectures. For example, in nephrology block, we had a case of a patient with a classical presentation of minimal change disease (a kidney disease that is classified under glomerulonephropathies). This case was given to us a few days before we were given our lecture on glomerulonephropathies. The intention is to get students to go out and read up on the subject beforehand, get a basic understanding of the topic, and then hear about it in lecture. However, there was some stuff we talked about as a PBL group that wasn't covered in lectures too.

 

Your question is really fair. It's tough to know when you've learned "enough." I think that's why they started us off with PBL in Intro block, to give us a feel for what is expected and what is reasonable. You'll find that as time goes on, you'll get a better idea of what's "enough" for PBL. Often, for PBL, I found myself researching the top 3 major topics of my "learning objective" and stopping there. I would then wait for the relevant lecture. If I still felt like I wanted to know more (or if I was still confused), I would take the initiative to go learn more.

 

Your question about having difficulties with another group member's presentation is also a really fair one. If you're having difficulties, I think the best thing to do is speak up and let him/her know. From my experience, there were many times when PBL turned into a mini-tutorial. I was really fortunate to get friendly and helpful group members so everyone was happy to help out other members that might be lost or confused. I think that the general consensus is, we're there to help each other learn. After all, I don't think anybody in my (or your) class will want a bad doctor/dentist in the future.

 

Most people are really good about doing their fair share and carrying their own load. Sometimes people slip up and might forget to do the research once or twice, which is understandable. In those cases, they usually make up for it by doing a bit more for the next session.

 

The way that learning objectives are divided up really depends on your group. For some objectives, they are so fundamental and important that everyone should be researching it (e.g. what is the heart?) These are things that everyone needs to know. Other things, however, are "less fundamental" and most groups just assign it to an individual (e.g. what are the most important issues to consider when asking a patient to adopt lifestyle changes in face of existing heart disease?")

 

I have heard of some groups, however, that don't divide learning issues up to individuals. Instead, everyone in the group is responsible for researching everything. I don't know much about that though because (thankfully) I was never in a group like that. It seems like a lot of work!

[Guest summervirus]

This just in: it turns out that there will be "real" PBL in Triple I this year!

[Guest fox]

What do you mean by "real" PBL? How is it different from the PBL we've been doing in intro block?

[Guest mirrille]

Last year, there was no "real" PBL in triple I. Instead there were "small group case discussions" or something like that. In practice I didn't really see much of a difference. It's mainly semantics. They give you a case and you work through it together as a group. I think the main difference is that your small group facilitator is supposed to take a more active part in your discussion and lead you toward the conclusion, which you should already have the information to solve somewhere in previous lectures, as opposed to making you go home and research stuff that you haven't been taught yet. We had a mix of clinical scenarios and paper discussions.

It doesn't really matter to this year's first years since I think they want to institute "real" PBL for this block.