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What are your opinions on PBL?

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    (Original post by OSharp)
    Thanks that's really insightful

    I would also add that the course I have an offer for is a mixture of PBL Lectures and and clinical skills from the outset so Hopefully i will get the best of both worlds
    PBL on its own is useless.

    It cannot be a standalone method for knowledge acquisition/teaching at the Pre-clinical level. Therefore, now no medical course uses PBL on its own, it is always complimented with other teaching methods.

    Even at medical schools which have a highly PBL-based curriculum (e.g Manchester, Peninsula, HYMS, UEA), it is not used on its own. A variety of other learning tools are also used in conjunction with PBL, i.e seminars, large group didactic teaching, small/large group interactive teaching and of course self-directed study.

    Also the types of PBL used currently across the UK are a far cry from the original PBL models originally implemented. Originally PBL was intended to be a solely student oriented unstructured activity where students worked together through a series of clinical problems.

    This is not the case now, PBL is now far more structured with clinicians facilitating the sessions, students are provided with a more structured study guide and a study guide/syllabus of the basic science content which should covered by lectures/seminars, tutorials and in self-study is available.

    Within a format as described above and a well functioning group, PBL works fantastically well. Even within PBL groups which are awful with poor facilitation the other aspects of so called PBL-based courses provide a net to prevent a lack of learning.

    The main disadvantage of PBL courses is that people can fall through the net, and easily get through (year 1 and 2) without learning a lot of the basics.


    This does not mean that PBL based courses are the way forward. However, the benefits PBL provides students in terms of team dynamics, adaptability, communications skills cannot be denied and not to mention the ability to find, select and use appropriate resources to acquire medical knowledge (pre-clinical and clinical) whilst evaluating the validity of those resources. (Wikipedia has its use but its is not an ideal resource and is rarely used as a standalone resource but merely a starting point)

    For these reasons there has recently been an increase in structured small group learning across the majority of all UK medical schools, all you need to do is look at the new/updated course structures several medical schools have been implementing over the last few years. (UCL and Cardiff spring to mind)
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    (Original post by digitalis)
    PBL is a bunch of ****e, imo.

    And whoever said that about wiki is right. I tell you the truth, the vast majority of our PBLs were done the night before off wikipedia/emedicine/patient.co.uk. If I was really cutting it fine I would skim the relevant page in the OHCM on the tube in the way in and blag it during the debrief. Half the time the facilitator didn't care anyway, such as a psychologist leading an obstetrics and gynaecology session. Couldn't answer any of our questions that were not on his preprinted 'tutor notes' (subsequently ended up on a website with everyone feverishly trying to copy what we were actually supposed to know which was often vastly different from what we actually covered)

    I did very well in my first year, got a Merit. Missed a merit by a few marks in my OSCE component (whoever would have thought a second year would be expected to do clinical medicine :facepalm:) but got the equivalent marks for a merit in my written papers.

    The gaps in my knowledge from my 'PBL based' course only came out two years later working for the USMLE Step 1 which was a slap in the face. A friend of mine in the year below, just done an iBSc, is working towards Step 1 now, a good student like me. He is currently at failing standard for Step 1, an exam designed to be taken after the second year of medical school.
    Pretty much this. It's not a good way to roll out preclinical medicine. I'm confident there are people in my year who will be as scientifically capable as a nurse practitioner, just with a doctor's degree.

    Though one thing PBL in preclinical years does do is give you a load of time to explore areas that interest you.
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    (Original post by Kinkerz)
    Pretty much this. It's not a good way to roll out preclinical medicine. I'm confident there are people in my year who will be as scientifically capable as a nurse practitioner, just with a doctor's degree.

    Though one thing PBL in preclinical years does do is give you a load of time to explore areas that interest you.

    The main disadvantage of PBL courses is that people can fall through the net, and easily get through without learning a lot of the basics.

    But those people are the exception not the rule, and are bound to pick it up in year 3 and 4. Most people use all the resources available to them and do learn everything that is required.

    Is it not a failure of other parts of the course/assessment that these people get through? (We have the same problem here, and I would say at least a quarter of my year fall into that category.)
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    As for the Wikipedia discussion:
    Giles, J: Special Report Internet encyclopaedias go head to head; Nature: 438, 900-901 (15 December 2005)

    I can't get access to the full thing. It'd be good if anyone could.
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    (Original post by carcinoma)
    The main disadvantage of PBL courses is that people can fall through the net, and easily get through without learning a lot of the basics.
    It's a dangerous net to fall through. And it shouldn't just be accepted that people will fall through it. It needs addressing.

    But those people are the exception not the rule, and are bound to pick it up in year 3 and 4.
    The scientific basis of medicine forms a very small part of most clinical year components. Once you're through the preclinical phase, that's, within reason, it. And they're not necessarily that big an exception.

    Most people use all the resources available to them and do learn everything that is required.
    Seems like a bold statement to make in my opinion. My experiences are somewhat different.
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    (Original post by Kinkerz)
    As for the Wikipedia discussion:
    Giles, J: Special Report Internet encyclopaedias go head to head; Nature: 438, 900-901 (15 December 2005)

    I can't get access to the full thing. It'd be good if anyone could.
    438900a.pdf

    Are you sure you dont have access, because the nature site is a pain to authenticate via Athens sometimes.
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    (Original post by carcinoma)
    Are you sure you dont have access, because the nature site is a pain to authenticate via Athens sometimes.
    Pretty sure? "Your institutional access to this resource has not been validated."
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    (Original post by Kinkerz)
    It's a dangerous net to fall through. And it shouldn't just be accepted that people will fall through it. It needs addressing.


    The scientific basis of medicine forms a very small part of most clinical year components. Once you're through the preclinical phase, that's, within reason, it. And they're not necessarily that big an exception.


    Seems like a bold statement to make in my opinion. My experiences are somewhat different.
    It does need addressing.

    My experiences are similar to yours but I would say it affects less than 50% of the cohort. Yes a large number of people will have some gaps but isn't this reflected everywhere.
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    (Original post by Kinkerz)
    Pretty sure? "Your institutional access to this resource has not been validated."
    Do you not have an internal Metalib or similar journals search engine/A-Z?

    Because even the university of Plymouth Athens account has access to Nature, and they barely have anything useful.
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    (Original post by carcinoma)
    It does need addressing.

    My experiences are similar to yours but I would say it affects less than 50% of the cohort. Yes a large number of people will have some gaps but isn't this reflected everywhere.
    Even if it's 30%, I'd say there's a problem.
    I think it is reflected everywhere. In all course types too (though perhaps slightly more often with PBL courses).

    It's just as much the way people are examined and tested as the medium through which they learn.
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    (Original post by carcinoma)
    But those people are the exception not the rule, and are bound to pick it up in year 3 and 4. Most people use all the resources available to them and do learn everything that is required.
    On the contrary. No-one really picks up basic science in 3rd and 4th year, they are too busy trying to rote learn associations rather than being able to derive them from first principles. We have built a house on very shaky foundations for this batch of medical students....

    Written finals really opened my eyes to the actual level of medical science that you are expected to know as a FY1 doctor. To say it would be minimal would be a gross understatement. We had a question on microbiology (identify the bug) and it was ridiculous. All the classic, knee jerk textbook descriptions literally put into the question stem. All questions one step logic. I mean, really, these are qualifying medical exams, not first year questions.

    PBL was a failure. It was a really nice concept that is extremely attractive to applicants, myself included. Instead of locking you up in a lecture theatre studying physiology for two months straight, you can 'learn real medicine' and emulate House sitting around a table mulling over a diagnosis, whilst learning your preclinical science the 'fun way!!' Who isn't going to fall for that?
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    My experiences are similar to yours but I would say it affects less than 50% of the cohort. Yes a large number of people will have some gaps but isn't this reflected everywhere.
    I'd say it affects 70-80%. Probably doesn't become apparent until the very later stages of your course/approaching postgraduate examinations.
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    (Original post by carcinoma)
    Do you not have an internal Metalib or similar journals search engine/A-Z?

    Because even the university of Plymouth Athens account has access to Nature, and they barely have anything useful.
    We get some Nature (and Nature sub-journals/reviews) access but not all. Still waiting on my NHS Athens account.
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    (Original post by digitalis)
    I'd say it affects 70-80%. Probably doesn't become apparent until the very later stages of your course/approaching postgraduate examinations.
    Is that based on your experiences of medical schools in general or just Barts? I've spent a lot of time looking and it certainly seems to me that the PBL courses have changed dramatically since they where first implemented. certainly there will be people who fall through the net but isn't this true with all forms of medical training? also I have noticed that alot of friends who also applied to do medicine have pointed out that some of the places they've applied to have also started to take a slightly less traditional approach to medicine introducing some PBL or SSGL in early years and far less places seem to offer things like cadaver dissection. your point that you found Final examinations questions easy and yet attended uni that utilizes PBL, surely this shows you have the knowledge required for those exams and it is therefore a problem with examination and not the course itself?

    also you say PBL was a failure as if it is no longer implemented anywhere in the world ever. Clearly this is not the case.

    I am as ever playing devils advocate here and wouldn't say i really know enough about either side to make a judgement. but parts of your argument just seem like an attack with no real justification, no offence intended.
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    (Original post by digitalis)
    On the contrary. No-one really picks up basic science in 3rd and 4th year, they are too busy trying to rote learn associations rather than being able to derive them from first principles. We have built a house on very shaky foundations for this batch of medical students....

    Written finals really opened my eyes to the actual level of medical science that you are expected to know as a FY1 doctor. To say it would be minimal would be a gross understatement. We had a question on microbiology (identify the bug) and it was ridiculous. All the classic, knee jerk textbook descriptions literally put into the question stem. All questions one step logic. I mean, really, these are qualifying medical exams, not first year questions.

    PBL was a failure. It was a really nice concept that is extremely attractive to applicants, myself included. Instead of locking you up in a lecture theatre studying physiology for two months straight, you can 'learn real medicine' and emulate House sitting around a table mulling over a diagnosis, whilst learning your preclinical science the 'fun way!!' Who isn't going to fall for that?
    We sit finals 4 times a year every year until graduation. I agree that some questions are so textbook that it becomes comical and the level of core principles is probably only 10% of the exam.

    I think it is too strong to say that PBL has been a failure, would you not admit that you will come out of medical school with knowledge as strong as the other FY1s of your cohort?

    Whilst PBL makes it more difficult to find and learn the information, I think it will make us better doctors that we have had to motivate ourselves at times to build the knowledge we will need to make us better doctors.
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    (Original post by carcinoma)
    We sit finals 4 times a year every year until graduation. I agree that some questions is so textbook that is becomes comical and the level of core principles is probably only 10% of the exam.

    I think it is too strong to say that PBL has been a failure, would you not admit that you will come out of medical school with knowledge as strong as the other FY1s of your cohort?

    Whilst PBL makes it more difficult to find and learn the information, I think it will make us better doctors that we have had to motivate ourselves at times to build the knowledge we will need to make us better doctors.
    Your last paragraph sounds like it was lifted out of a prospectus As I said before, motivation for PBL? That's a joke dude...

    End of year 'finals' =/= "Finals finals"

    Well, I don't know about comparing myself to the rest of my cohort. I guess I will find out in July.
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    (Original post by carcinoma)
    I think it is too strong to say that PBL has been a failure, would you not admit that you will come out of medical school with knowledge as strong as the other FY1s of your cohort?
    I think most of my cohort will be very comfortable with the core clinical knowledge. Many will understand very little of the science behind what they do and possibly be paralysed from an academic career.

    Whilst PBL makes it more difficult to find and learn the information, I think it will make us better doctors that we have had to motivate ourselves at times to build the knowledge we will need to make us better doctors.
    That's part of the problem. Many don't have that motivation and consequently have significant gaps in their knowledge. Take me with anatomy, for instance.
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    (Original post by digitalis)
    Your last paragraph sounds like it was lifted out of a prospectus As I said before, motivation for PBL? That's a joke dude...

    End of year 'finals' =/= "Finals finals"

    Well, I don't know about comparing myself to the rest of my cohort. I guess I will find out in July.
    I was not referring to end of year 'finals' is was referring to "finals finals". We just happen to do them every 8 weeks until graduation in a progress test format.
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    (Original post by Kinkerz)
    I think an uncomfortable proportion of my cohort will be very comfortable with the core clinical knowledge. They'll understand very little of the science behind what they do and possibly be paralysed from an academic career.
    Without a doubt and that's a very sad thing. I think that is reflected with most of the PBL courses. Only a handful (if that) of our graduates go via the academic medicine route after graduation.

    But I think that may be more to do with the "doctor factory" mentality of the government (via the GMC)



    (Original post by Kinkerz)
    That's part of the problem. Many don't have that motivation and consequently have significant gaps in their knowledge. Take me with anatomy, for instance.

    Very true.

    On a side note my cohort became the first to trial anatomy spotter tests, which is hoped will be introduced into the curriculum.

    I cant understand why they weren't included at the conception of the course.
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    (Original post by carcinoma)
    I was not referring to end of year 'finals' is was referring to "finals finals". We just happen to do them every 8 weeks until graduation in a progress test format.
    I'll pose you a scenario as an illustration. If I was to go around and do a cross sectional survey so to speak of my year and said 'what are the major complications of diabetes?' The vast majority would rattle off diabetic nephropathy, retinopathy and neuropathy.

    This in itself is decent clinical knowledge.

    However, if I then posed the question 'how does diabetic hyperglycaemia cause periphereal neuropathy?'

    I reckon maybe 10% could tell me that it is due to glucose being converted to osmotically active sorbitol and that is taken up by nerves causing osmotic damage, which is reasonably simple physiology.

    The problem is, that PBL trains doctors to make snap clinical decisions and assumptions based on rote learning of symptomology. This is useful for physicians who have been practising for decades, but not so useful for a house officer when confronted with a disease that they haven't encountered before, or a new drug class with a new mode of action. Therefore the minute you come across something that strays from whatever you have rote learned, you are screwed. This is totally aside from encouraging academia in medicine which has been slowly eroded away over the years.

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