Wednesday, 23 May 2007

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] 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!


Murk said...

I'll just stick to thanking my lucky stars that I'm going to a traditional course rather than PBL. Nice write up though, I did have a conversation at one of my interviews discussing the pros and cons of PBL with a professor at a non PBL school. The Prof in question was very suspicious of the basic scientific fundamentals of those who'd just come out of a PBL course and much preferred the traditional way.

Cal said...

Oh my goodness, tell me about it. At our medical school, they assigned some completely rubbish tutor to my group who had no idea what 'myxodema' meant - and this was a thyroid case. It was absolutely shocking.

Also, the group dynamic really didn't work that well - I think no one was really motivated enough to do anything serious, myself included.

When we came up with our own learning objectives and assigned them out, I always flat out refused to ever cover any 'social' or 'ethical' or medicolegal waffle, I always chose something science-related, whilst it was the opposite with some other people.

PBL notes just got randomly forwarded around, and no one really cared about it - I compiled them all in a folder and then promptly deleted the entire folder as soon as one case was over.

Personally, I think it was a waste of time...

Merys said...

You see, having been fortunate to have an amazingly motivated group this year, I am really dreading next year. I've heard some shocking horror stories about other groups through the different units, and it really panics me. Our write ups have been clear and easy to revise from, and all the work has been done on time.
Sadly, I reckon my luck is out....
PBHell has its strengths and its weaknesses, yet sadly the bad things mar its reputation.

Harry said...

I'm really curious about PBL, can't wait to find out for myself. I was kinda sick of traditional based lectures in Biomed and hoped I'd have enough of a knowledge-base built up from my BSc to apply to a PBL course. I think I'll benefit more from a PBL course than if i were to sit through lectures with content I'd already covered.