Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.



Disclaimer:
HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes. Also, I am an anonymous internet person. Why should you trust an anonymous internet person to give you medical advice? Don't ask me, ask your doctor!
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Posts tagged "pbl"
Asker sammbaamm Asks:
I keep hearing about how med schools have different teaching methods and all that and it confuses me.. Can you explain what the different teaching methods are and how they are different??
wayfaringmd wayfaringmd Said:

The two main teaching styles in the first 2 years are lecture-style and PBL (problem-based learning). Lecture style is your traditional sit in a big room and listen to someone talk style. Most schools that do this style do not have mandatory attendance policies and usually record their lectures so students can watch whenever they want. Lecture style schools also often follow the semester system. 

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PBL style is a bit different and is done slightly differently everywhere you go. The basic gist is that the school divides students up into groups of 8-10 with 1 or 2 “tutors” (aka professors) in each group. In schools that are exclusively PBL style, of which there are still very few, students set issues for discussion and read everything in their textbooks on their own time to be prepared for discussion. Discussions are based on a medical case and are geared toward explaining every miniscule detail of the case with basic science. The tutor’s job is to facilitate discussion, make sure the students hit the right details, and keep them on track. PBL schools usually have a block system. Each block (anywhere from 4-10 weeks) is based on a different basic science subject or body system. My school was systems based, so for example in the Cardiology block we would have cases related to heart problems and would learn the anatomy, physiology, pharmacology, biochemistry, etc, all related to the cardiovascular system. I have more on PBL here if you are interested. 

Lots of schools are adopting a lecture/PBL hybrid system to get the best of both worlds. 

In addition to lectures or PBL, most medical schools start teaching patient care even early in the first year. Again, the styles vary widely. Many places have adopted a “standardized patient” clinic where students practice on actors before they are thrown out into the real world. 

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After the first 2 years, med school curriculum is mostly the same everywhere. Third year students do all the same rotations at every school. The details, of course, vary. Fourth years also have certain required rotations and then get electives. But yeah, 3rd and 4th years are pretty much the same everywhere. 

Is that clear as mud?

Asker Anonymous Asks:
what do you think about pbl based med schools?
wayfaringmd wayfaringmd Said:

ladykaymd:

PBL (problem based learning) or TBL (team based learning) for those who don’t know are both terms for when groups of students work together in a room on a case study. This is a very “self-directed” style of learning where students often work through issues as they come up instead of sitting in a lecture hall and listening to someone teach.  These students work in groups of students generally without any (or very minimal) guidance from faculty. 

I think PBL is a great addition to lectures. I don’t think that it should be the ONLY method of learning. There is so much information in the world and people have written thousands of pages on any subject you might come across in medicine. It’s important to have teachers to guide you as to what is the most important information and how to learn it most successfully. 

Unfortunately, in medicine there has become this attitude that students could “learn it all on their own” or “do it online”. 

You can’t do that. 

Future doctors need the assistance of scientists who are at the tops of their field, clinicians who can tell you about the real world applications of what you’re learning, and experts who understand how the pieces fit together. 

I was just answering an ask about how I’m an autodidact—meaning I do a lot of “self-learning” and enjoy learning on my own or working through the problem. But this would not be enough for me to be a good doctor—or even a decent one. 

You’ll notice there are lots of people in the world who became great musicians without ever taking a lesson or great artists without a master looking over their shoulder or great economists or great this or that. 

There is not a single doctor in the world who became a doctor without the help of a thousand teachers. We don’t let our students out onto the wards without a thousand teachers surrounding them. The resident shows you how to place the line before you do it yourself. A nurse teaches you how to change a dressing or how to do an injection so it causes less pain. An attending (patiently?) explains to you why you know nothing about DKA. A PT teaches you how to help a patient’s pain by assisting in bending their knee. A social worker shows you how to find support for the single mom in the ER so next time you don’t have to send her home without the medications her child needs.

PBL is a really fantastic way for students to learn to think like clinicians, to work in teams, to discover how to move through a case step by step, and even to integrate knowledge. But if we could all teach ourselves to be doctors on our own or with a group of our friends we wouldn’t pay so much for tuition. 

I love PBL, I really do—please don’t think any of this is me saying PBL is bad—because PBL is excellent. I think every medical school in this country should have it as part of the curriculum. But I also see that there has been too strong a push for it at some schools moving to a “PBL-only” type format. And this is a mistake in my opinion—students will be bogged down in the plethora of information and will be unable to adequately determine what information is needed and what is not. Students may easily become side-tracked or spend hours learning something ineffectively because there wasn’t the guidance of someone who had the expertise to teach them. 

And I am of the opinion that you cannot make great doctors without training them as scientists. You cannot make great doctors without great teachers. 

(This was a really simple question that I turned into a crusade about medical education and I’m sorry about that—but I am pretty passionate about medical education and teaching—so if you give me the soap box, I’ll climb up.)  :)

Thought I’d weigh in since I went to one of those PBL-only schools.

It is a common misconception that there is not formal teaching at PBL-only schools. But we didn’t actually learn everything on our own. Our PBL groups of about 8 students usually had 1-2 tutors who were either MDs or PhDs. Their job was to make sure we didn’t get bogged down in the information and go too deep into the minutiae, and on the flip side, to be sure we were digging deeply enough when it was appropriate. They were there to clarify issues that were cloudy, offer clinical correlations, and explain things as needed. They also would help us set issues to discuss for future group sessions to ensure that we gave the material the attention it needed.

Professors in group would bring in models, powerpoints, or printed handouts to help us with difficult concepts. Though every professor had a different style and a different level of participation in group, they all taught us, be sure of that. 

We had the option to ask for supplemental lectures if we were struggling with certain topics. We usually averaged 1-2 supplemental lectures a week, though some phases (hello, neuro) there were more.

The great thing about PBL for me was actually the availability of the professors. I went to an undergrad school that valued small class sizes and interaction between students and professors, so this same philosophy is what drew me to PBL. If I had gone to a lecture-style school, I would have had much less 1-on-1 access to my professors, and it would have been limited to a few office hours a week. Whereas at my school, most professors had an open door policy. They stuck around after group sessions, were available on “off” days, gave out their cell phone numbers (yep, I called one at 11pm once, and when I apologized for the hour he answered “no problem! I am usually up til 2 anyway!”), and ate lunch in the common areas with us. 

Had I gone to a school that offered mostly lectures, I personally would not have done as well. I would have memorized material to spit back onto a test paper rather than learn to integrate subjects and make clinical correlations with even the most minute basic science concept. Plus all the practice of group learning in my first 2 years of med school made the second 2 a breeze because I was able to figure out which details were important for me to read about and study on my own. 

If you’re the type of person who does well with group learning and who functions well when multiple learning styles are integrated (visual, auditory, etc), PBL might be for you. If you’re the kind of person who, like me, spaces out or doodles during lectures, a small group setting might work wonders for you. Coming from a school that took mediocre MCAT scores and turned us all into doctors with above national average USMLE scores, I’d have to say it worked pretty well for us. 

chanceuse-et-heureuse replied to your post: How was the tutor after all? Was he super weird?

…but… what if you completely fail to figure something out on your own? why would somebody deliberately not offer help? is medicine not a team sport?

I think his point in not helping us (besides just being a jerk) was to teach us to rely on ourselves, and then on our group members when we couldn’t figure things out on our own. Of course, the VAST majority of our tutors were always available for questions and help during office hours too. 

How was the tutor after all? Was he super weird?
wayfaringmd wayfaringmd Said:

He ended up being my least favorite tutor (and one of my least favorite attendings) in all of med school. He had a bad attitude all the time, was extremely sarcastic, and never helped us at all in group. But the one thing I did learn from him was not to expect tutors to spoon feed us any material. I learned from day 1 that if I didn’t understand something, I needed to figure it out on my own. It probably made me more of a self-learner. 

Asker Anonymous Asks:
Besides your school, do you know of any other medical schools with a PBL curriculum ?
wayfaringmd wayfaringmd Said:

Er uh, I looked online for a list of schools with PBL, and the only list I could find was for the UK. 

LOTS of US schools use PBL now. Some will have a traditional vs. a PBL track, while others will integrate the two in varying proportions.

Sorry, I looked, but I couldn’t find a good list. Check with individual schools when you start looking to apply. 

Anyone got an answer for this? Help a sister out. 

Asker Anonymous Asks:
I'm curious in regards to how the system works in a traditional setting (vs how I've learned it in the Caribbean in a trimester system). Do you feel it's at all difficult to grasp the material to master each subject when it's taught throughout the year? For instance do you think you'd learn it better if you were taught all of Anatomy then all of Physio?
wayfaringmd wayfaringmd Said:

I’m a big picture person. Details are only useful to me if I can fit them in the big picture. So for me, learning all subjects at once—as they related to an organ system or particular disease process—made sense. After all, when you see a patient, you think about how all their diseases work in tandem to produce an effect you see on the patient, right? When thinking about a patient’s kidney function, you would consider how their diabetes and their uncontrolled hypertension affects them, right? 

It would be much harder for me to draw connections between anatomy, physiology, and biochemistry as they relate to diabetes, for example, if I had learned each subject separately. Instead, I started with diabetes and then delved into more specific details, like the histological appearance of pancreatic beta cells and the biochemical structure of insulin. 

I dunno, it worked for me. I suppose I would have gotten it eventually the traditional way, too, though. 

navamon:

Lately, my professor in pathology class has been implementing Patient-Based Learning (PBL) method on us. We usually have a professor for each class who lectures to us for a certain period of time. Sure, you can raise your hands and ask questions in class. But most of the times, you just listen and take down notes. This is an example of teach-centered approach.

Another description of PBL (here’s mine), which we call Problem-Based Learning. It is a great system and I’m not sure I would have done as well in a lecture-style curriculum. 

20. How much do you study?

Well, since I did a problem-based learning curriculum, I’m willing to bet we studied more than your average student at a lecture-style school. 

During my first 2 years of school, I pretty much did nothing but read all day, everyday, with breaks for class and church on Sunday. On class days (9-12 MWF) I would start my reading at 1:00 and stop around 10 or 11, so that’s 9-10 hours unless there were lectures. On Tuesdays and Thursdays, if we didn’t have clinical skills or supplemental lectures, I’d start around 8:30 or 9 and read until about 10pm, with 30 minute breaks for meals and sometimes an hour of gym time. So that’s probably about 10-11 hours as well. 

I added up all the pages I needed to read in the 6 week phase (actually we set the goal of finishing the reading by the 4 week mark to leave 2 weeks to study for the test), and divided it into 25 days (I always left a few extra days in there just in case something came up or I got behind). As long as I read the allotted amount of pages every day, it didn’t really matter how long it took. Some days it took much longer than others. If I got through it quicker one day, I’d read some extra pages to make up for slow days. Number of pages varied from 30-75 a day, which doesn’t sound like much, but when it’s Robbins or Boron, believe me, it is a crap-ton. 

I read on weekends, too, though I made room for some social events.

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13. What is this Problem-Based Learning stuff? 

So my school does nothing but PBL, and I think it works really well. 

Some schools are using 50/50 programs that are half PBL, or they’ll do some small bit of PBL to help students incorporate everything they’ve read. 

The way it works at my school is that we meet 3 days a week (MWF) from 9-12 in groups of 8-10 students plus one tutor who is an MD or PhD (their job is not to teach. It’s to keep you on the right track during discussion). We read a medical case and then set issues to discuss about it. We teach each other the material. By the time we’re done, we are able to explain the basic science behind every tiny aspect of the case. On Tuesdays and Thursdays we have some optional lectures plus clinical skills training. 

We learn in 6 week phases where we study all subjects at once as they pertain to a certain body system. There are 6 phases in a year. Our 12 phases are: Biochem & Cell Bio, Genetics, Host Defense, Heme, Neuro, Musculoskeletal, Cardio, Brain & Behavior, Pulm, GI, Renal, and Endocrine. We also have community medicine dispersed in there too. So if you’re in GI phase, you’re learning the biochem, physiology, anatomy, pathology, etc etc that relates to GI. And you learn it as it relates to your patient case, so you can put all your knowledge in context. 

14. What are the advantages to PBL over lectures?

You learn how to study and learn on your own, which is very important when you get to your clinical years and residency. Plus, you learn more comprehensively. You make connections between all the subjects that are more difficult to make if you studied each subject separately. 

At my school, it definitely keeps people from being so competitive. We all depend on each other to help us learn the material, so we share notes (we have an online database where we upload our notes) and study together. 

Also, the scores we produce are just as good or better than traditional schools. 

15. What are the difficulties of PBL?

You have to learn on your own. You don’t get spoon-fed the material through lectures. But we do have some extra optional lectures for extra help. And all of our professors are super helpful and are available to discuss the material any time. 

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