PBL any good?

[USvsCan]

I 'm a Canadian citizen but American med student and just got back from completing my USMLE Step 1. I have a few friends who attended Mac med school and were just entering their residency. After having a few discussions with them, I realized that their basic sciences were extremely extremely weak. I have friends from the caribbean system who have a much stronger foundation than a lot of mcmaster medical students.

 

What are they teaching you in your PBL sessions? How do u expect to come up with a solid diagnosis/tx plan without a sufficient foundation in basic sciences? I realize that McMaster puts an emphasis on PBL and clinical skills; however, what good are those skills if u lack a sound foundation in basic sciences? Especially in a school that does not have any pre-med requirements, theoretically, you can have a non-science major with no science/pre-med background going to Mac Med getting a poor basic sciences foundation, entering residency and begin treating patients...i find that somewhat scary.

[JPJ]

I 'm a Canadian citizen but American med student and just got back from completing my USMLE Step 1. I have a few friends who attended Mac med school and were just entering their residency. After having a few discussions with them, I realized that their basic sciences were extremely extremely weak. I have friends from the caribbean system who have a much stronger foundation than a lot of mcmaster medical students.

 

What are they teaching you in your PBL sessions? How do u expect to come up with a solid diagnosis/tx plan without a sufficient foundation in basic sciences? I realize that McMaster puts an emphasis on PBL and clinical skills; however, what good are those skills if u lack a sound foundation in basic sciences? Especially in a school that does not have any pre-med requirements, theoretically, you can have a non-science major with no science/pre-med background going to Mac Med getting a poor basic sciences foundation, entering residency and begin treating patients...i find that somewhat scary.

 

Hoping that you are not a troll, here's my take on this issue:

I got accepted into Mac, and really had a tough time deciding between it and other schools. McMaster's medical program follows the philosophy of problem based learning where you learn concepts and principles based on given problems. If you read the literature that has been authored by the initial founders of the Mac PBL program, you can see that, among others, their goals included making the medical program more enjoyable and ensuring that students need to learn what they need to know rather than what they want to know. From talking to mac students, your PBL sessions are guided by a set of objectives that help you to acquire the information that you need. Also, Mac's program is very experiential-meaning you have lots of opportunities to get plenty of experience in the disciplines of your interest, starting from your horizontal electives in year 1. I think this program is best suited for mature (not age wise, but learning style) and independent learners. You can appreciate how this kind of program incorporates both knowledge acquisition and skills development effectively (e.g. the skills that are required to contribute effectively to group processes and to research the required information). IMO, these skills are very important in your long term career as a physician. Now, coming to complaints about some students who are not competent graduates from the program, a useful proverb to remember is that if you have a large white wall with just one small speck of dirt, you focus on the speck of dirt and not on the remaining glorious white wall. Maybe some graduates are not upto the mark after graduation, but I think this is more due to individual variation rather than the quality of the program. If you need some inspiring graduates from Mac's MD program, look no further than James Orbinski, Nobel peace laureate on behalf of doctors without borders. Bottom line, as others have said in the past, with mac's program, "you get as much out of it as you put into it".

[fireball]

Hoping that you are not a troll, here's my take on this issue:

I got accepted into Mac, and really had a tough time deciding between it and other schools. McMaster's medical program follows the philosophy of problem based learning where you learn concepts and principles based on given problems. If you read the literature that has been authored by the initial founders of the Mac PBL program, you can see that, among others, their goals included making the medical program more enjoyable and ensuring that students need to learn what they need to know rather than what they want to know. From talking to mac students, your PBL sessions are guided by a set of objectives that help you to acquire the information that you need. Also, Mac's program is very experiential-meaning you have lots of opportunities to get plenty of experience in the disciplines of your interest, starting from your horizontal electives in year 1. I think this program is best suited for mature (not age wise, but learning style) and independent learners. You can appreciate how this kind of program incorporates both knowledge acquisition and skills development effectively (e.g. the skills that are required to contribute effectively to group processes and to research the required information). IMO, these skills are very important in your long term career as a physician. Now, coming to complaints about some students who are not competent graduates from the program, a useful proverb to remember is that if you have a large white wall with just one small speck of dirt, you focus on the speck of dirt and not on the remaining glorious white wall. Maybe some graduates are not upto the mark after graduation, but I think this is more due to individual variation rather than the quality of the program. If you need some inspiring graduates from Mac's MD program, look no further than James Orbinski, Nobel peace laureate on behalf of doctors without borders. Bottom line, as others have said in the past, with mac's program, "you get as much out of it as you put into it".

 

Great post!

[ma_ta]

McMaster med students have classes 2 times a week...so there are lectures...thus, there is a sound foundation in basic sciences which you claim the program lacks

[bnface]

How do u expect to come up with a solid diagnosis/tx plan without a sufficient foundation in basic sciences?

 

Curriculum matters aside, this question shows how little you know about how medicine is actually practiced in the real world. If you need to think through the molecular biology before making a clinical decision, you probably are not very good at what you do. Most residents, let alone physicians, have long forgotten the electron transport chain....and yet are still able to reason through decision on a more clinical level.

 

P.S. The only reason caribbean students learn so much basic science is so that they can pass the USMLE step I... their curriculum is tailor-made for this.

[RCP90]

The US Medical school system is outdated and needs an overhaul, but like a big company, it's easier to just keep doing things the way its doing. Forcing students to memorize basic science (binge and purge) doesn't work. Students who learn about transcription factors binding to site xyz and then causing some cell cycle factor to become volatile forget these things in a month. If it's not practical and relevant, the student will forget, 100% guarantee. Many US med school profs will say that the curriculum in the first two years is pretty useless, and doctors will tell you that you don't learn anything for real until clerkship. Yes, I have talked to a few.

 

You might feel you know a lot of basic science now because you just took Step 1. That's what the test is about-- basic sciences. So you crammed for it, and will forget it in a month, or at most, a year.

 

And like bnface said, Carib schools teach to the boards. They hope that the students will get enough Step 1 prep to get good scores, and make the school look respectable, because in the US nothing matters more for your whole medical career than your Step 1 score does.

[NotDentistButDoctor]

What USvsCan is saying is sensible. I use to think the same thing, how can one learn how to treat illnesses and become a successful physician without a strong background in the basic sciences. It makes sense to have a strong background in this area because your understanding of how diseases affect people and how drugs and treatments interact with diseases is very beneficial. I was fortunate enough to be accepted at UofAlberta and UofCalgary. Calgary's program is very similar to McMasters and the program at UofAlberta is slightly more traditional. When I was trying to decide where to go I talked to many people, one of them being a surgeon and a nurse practitioner.

 

The surgeon told me that 95% of the operating knowledge he currently uses on a day to day basis to treat illnesses etc. was gained during his residency, not during medical school. He said that the information he learned in medical school was all book knowledge and not very useful in his day to day practice. He felt that learning medicine from a Problem Based perspective is much more useful because as a resident or a senior doctor you are always faced with Problem based situations. Hence to learn material in this way from the beginning just makes sense because by the time you start residency you will already have some training and insight into how doctors really think when they see patients.

 

 

The Nurse Practitioner told me that students from more traditional schools like UofAlberta have a very strong grasp on the basic and theoretical sciences in comparison to students from UofC. However, she found that students from UofC were much faster and efficient at communicating with patients, diagnosing and figuring out treatments.

 

In addition I read several articles on medical education and it seems that schools in Canada are gradually shifting towards a Problem-based learning style of teaching. In the end I decided to go to UofC, I'd rather start thinking like a doctor now rather than later

 

From my understanding the UCalgary curriculum is actually very similar to Mcmaster.

[leviathan]

Since I just wrote the Step 1, I have to agree the basic sciences are crucial to a deeper understanding of medicine. There isn't much molecular biology or biochemistry on the exam that is not clinically relevant (although admittedly there were some questions which were ridiculous), so some of the examples given are inappropriate. I think having that deeper understanding makes it easier to understand the clinical rationale for why certain things are done in medicine. For example, you can understand WHY ACE inhibitors are given in cardiac and renal patients rather than just memorizing it. Actually related to that, I saw a patient with b/l renal artery stenosis who someone had tried to give ACE inhibitors to awhile ago. Did they learn about the contraindication and just forget about it? Would they have been less likely to forget it if they had a good understanding of the physiology and pharmacology involved? I don't know.

 

So is the end result the same if both doctor A and B manage the patient the same? I suppose, but it probably makes doctor A's life a lot easier to retain his/her knowledge and understand exceptions to the rule, whereas doctor B ends up practicing medicine more like they're following a recipe in a cookbook. By the way, I'm not suggesting McMaster students are like Doctor B; I'm sure their basic science education is adequate, but I just want to dispel the notion that we don't need to learn these things.

[pretense]

I went through a pretty rigourous basic science curriculum in my first two years of medical school and I wish I went to a PBL school. Let's face it; by the time you're a clerk or a resident, 95+% of your basic and clinical science knowledge that you need is going to be on your smartphone or tablet. It's going to be your communication skills that make you a better physician than the others.

[leviathan]

A lot of your clinical knowledge is on your phone, but not the rationale for that clinical decision making. Like the example I gave you may find that ACE-Is are cautioned/contraindicated in renal artery stenosis on your phone, but it probably won't say why. It's easy to forget the thousands of things we need to know if you're just memorizing lists with no deeper understanding of why.

 

That's one of the reasons why I feel an MD is better than a midlevel provider like a PA or NP. Midlevels don't have the deeper understanding of medicine that we have, and they are more prone to making mistakes with treatment or missing the atypical presentation of a disease. But 90% of the time an experienced PA or NP can do just as good a job as a doctor, because following algorithms and protocols gets you through a lot of clinical scenarios without any troubles. It's the other 10% of the time that separates us, and a lot of that separation comes from basic science training.

[itimebomb2]

I went through a pretty rigourous basic science curriculum in my first two years of medical school and I wish I went to a PBL school. Let's face it; by the time you're a clerk or a resident, 95+% of your basic and clinical science knowledge that you need is going to be on your smartphone or tablet. It's going to be your communication skills that make you a better physician than the others.

 

This is true. I bet most clinicians today would fail the USMLE or the LMCC basic science sections because you simply don't use most of this information much in the real world, if ever.

 

A lot of your clinical knowledge is on your phone, but not the rationale for that clinical decision making. Like the example I gave you may find that ACE-Is are cautioned/contraindicated in renal artery stenosis on your phone, but it probably won't say why. It's easy to forget the thousands of things we need to know if you're just memorizing lists with no deeper understanding of why.

 

You're definition of "basic science" is a little hazy here - at Mac, we definitely learn the pharmacokinetics of ACE inhibitors, and most drugs that we look at. The whole point is that we learn relevant scientific principles - and certain drug mechanisms are important to know - therefore we learn them. When we talk about "useless basic science stuff" we're more talking about things like histology, obscure diagnostic tests, memorizing long lists of differentials, names of different types of cell receptors and things like that. Most of the people I know at U of T tell me that a large part of what they learn in the classroom is totally useless and quickly forgotten. In fact, the program at U of T, last I heard, is being overhauled to incorporate less irrelevant material to better serve the students.

 

The age of the intellectual, arm-chair physician ended a decade ago. Today, physicians are expected to be personable, more than scientific, because studies have shown that this is what patients want and expect - and not only that, but it leads to better health outcomes. Does every doctor need to be able to name 50 types of interstitial lung disease? No. Like somebody else said earlier, technology has largely negated the need for tiresome rote memory that is so characteristic of old-fashioned medical schools.

 

When you add up the time Mac students spend learning vs U of T students, I would say that we at Mac do in three years at least as much actual thinking as U of T students, since U of T students spend 40 hours a week sitting in lecture halls, mindlessly getting spoon fed information from a speaker. Then they go home and spend many more hours cramming for exams because they're in an ultra-competitive environment. Neither of these two teaching methods seem useful in the long run to me. I had my days of rote memorization in undergrad - thankfully they are over for me now. How much do you remember about organic chemistry from your undergrad? If you're anything like most people... probably close to nothing.

 

p.s. no disrespect meant to U of T! love you guys

[leviathan]

You're definition of "basic science" is a little hazy here - at Mac, we definitely learn the pharmacokinetics of ACE inhibitors, and most drugs that we look at. The whole point is that we learn relevant scientific principles - and certain drug mechanisms are important to know - therefore we learn them. When we talk about "useless basic science stuff" we're more talking about things like histology, obscure diagnostic tests, memorizing long lists of differentials, names of different types of cell receptors and things like that.

I suppose histo is useless unless you want to become a pathologist, although it is probably helpful to understand a pathologist's consult letter to you when they describe their findings. Don't know see how having a good differential is 'basic sciencey' though. Cell receptors are lower yield, although again I'd say you can't know pharm without knowing where drugs act, at least you should know muscarinic + adrenergic receptors in and out. And that receptor info probably helps to remember things like why you wouldn't give beta blockers to someone with a cocaine overdose (yes i know, this theory has been mostly disproven), or why we give glucagon in a beta blocker overdose. Or when do you give phenoxybenzamine vs. phentolamine vs. prazosin vs. tamsulosin to a patient, all of which are alpha blockers? You could just memorize when they're needed, but if you understand cell receptors it makes your life 10x easier.

 

Of course this is coming from someone who is just starting clerkship and my opinion could definitely change when I'm done in 2 years.

 

The age of the intellectual, arm-chair physician ended a decade ago. Today, physicians are expected to be personable, more than scientific, because studies have shown that this is what patients want and expect

Sure, but being personable and knowledgable/scientific are not mutually exclusive things at all.

 

How much do you remember about organic chemistry from your undergrad? If you're anything like most people... probably close to nothing.

 

p.s. no disrespect meant to U of T! love you guys

Umm..organic chem? Markovnikov + Grignard reactiosn? Something about sn1 sn2 is floating around in my head but I don't remember what those mean anymore. That said, I feel like the things you are doing in medicine should help keep your basic science knowledge fresh in your mind, at least for the stuff which IS clinically relevant. I absolutely agree that there's a lot of irrelevant stuff taught in the more traditional med schools, but I think it's only a small minority of what is taught.

 

And as I said before, maybe you're right and having a deeper understanding of why we do the things we do isn't important, and the outcomes are the same? But then what's the point of basic sciences anyway; maybe we should axe medical schools and just start using PA schools which I feel is like a bare-bones version of med school with all the basic sciences cut out.

[Sev]

The age of the intellectual, arm-chair physician ended a decade ago. Today, physicians are expected to be personable, more than scientific, because studies have shown that this is what patients want and expect - and not only that, but it leads to better health outcomes. Does every doctor need to be able to name 50 types of interstitial lung disease? No. Like somebody else said earlier, technology has largely negated the need for tiresome rote memory that is so characteristic of old-fashioned medical schools.

 

It appears that you are claiming a PBL-focused education results in more personable medical graduates. Are there literature studies to support this claim? Students do not become more personable with patients merely by discussing a clinical case with classmates. They largely learn how to be more personable by actually interacting with patients. In this sense, every Canadian medical school provides students practice in becoming more personable, not just Mac.

 

However, let's assume that your claim is correct. Since most Canadian medical schools have PBL in some form or other running parallel to basic science education, the difference in degree of personableness between Mac graduates and those from other schools should be minimal--and essentially negligible by the time these graduates reach their second/third year of residency.

 

I think you are somewhat off the mark with your personable vs. scientific comment. At the end of the day, what truly matters is not whether you are Dr. Hold Your Hand or Dr. Esoteric Knowledge, but that you are competent. Patients do not care how nice you were if it comes to light that you may have erred in diagnosis; they will still haul your derriere out to court. On the other hand, an arrogant show-off of a physician will still be forgiven his personal failings if he is good at what he does. I think you should be judging McMaster more on the competency of their medical graduates than on how personable they are. (NOTE: I am not saying McMaster graduates are incompetent.)

 

When you add up the time Mac students spend learning vs U of T students, I would say that we at Mac do in three years at least as much actual thinking as U of T students, since U of T students spend 40 hours a week sitting in lecture halls, mindlessly getting spoon fed information from a speaker.

 

As mentioned above, UofT Medicine also has PBL (as do UBC, McGill, etc.), so students there certainly do engage in clinical discussion and thought similar to McMaster students.

[leviathan]

You're actually much less likely to be sued if your patients like you and found you to be caring/compassionate/attentive/etc.

[itimebomb2]

I think you are somewhat off the mark with your personable vs. scientific comment. At the end of the day, what truly matters is not whether you are Dr. Hold Your Hand or Dr. Esoteric Knowledge, but that you are competent. Patients do not care how nice you were if it comes to light that you may have erred in diagnosis; they will still haul your derriere out to court. On the other hand, an arrogant show-off of a physician will still be forgiven his personal failings if he is good at what he does. I think you should be judging McMaster more on the competency of their medical graduates than on how personable they are. (NOTE: I am not saying McMaster graduates are incompetent.).

 

Obviously being competent is the bottom line - but the idea I'm trying to get across the paradigm shift that personability is competency. There are research studies (that I've heard of but dont care to take the time to produce for you) that show that good relationships lead to better health outcomes. Obviously this doesn't apply to all specialties, but particularly in primary care (which is by far the most important type of care), it is crucial. If doctors could actually convince their patients to lose weight, quit smoking, or eat healthily - this would be much more effective than knowing which beta-blocker to give when they get cardiovascular disease (which is of course, also important).

 

Do Mac students make more personable doctors? Well this remains to be seen - but at very least, the curriculum here recognizes this and makes a solid effort at developing well-rounded doctors. Nothing ventured, nothing gained, right? Whether or not it is successful currently is debatable - but changes happen every year to improve the curriculum and one day, it may be that a PBL focused curriculum comes out on top. Your point that most medical schools have now incorporated some element of PBL into their schooling is a testament to that already (although how seriously they take it is of serious question).

 

I should make the point that we DO learn about drug mechanisms here. When I'm talking about receptors, I'm not talking about basic stuff like alpha1,2 and beta1,2,3 receptors - again you picked the most obvious example of important pharmacokinetics out there - and yes, we do know what these are at Mac! There are tonnes of examples of useless biochemical mechanisms out there that have no bearing on day-to-day clinical practice.

[A-Stark]

This is true. I bet most clinicians today would fail the USMLE or the LMCC basic science sections because you simply don't use most of this information much in the real world, if ever.

 

What LMCC basic science section? You can't look up everything, and you can't say "I'll look it up on my iPhone" if asked about the management of an acute asthma attack by your staff in Emerg. The USMLE is actually very clinically-oriented, despite the reputation to the contrary, and apart from pathology minutiae, I can't fault what it covers at all.

 

You're definition of "basic science" is a little hazy here - at Mac, we definitely learn the pharmacokinetics of ACE inhibitors, and most drugs that we look at. The whole point is that we learn relevant scientific principles - and certain drug mechanisms are important to know - therefore we learn them. When we talk about "useless basic science stuff" we're more talking about things like histology, obscure diagnostic tests, memorizing long lists of differentials, names of different types of cell receptors and things like that. Most of the people I know at U of T tell me that a large part of what they learn in the classroom is totally useless and quickly forgotten. In fact, the program at U of T, last I heard, is being overhauled to incorporate less irrelevant material to better serve the students.

 

Pharmacokinetics? Might want to check the definition there, since I'm rather certain that leviathan was talking about drug mechanisms. An appreciation for fundamental normal histology and anatomy is essential, and there is nothing about diagnostic tests or differentials that pertains to basic science per se. I can't speak to UofT, but certainly Mac has had - in the past - a reputation for "suboptimal" performance on the LMCCs, which as far as I can tell test clinical knowledge.

 

The age of the intellectual, arm-chair physician ended a decade ago. Today, physicians are expected to be personable, more than scientific, because studies have shown that this is what patients want and expect - and not only that, but it leads to better health outcomes. Does every doctor need to be able to name 50 types of interstitial lung disease? No. Like somebody else said earlier, technology has largely negated the need for tiresome rote memory that is so characteristic of old-fashioned medical schools.

 

I really have to take issue with this. It was always possible to look stuff up before, and references moving from pocket books to electronic devices isn't as revolutionary as you think. In any case, you're setting up a false dichotomy - physicians with poor basic science and clinical knowledge are hardly going to lead to "better health outcomes".

 

When you add up the time Mac students spend learning vs U of T students, I would say that we at Mac do in three years at least as much actual thinking as U of T students, since U of T students spend 40 hours a week sitting in lecture halls, mindlessly getting spoon fed information from a speaker. Then they go home and spend many more hours cramming for exams because they're in an ultra-competitive environment. Neither of these two teaching methods seem useful in the long run to me. I had my days of rote memorization in undergrad - thankfully they are over for me now. How much do you remember about organic chemistry from your undergrad? If you're anything like most people... probably close to nothing.

 

p.s. no disrespect meant to U of T! love you guys

 

I'm not a fan of UofT's wall-to-wall lectures, but Mac is hardly alone in its use of PBL. Dal has been "case oriented problem stimulated" and now "case based" for 20 years, but what's key is early exposure to patients, not any putative amounts of "thinking" done. And if you think you're done with rote memorization, I'll wish you luck on the LMCCs and clerkship exams. I guess you won't be writing the USMLE either?

[Mei_Mei_girl]

There are no free lunches

[bj89]

PBL's no good, br0