Learning Based Problem

The course at my medical school is almost exclusively based around PBL and the question I get asked most often by students applying for medical school is; “What is PBL?” This is also a common question at interviews, in fact, it was one of the questions I was asked 4 years ago when I applied – I think I gave a better answer than I could give now having done it for 3 and a half years.

I thought when I was applying that a PBL course would suit me far better than a more traditional based course. In that respect I think I was right because I usually fall asleep in the few lectures we have, I dread to think how I’d have coped with a lecture based course studying traditional components such as anatomy, physiology, etc, etc.

It wasn’t until I got to medical school that I realised just how different PBL is from the didactic teaching styles I was used to. Even now I’m still unsure if it’s a good or bad way of learning but I can say, sometimes I love it and sometimes I hate it.

In order to get the most out of PBL, one must be very self-motivated, not one of my strongest qualities. This is perhaps why PBL doesn’t suit me quite as much as I thought it would. In fact, I can often be heard moaning about how I hate PBL or that PBL is boring/stupid/a waste of time. Interestingly many of my PBL tutors, usually clinicians of consultant level who supervise our group sessions, tend to agree with me when I throw one of my PBL tantrums about how it’s a stupid way of learning.

Fundamentally I like the concept that is PBL however the reality is, this concept is rarely, if ever, fulfils its true potential. My understanding is that PBL is supposed to stimulate a group learning experience which will be of benefit to us as ‘life long learners’ and improve our ‘communication skills’. These benefits come at a price – in my opinion, at best PBL leaves gaps in our knowledge and at worst (and more often) more like huge craters of emptiness.

The thing I like most about PBL is the freedom to do what you want, when you want. In the last 4 years, I’ve been able to work when I wanted, cover what I wanted/thought was relevant and had the freedom to be my own teacher. The problem with this is that often the temptation to procrastinate overrides me and I end up doing no work at all. It does generally come together at the end of the day though and as yet I’ve had no problem passing my exams [touch wood]. One of the main gaps in my knowledge is anatomy, I know little, if any, but neither does most of the rest of the medical school. We get only a fraction of teaching on anatomy during our pre-clinical years and as a result often look stupid in front of consultants who have now come to understand that its not our fault: its PBL’s fault. Nobody ever knows what we need to learn and in how much detail, I sometimes wish we were just spoon-fed exactly what we need to learn, although I accept this probably wouldn’t make us better doctors.

When done properly, a PBL can be a very stimulating and interesting experience, but in the hundreds of PBL sessions I’ve been to in the last 4 years, the number of really good sessions probably remains in single figures. Most of the time it’s made up of a group of students reading out extracts from textbooks which they’ve copied into their notes. Everyone knows that everyone sat around the table has exactly the same information as everyone else but still they see fit to subject us to reading it aloud, it’s like watching paint dry. Why? That’s not the point of PBL, you’re supposed to have spontaneous, interesting discussion about hard or interesting topics and when you do get the occasional interesting topic I really like PBL but otherwise it’s as boring as fuck. The number of interesting discussions is dependent on the dynamics of the PBL group; this is the single most important factor in determining the usefulness of PBL.

So… is PBL a good or bad thing overall? I think it probably depends on what type of person you are. Personally I wouldn’t have it any other way as I’m sure I’d hate a traditional based course, however I do often hate PBL, usually when I’m in an awful group. There will be gaps in my knowledge which may yet hinder my career but at least I’ll be well placed for ‘life long learning’. Will it make me a better doctor? I don't know, i'll tell you in a few years, if I make it that far!