Problem Based Learning aka DIY Medicine.

I've been promising a post on Problem Based Learning (PBL) for a while now. A few people in particular have emailed me to ask about it, and medical school in general (Unfortunately I think I've terrified at least 3 people who might be coming to my medical school - oops.)

I wrote about PBL before...early in my blogging days in a post titled Learning Based Problem. Due to my developing interest in medical education, I approached the Dean to see if I could do a 3 week SSC on PBL. Fortunately he agreed and I spent most of the 3 weeks in bed reading various books and journals. It was a fairly relaxing SSC (although that's not the reason I requested to be allowed to do it!) but it was really rather interesting (I realise it probably makes me quite sad but I quite enjoyed reading about learning theory and the evidence behind PBL.) My 4500 word write up, again under the title Learning Based Problem was in the end quite good, although I didn't feel it really summarised my thoughts very well.

Despite having experienced 4 years of PBL, whenever anyone asks what I think of it I’m never quite sure what to say. Fundamentally I can see what the concept of PBL has to offer and I think the theory which supports PBL is sound; however most of the time, in practice, I don’t think PBL works. A successful PBL experience is dependent on too many variables which are rarely all fulfilled at the same time and as a result the process falls down, for example, a poor group dynamic or ineffective tutor can almost instantly render the whole process useless.

One important question is what are the most important qualities a doctor should posses? The GMC’s answer to that (Tomorrow's Doctors) is that more emphasis should be placed on the acquisition of general competencies rather than retention of facts. To a certain extent I agree but it is also important that doctors have the knowledge as well as general competency to be a successful doctor.

The evidence behind PBL is rather muddled, there is evidence to suggest it has benefits and weaknesses. Little has been done to compare PBL directly with more traditional courses due to the difficulties in assessing students from different courses. PBL is based on educational various educational theories. (I can't be bothered to go into this here. If you're really interested email me at imamedicalstudentgetmeoutofhere[AT]hotmail.co.uk and I'll send you a copy of my SSC.) In summary; the evidence that is available tends to suggest that PBL students have less basic science knowledge but have better clinical knowledge and basic competencies such as communication skills and team work. The latter could be explained by the fact that PBL curricula tend to have more communication skills teaching, Rather than attributing the improvement on PBL alone.

PBL is here to stay for the foreseeable future, and until someone devises an appropriate method of comparing students from both types of course the evidence base behind PBL will remain somewhat vague.

PBL does stimulate curiosity but in order to learn one must be very motivated all of the time, this is a hard concept to grasp when one is used to didactic teaching methods. PBL seems to have been taken up with some enthusiasm; however one of the main reasons for its failure in my opinion is that after the initial effort and outlay, some courses seem to be neglected, without constant update and maintenance the curriculum becomes neglected and ineffective.

In my opinion the benefits of PBL do not justify the resources required to implement such a drastic change in the curriculum. I do believe that both PBL and traditional methods of medical education have something to offer, but perhaps a combination of the two or even an entirely new approach to medical education would be best.

To be honest, I really dislike PBL. I enjoyed it in my first year (even though I had no idea what I was doing then) because it worked. Now it has just become a waste of my time, i'd be better off spending 2 hours reading a book than engaging in the pointless task that is PBL. After all, it is do it yourself medicine. Even most of my tutors are unsure about it, so what chance do we have? Saying that, I do like the freedom a PBL course gives you to learn what you want, when you want. I would have hated a completely traditional course.

Meh...that was just a muddled rant. I can never really explain PBL very well. Oh well, I hope some of you found it useful. I should just go back to moaning!

(mis)communication skills

The Little Medic was practising a respiratory and cardiac exam on me. I have drawn a picture to show the misunderstanding:

Thank You

I just wanted to say a quick thank you to those who've read and commented on my blog. Particularly on my last post, and other equally challenging posts. It is reassuring and refreshing to read comments sympathising with me, and equally as interesting to read comments which challenge my thoughts.

My last post seemed to generate a recurring theme that the same kind of things happen elsewhere. Which is reassuring I suppose, although perhaps I'll never be free from this kind of thing? Another message was that people are human and make mistakes, this is true, and I would never blame individuals. It is the institution as a whole which I blame, I've been saying since the end of my first year here that I no longer had any faith in my university. I've been lied to, ignored, and threatened by my medical school in the last 3-4 years, not once have I been offered help, or an apology. I wish I didn't have to rely on them for my degree, and it makes me rather sad to think like that.

I'm fairly sure that people from my medical school read my blog, perhaps some of the university staff do. They probably don't like it and right now I sit here considering getting rid of my blog altogether. Many of us bloggers seem to be rather paranoid about being disciplined because of our rants, perhaps I should be paranoid more than others due to the critical nature of some of my posts.

Anyway, I just wanted to say thanks to my 10,000+ visitors (9990 of which is probably me.) I hope you enjoy reading, and I hope you continue to enjoy it until the time comes when my paranoia gets the better of me and I hit that big red delete button!

POo Time Of Year.

Every other medical student I know seems to be finishing off exams and coming towards the end of term and a lovely long summer holiday. Me? I wish, for the next 10 or so weeks all the fourth year's have to complete a 'Project Option' (PO - hence the title, witty eh?), this can be either research, an audit or something else. I decided to do mine on orthopaedics but 3 days in I'm still not really sure what on Earth I'm doing. I don't even know if its research or an audit, it feels like a mix of the two. Anyway I've got a huge spreadsheet with lots of names and data, but what am I supposed to do with it? It doesn't tell me much. I need to fill in lots of gaps before I can even start to think about what I can do with it.

I've got to wait till the end of lunch time until I can go an pester my consultant's secretary for help. Then, hopefully I'll have even more things to put into my huge spreadsheet. Yippee!

Oh yeah, there is the small matter of 10,000 words and a presentation at the end of it.

I'm starting to get a bit stressed with things
a) No hot water
b) Broken Laptop (New HD on its way...) (13 months after I got it, honestly its like the HD had a little bomb inside just waiting for the warranty to expire)
c) Not really having a clue what I'm doing
d) OSCE results on friday
e) arghhhhhhhhhhhhhhhhhhh....

I need a good rant to relax myself a bit, suggestions please...

(wooo lunchtime is over... time to go and harass people)
(6 Consecutive Days of blogging? What is wrong with me!)

Somebody call 999! (disclaimer: don't really)

Laptop - Time of death 21:20

At 20:30 my laptop suffered an attack of the blue screen of death.

This, normally minor ailment, became serious when during resuscitation "No Operating System [was] Found"

At 20:49 a successful resuscitation attempt allowed me to clone the laptop's mind (aka backed-up most of my data)

Several more arrests occurred and I can unfortunately now announce that my Hard Drive has died.

RIP.

I'm actually quite looking forward to spending 3 months without technology now. Stupid, useless, fucking piece of annoying of annoyingness!

Testing times....(NO MORE EXAMS TILL FINALS! - HOPEFULLY)

Well that's it, 4th year exams over and done with! Perhaps option d) wasn't the best option, Today's exam was atrocious, and it wasn't because I'd done too little work. The university say we should only do about 6 hours work before the exam.

The first time went through the paper, I answered the ones I was sure about, when I looked at my answer sheet, it was a mass of emptyness. I hated almost every single one of the 125 stupid questions.

Many of the questions are stupid and vague such as this one:

A 20 year old girl is admitted to hospital and undergoes an appendectomy. 3 Days later she finds out that she has miscarried her 11 week pregnancy which she did not previously declare. She has asked to speak to a doctor because she believes she lost the pregnancy as a result of the operation and would like to make a complaint. You are the house officer, do you:

a) Listen sympathetically and then tell her that the operation caused the miscarriage
b) Listen sympathetically and then call your consultant to speak to her
c) Listen sympathetically and then explain the fact that she had previously not disclosed the pregnancy
d) Listen sympathetically and then say that the anaesthetic caused the miscarriage
e) Listen sympathetically and then tell her that the operation and the miscarriage were not linked.

(these are not the exact answers as I forgot them but they're along these lines)

It is obviously not a, d or e, but it could feasibly, in my opinion, be b or c, I went with c, but I'm not sure it's right. It is an unfair exam in my opinion as many of the questions have two possible answers. (Don't even get me started on the questions about the 'best immediate management')

Anyway its over and done with now, results in a month. OSCE results this Friday, if I've passed both, no more exams till finals! Otherwise - resits next year...I'll keep you posted.

MCQ for You

The day before an MCQ exam, having done little work so far, which of the following should you do?

a) Read over as many notes as you can. (Well I don't make any notes so that's option a out)
b) Read "Medicine at a Glance" in the vague hope that you'll absorb the words intradermally as you turn the pages.
c) Spend the day doing practice questions. (I've already done the ones I've got about 5 times)
d) Forget about the exam by going to the cinema, gobbling roast dinner, then proceeding to watch two thirds of the Die Hard trilogy.

Answers here please

BLOODY PIGEONS!

I hate them, they are evil personified (or pigeonified,) what purpose do they serve? I can hear them right now, cooing evilness sat in my fucking ceiling. I usually slow down when they get in my way when I'm parking my car but in future I'm going to speed up squash the little monsters.

Yet again we've got no hot water, why? Because of those stupid, disgusting, waste of space little freaks living in our flue! The plumber is going to have to come and sort it out, hopefully good and proper this time by blocking them in. MWAHAHAHAH!!!

I've finally finished my SSC project on medical education (Obviously in true last minute style I was up till 3am the night before it was due.) I wasn't particularly happy with my final report. It didn't quite summarise my thoughts or all the stuff i've read. I was able to conclude that PBL doesn't work so I was happy about that (I'll write more about that tomorrow)

I've got an exam on monday :( I'd almost completely forgotten about it and i've done precisely NO work for it. I think I've written about it before 120+ multiple choice questions aka the Progress Test! Problem is there is no way i'm going to do as well as I did last time so it's going to be a case of backwards progress...if thats possible. After that I've got an 11 week orthopaedic research project to do which should be interesting and relatively easy once I get my head around statistics.

Elective Update: Its is booked and paid for!!! at last!
Departing the 30th of July for exactly 80 days of round the world fun and frivolity!
UK -> Bangkok -> Sydney -> Fiji -> Honiara -> Lata Hospital -> Honiara -> Fiji -> Los Angeles -> UK!

And Now.....The Moment You've All Been Waiting For:

I told you in my last post that I had an "announcement to shock the world", whilst it might not quite be in the world shocker that I promised, it's still rather important!

Have you guessed what it is yet? The Angry Medic and HospitalPhoenix have speculated in the comments section of my previous post and they weren't far off the mark.

You might be surprised to hear that the main reason for our trip to Cambridge wasn't to stalk The Angry Medic (sorry Angry...) It was to return to the point where missbliss and I had our first date. Come on...surely you can see where this is going now.

And so...the announcement!

***

missbliss and I are engaged!

***

I'll leave it to missbliss to tell you the nitty gritty...

p.s. - Well done Angry, your guess was right.

p.p.s - My SSC write-up is going exceedingly slow.

p.p.p.s - It is amazing how fast news travels in todays world, I blame Facebook.

Coming soon to a blog near you...

It has been an eventful weekend (more on that in a future update, including an announcement which might just shock the world)

We've been stalking The Angry Medic in Cambridge this weekend. See if you can spot him in this picture below*:

Anyway I have 4-5000 words to write this evening as a draft of my SSC report on medical education. At least I've actually done some work on it up to now which is a change and I've actually written a plan! (OMHFG!) Why oh why do I always leave these things till the last minute?

Watch this space; this week as I'll be revealing:

• That big announcement to shock the world
• More secret photos of The Angry Medic (mwahaha)**
• My thoughts on medical education
• My plan for world domination
• The secret to eternal life
• And much, much more....

*goes off to write essay, I forsee a late, or even all-nighter!*

(*The Angry Medic is not actually in this picture - as far as I know, I just wanted to see how many of you I could fool into looking for him. Don't hate me for being evil...)

(**This is also a lie, I didn't take any sneaky photos of him)

May 2007 - The most expensive month of my life (so far)

Car service and MOT = £150 (got to be done I suppose, don't want to crash)
Car Tax = £110 (Stupid tax man!)
Car Insurance = £700 (Yes, I'm a boy, I'm 21 and I live in big, crime-ridden city)
Petrol = £160 (Don't ask...)
Elective Flights = £1300 (Round the world in 80 days (well 78 to be precise))
Other Elective Stuff = £400 (If you're going to do it, you may as well do it properly!)
Rent = £237.50 (I'm proud of our pokey little hole)
Bills = £72.50 (I need my phone and the net to keep blogging!)
TOTAL = £3130 (And that's excluding food and luxuries....bread and water it is then)

Elective Update: Currently the plan is as follows;-
July - UK -> Bangkok -> Sydney -> New Zealand -> Fiji -> Honiara (Solomon Islands) -> Lata Hospital (7 weeks of doctor-ness) -> Honiara -> Fiji -> Los Angeles -> UK - October

"Wow!...so...Where the hell are they?"

It is about time I announced my plans for summer to my plethora of readers (or more likely, those few of you who bother to read my rantings.)

Those of you who are medical students or doctors will be aware that most medical schools have an elective period whereby you are given the chance to go anywhere in the world for a while and either a)learn about a new aspect of medicine or b)have a bloody great holiday and not do a lot.

So....where did I decide to go? Well, originally I had my heart set on Canada, or maybe Australia, or how about joining Dr House's team in the USA! One of my friends arranged hers in East Timor, the day after she arranged it, they broke out in civil war! (they must have heard she was coming.) Others picked Africa, South America, India, Australia and even Micronesia (wherever the hell that is...it sounds more like a disease of the knee than an actual place)

Not to be outdone I decided on one of the remotest places on Earth - in fact, It may as well be on the Moon! (Dammit, I should have applied to NASA!) Have you guessed where it is yet? Most people have never even heard of them, hence the title of the post, which is the usual reaction whenever I tell anyone.

As of August, missbliss and I will be jetting off around the world for a 3 month extravaganza! A month or so of travelling before I begin my elective and missbliss puts her English teaching skills to good use.

I'm going to be spending about 7 weeks pretending to be a doctor, here:


1 senior doctor, 4 wards, 40 beds, and not a CT or MRI in sight! This ladies and gentlemen is Lata Hospital, situated on one of the Santa Cruz Islands located in the Temotu Province of the Solomon Islands! (see map of South Pacific below)

So, there we go, now you know! It is going to be an experience that's for sure, I'm sure you'll be hearing much more about it before I go as I blog about our preparations for departure. Who knows, I might even be able to keep you updated whilst we're there. Although I wouldn't hold your breath, their Internet is powered by crabs.

One more picture just to show how beautiful it really is:

Watch this space...