Problem Based Learning is a bit like Marmite – you either love it or hate it. When applying to medical school, many applicants discriminate their choices based on things like grade requirements, extra-curricular requirements, entry test requirements and so on. Some lucky applicants (or those applicants who have applied unwisely) are in the position to further narrow their search if they meet all of the entry requirements – they can now, for example, decide on things like the city, student life and course. The last option here is key – the course.
Medical courses tend to be either lecture based, problem-based or a bit of a combination of the two (which is what mine is). Many medical schools have thrown out names like case-based learning but, from having a read of what they entail, they just seem like fancy names for problem-based learning (PBL) as a way of attracting applicants to their medical school.
Having experienced both at my medical school (admittedly, my medical school is very heavily lecture based with just the odd PBL session thrown in here and there), I have decided that I really don’t like PBL as a teaching mechanism. This isn’t to say that it’s a bad method for everyone and indeed, many medical students do love it. Nor do I wish to diss any fellow medical students or doctors who learnt via PBL, for they are not any less competent.
How exactly does PBL work?
Before I explain my feelings for PBL, let me provide a quick outline of how it works.
We’re all in groups of about 10 at my medical school. Although PBL is very much student-led, there is a facilitator in each session who is meant to make sure that the group stays on topic and gives a few hints here and there if he/she feels we need it. The very first thing that we all have to do is decide on a chairperson and a scribe. Both titles are self explanatory really, with the chairperson being in charge of the session and the scribe jotting down all thoughts on the board.
Once that is done, a case is given to us. The case tends to be a clinical case, with a patient coming in with various signs and symptoms and the results of his investigations. The case is then discussed, with the group picking out words/phrases from the case that they don’t understand. Eventually, learning objectives are formed on the basis of what is not understood and it is decided which group member(s) will research each learning objective. The session then ends.
In the time period between this session and the next, each group member researches their learning objective and makes some sort of presentation. In the next session, the group member presents their findings to the rest of the group and questions are asked. The case is then concluded.
Good things about PBL
There are definitely good things that can be gained out of PBL. You can just have a quick read of what PBL entails without even experiencing it and manage to come up with some advantages. You don’t need to experience it to come up with these.
The very first good thing, and perhaps most obvious, is that PBL gives everyone an opportunity to work together in a group. Teamwork is always banged on about as being a very important part of healthcare, and so introducing the concept of working together in a way such as this early could be argued to be beneficial. It is also a good way to break the ice between everyone in the first few weeks of medical school where no one knows each other. It almost forces us to get to know each other, and allows us to make friends early.
Otherwise, it also allows each member to really become an expert on their learning objective that they’ve been asked to research. Each member, perhaps to save embarrassment when presenting, often feels as though they have a sense of responsibility to adequately cover their learning objective and so they go out and research it extensively. I remember, for example, a question that came up in one of my exams last year. It was a question asking about sickle cell anaemia and…it was the question I was asked to research for a PBL session. It became an easy 5 marks.
In my opinion, however, the advantages are very small. I far prefer lecture based learning. I’m not trying to suggest that lecture based learning is perfect either, for it very much depends on a number of factors too. But that’s a whole other story. Here’s what I dislike about PBL.
1) It’s essentially using Google and Wikipedia to self-teach yourself Medicine
This is the bottom line of PBL.
We are all told of the importance of resources when carrying out research, and so are told to search for things like journal articles. In reality though? Journal articles are extremely long and it is highly unlikely that a medical student will spend literally 3o minutes reading and analysing one article (no exaggeration on the time – if anything, it’s perhaps a lower than average time) to present it for a PBL session. Instead, they will just Google it and just put down what is said on Wikipedia. The task can be completed quickly that way, and other medical school tasks that need to be done can be completed.
It’s rather funny – we are essentially paying £9000 a year to use Google to learn.
(Well, I am scare-mongering a little. The repayment system for tuition fees is a fair system in my view, and you could just as easily argue that there is a lot of self-teaching involved in lecture based learning too).
2) There is no way to tell if what you are being taught is ‘correct’ or not
As said above, many medical students will not go to journal articles to get their sources of information. This can lead to us using resources that provide false information, and so it is very easy for misconceptions to set in. Even if we do use journal articles, there is often conflicting evidence there too to confuse a medical student with limited pre-clinical knowledge.
Some may wonder why the facilitator of each session can’t prevent this from happening. In my experiences, the facilitator is usually someone who – whilst very clever in their own field – don’t necessarily understand fully the field that the case is based on. I remember having a facilitator recently, for example, who wasn’t aware that normal blood pressure is 120/80. This is not to say that he wasn’t clever: he was very talented in his own field of research, but things like clinical medicine were of little importance or relevance to him.
3) You become an expert on your own learning objective but know nothing about the others
In my experiences, the aim of everyone in PBL was to try to get the sessions finished as soon as possible. As a result, we all tended to zone out when other people were giving their presentations. If we hadn’t already given our presentation already either, we tended to simply be going over what we were about to say in our heads instead of listening. The net result?
Knowing a good deal about one topic – assuming, of course, that the sources used were reliable – and knowing next to nothing about the others.
Having written all of this, I would like to say that I am still glad that we have a small element of PBL in our course. That way, we can gain some of the positive advantages of having PBL in the limited number of sessions that we have, and limit the negativity as most of the teaching is done in a lecture based manner.
Of course, many people will have differing opinions or counter-arguments to what I have said. This is a good thing, for it demonstrated that whatever medical school you get to, you will likely end up adapting to the course style there and think that it’s the best style ever. It also means that you will become a doctor no matter which medical school you end up at.