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!