Original post by WangersWe did a small amount of PBL, about 2 sessions. Absolute nightmare. You have medical students, who know sod all, teaching medical students, who know sod all. It can be literally the blind leading the blind. Sure, we had a session after to fill in the gaps, but why not just cut out the middle man and go to the lecture? You know that the lecture will be a) relavent (unlike some PBL material, and b) probably correct (teaching each other can be like chinese whispers when you haven't actually understood something). It is true that the lecture format is one of the worst ways to deliver information - because people sleep or the speed of the lecture is either too quick or slow, but this depends very much on the lecturer - the medical schol does feedback and tends to weed out the less talented ones. The issue is that for undergraduate medical education, you are not expected to know the rareities, but in group work this is what usually pops up - because people like looking up things that are rare, and therefore interesting. Alot of the bread and butter work is largely dull donkey work until you get to a point where you know enough to start using it - there is alot of effort initially for little gain (although this changes in clinical years, you learn things quicker, but there is still alot of time and effort before clinical accumen improves). For me at least, PBL would be ab absolute disaster.
I don't see how it makes anyone into lifelong learners any less than lectures. You still need to learn the lecture material, there is still thought required. My gripe with PBL is that for undergrad med, you need to have a sense of perspective - ie learn more about big common things, less about rare things, and when you start out, you have none of that, I know our sessions arn't in any way representitive, and it dosn't help that faculty don't like PBL. As someone who did pbl once told me 'you waste too much time because you don't know what you're doing'.
I think part of the short-termist view is that at postgrad, there is nobody to force you to study for Membership, you do it because you want to learn and it's your own career. I think part of it (from personal experience) is that in medical school you have no idea how little you know, and when you start realising that, the fear kicks in) This is a different kind of fear to the 'oh **** I have exams fear', this is more like ' oh **** I know so little I'm probably dangerous' fear.
I guess the other point is that 'traditional methods' have turned out doctors for generations, whereas PBL is the new kid on the block. What would be interesting is to do a study on final years, or just starting F1s, and put them through one single exam like the MRCP and see what happens, make them do all of it, regardless of failing parts, and then we might be able to tease out if there are any systemic knowledge or clinical skills differences between schools that are independent from on the job learning and experience. If PBL is just as good, then the results should be indistinguishable from traditional methods, assuming a similar bell distribution of ability across all medical schools.
The problem I see with medical education is that we're getting too much on things like phycological theories of illness (year two friday mornings is a block of psych), which not many people go to, and too little on things that will actually increase clinical accumen. I know what every generation bemoans standards falling, but as one of our consultants pointed out ' you can't communicate with a dead patient'. It's not so much standards falling, but just the increased emphysis towards non medical 'holistic' care. You can afford to be holistic if you're confortable with the medicine, if you have no idea whats going on with this patient in front of you, holisticness isn't going to help. You take in kids that are 18/19/20s - by that age, if they can communicate with people, if they have social skills they will already have them. It is true that communicating with patients is different to having a drink down the pub, but anyone who has done coustomer service will probably be able to adapt.
What would I do? Have some communication stuff, but what would really sort peopel out would be to force them to go on wards and just talk to patients - I would have every medical school link up with the local trusts' staff bank office and offer locum HCA work to medical students. Everyones a winner - students get 'communication skills practice', a well paid flexible job, patients get care, and it's cheaper for the trusts because all the security checks have been done. Simples. And they'll pick things up on the wards too. Thats the way to be more confortable dealing with patients.