[GrahamRodney]

(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 guess you will. I have no axe to grind about this, not having received much of it, but you might be interested to look at http://www.ltsn-01.ac.uk/static/uplo...pbl_report.pdf - A pilot systematic review and meta-analysis on the effectiveness of Problem Based Learning
On behalf of the Campbell Collaboration Systematic Review Group on the effectiveness of Problem Based Learning.

But then again, you might not

[carcinoma]

(Original post by digitalis)
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.

Yes, I absolutely agree with this example.

But how can PBL train doctors to "make snap clinical decisions and assumptions based on rote learning of symptomology" if it is only used in years 1 and 2 of most PBL curriculums?

From then on the shift moves to consultant lead small group learning, but it does leave gaps in basic pathophysiology in some areas (as you identified above) but those gaps are not in all pathophysiology only several examples. But surely the complications of diabetes are re-visited more than once which should wean out that lack of knowledge earlier than finals.

I think PBL has made us all obsessed with the basics as well as the clinical medicine, rather than making us despise it in lectures.

[digitalis]

(Original post by GrahamRodney)
I guess you will. I have no axe to grind about this, not having received much of it, but you might be interested to look at http://www.ltsn-01.ac.uk/static/uplo...pbl_report.pdf - A pilot systematic review and meta-analysis on the effectiveness of Problem Based Learning
On behalf of the Campbell Collaboration Systematic Review Group on the effectiveness of Problem Based Learning.

But then again, you might not

Thanks

It's a bit weighty for me to read the day before OSCEs but I have downloaded it to read next week. I have briefly skimmed the inclusion criteria and meta-analysis (I am only really interested in the accumulation of knowledge criteria, the other seem to be very vague and I wonder about their ability to be measured accurately and usefulness) and note the following:

"The general impression of the results of these studies gained from the tables is that they indicate that outcomes for students in the PBL groups were less favourable"

and

"However, the even with this result excluded the confidence interval still does not exclude the possibility of a large negative effect size (d= -1.0)."

[carcinoma]

(Original post by digitalis)
Thanks

It's a bit weighty for me to read the day before OSCEs but I have downloaded it to read next week. I have briefly skimmed the inclusion criteria and meta-analysis (I am only really interested in the accumulation of knowledge criteria, the other seem to be very vague and I wonder about their ability to be measured accurately and usefulness) and note the following:

"The general impression of the results of these studies gained from the tables is that they indicate that outcomes for students in the PBL groups were less favourable"

and

"However, the even with this result excluded the confidence interval still does not exclude the possibility of a large negative effect size (d= -1.0)."

I wouldn't bother reading it, its an 03 paper, which mostly reviews the mild evidence that PBL was implemented based upon.

[GrahamRodney]

(Original post by digitalis)
Thanks

It's a bit weighty for me to read the day before OSCEs but I have downloaded it to read next week. I have briefly skimmed the inclusion criteria and meta-analysis (I am only really interested in the accumulation of knowledge criteria, the other seem to be very vague and I wonder about their ability to be measured accurately and usefulness) and note the following:

"The general impression of the results of these studies gained from the tables is that they indicate that outcomes for students in the PBL groups were less favourable"

and

"However, the even with this result excluded the confidence interval still does not exclude the possibility of a large negative effect size (d= -1.0)."

I agree - its a bit of a mess. However: I can't find the reference, but a mate of mine taught at the University of Newcastle (NSW) where the curriculum is - or was - practically all PBL. Some years after the founding of the School they compared the student's postgraduate progress with traditional school's performance. Not surprisingly there was no difference. For me this means that, with bright kids from a carefully selected gene pool, is does not matter how the hell you teach them, they will do well.

Cynical, or wot?

[GrahamRodney]

(Original post by carcinoma)
I wouldn't bother reading it, its an 03 paper, which mostly reviews the mild evidence that PBL was implemented based upon.

Come on, this technique had been in place at McMaster and Newcastle for many years before that. Its one of the very few systematic reviews on PBL.

[digitalis]

(Original post by GrahamRodney)
I agree - its a bit of a mess. However: I can't find the reference, but a mate of mine taught at the University of Newcastle (NSW) where the curriculum is - or was - practically all PBL. Some years after the founding of the School they compared the student's postgraduate progress with traditional school's performance. Not surprisingly there was no difference. For me this means that, with bright kids from a carefully selected gene pool, is does not matter how the hell you teach them, they will do well.

Cynical, or wot?

Can't unseat me from my cynics spot

I'd like to pick your brains on a topic if I may.

Students doing more on firms. Why don't they? Was discussed on current medics, opinion was that we don't do a lot. Usually an observer on the ward and on clinics etc, curtain pulling or folder holding. Never really assume any patient responsibility, even as an 'acting HO' in fifth year.

Is it resistance from the consultants? Trusts not liking students more involved in patient care? Institutional/just the way it always has been?

[GrahamRodney]

(Original post by digitalis)
Can't unseat me from my cynics spot

I'd like to pick your brains on a topic if I may.

Students doing more on firms. Why don't they? Was discussed on current medics, opinion was that we don't do a lot. Usually an observer on the ward and on clinics etc, curtain pulling or folder holding. Never really assume any patient responsibility, even as an 'acting HO' in fifth year.

Is it resistance from the consultants? Trusts not liking students more involved in patient care? Institutional/just the way it always has been?

No, not the consultants - its the system. I remember being told my my teachers that when they were students they did locums for absent FY1 doctors, and (under supervision) did most of the procedures they did, LPs, lines, even chest drains. I suppose the system now won't allow this even though the supervising individual's insurance, via the Trust, might be thought to cover the student under supervision. I did hear that something was being done to bring this back but have not heard any more recently. In point of fact NHS Indemnity says the following : 'NHS Indemnity applies where students are working under the supervision of NHS employees. This should be made clear in the agreement between the NHS body and the student’s educational body. This will apply to students of all the health care professions and to school students on, for example, work experience placements. Students working in NHS premises, under supervision of medical academic staff employed by universities holding honorary contracts, are also covered. Students who spend time in a primary care setting will only be covered if this is part of an NHS contract. Potential students making preliminary visits and school placements should be adequately supervised and should not become involved in any clinical work. Therefore, no clinical negligence should arise on their part.

In the unlikely event of a school making a negligent choice of work placement for a pupil to work in the NHS, then the school, and not NHS indemnity, should pick up the legal responsibility for the actions of that pupil. The contractual arrangement between the NHS and the school should make this clear'. So, there's no real reason why students should not do more. it just no longer seems to happen and its a shame.

[digitalis]

(Original post by GrahamRodney)
No, not the consultants - its the system. I remember being told my my teachers that when they were students they did locums for absent FY1 doctors, and (under supervision) did most of the procedures they did, LPs, lines, even chest drains. I suppose the system now won't allow this even though the supervising individual's insurance, via the Trust, might be thought to cover the student under supervision. I did hear that something was being done to bring this back but have not heard any more recently. In point of fact NHS Indemnity says the following : 'NHS Indemnity applies where students are working under the supervision of NHS employees. This should be made clear in the agreement between the NHS body and the student’s educational body. This will apply to students of all the health care professions and to school students on, for example, work experience placements. Students working in NHS premises, under supervision of medical academic staff employed by universities holding honorary contracts, are also covered. Students who spend time in a primary care setting will only be covered if this is part of an NHS contract. Potential students making preliminary visits and school placements should be adequately supervised and should not become involved in any clinical work. Therefore, no clinical negligence should arise on their part.

In the unlikely event of a school making a negligent choice of work placement for a pupil to work in the NHS, then the school, and not NHS indemnity, should pick up the legal responsibility for the actions of that pupil. The contractual arrangement between the NHS and the school should make this clear'. So, there's no real reason why students should not do more. it just no longer seems to happen and its a shame.

Interesting. When did you qualify?

[GrahamRodney]

(Original post by digitalis)
Interesting. When did you qualify?

Let's say at a time when Barts and the London was just finding its feet after the merger. That's why I am just a little bit chauvanist on behalf of BL.

[carcinoma]

(Original post by GrahamRodney)
Come on, this technique had been in place at McMaster and Newcastle for many years before that. Its one of the very few systematic reviews on PBL.

This is true, but I think the threshold they set for a positive effect on knowledge acquisitions measures was slightly too high. (as has been said in reviews and letters since that paper)

I think PBL has more benefits than that paper give it credit for.

[carcinoma]

(Original post by digitalis)
Can't unseat me from my cynics spot

I'd like to pick your brains on a topic if I may.

Students doing more on firms. Why don't they? Was discussed on current medics, opinion was that we don't do a lot. Usually an observer on the ward and on clinics etc, curtain pulling or folder holding. Never really assume any patient responsibility, even as an 'acting HO' in fifth year.

Is it resistance from the consultants? Trusts not liking students more involved in patient care? Institutional/just the way it always has been?

I would say that the feel down our way is very different.

Clinical year students on rotations are far more involved within their 'firms' on rotations, and in fifth year for one week in each rotation they take on the role of the FY1.

[digitalis]

Such as what? I'd be interested to hear some examples of what they get up to.

[carcinoma]

(Original post by digitalis)
Such as what? I'd be interested to hear some examples of what they get up to.

Based on the Year 5 rotation info

The student assistantship (professional practice) week is the last week of your 6 weeks block.

• During this week you are expected to act-up as FY1 doctor (FY2 doctor in departments who do not have FY1 doctors).
• Please check with the FY1/FY2 doctor you are shadowing what their duties of the week are
• Keep a log of all clinical skills you carry out during this week

[digitalis]

(Original post by carcinoma)
Based on the Year 5 rotation info

Yeah yeah. We have the same jazz. The reality is very different on the wards.

[OSharp]

(Original post by carcinoma)
Based on the Year 5 rotation info

That is beyond awsome. Really hope this still happens if and when I get to Y5 in Peninsula

[Kinkerz]

(Original post by digitalis)
Yeah yeah. We have the same jazz. The reality is very different on the wards.

I was just about to say this.

My first clinical year has been somewhat of a disappointment. Though the years above do say that it gets better for 4th/5th year.

[digitalis]

(Original post by OSharp)
That is beyond awsome. Really hope this still happens if and when I get to Y5 in Peninsula

Come on. Be serious, if the extent of what medical students do on the ward in every other year is useless clerking of patients, curtain tugging or obs holding (oh, don't forget the 'gift' of occasionally writing in the notes) and the occasional bleed/cannula...

Do you really think a consultant is going to let a medical student who can't prescribe or order anything act up as an SHO? You can't even do the on call!

[carcinoma]

(Original post by digitalis)
Yeah yeah. We have the same jazz. The reality is very different on the wards.

(Original post by Kinkerz)
I was just about to say this.

My first clinical year has been somewhat of a disappointment. Though the years above do say that it gets better for 4th/5th year.

From what I have heard, they actually are given more responsiblity than before.

But ill get actual examples from some 5th years.

[.eXe]

Can any current student from Liverpool please comment on their PBL style? I am having a hard time making a decision between PBL or traditional and would love to hear some first-hand feedback on it.