The Problem Based Learning F.A.Q. by Richie Truxillo 1. What is Problem Based Learning (PBL)?
Problem Based Learning is a new medical school curriculum with emphasis on active, self-directed learning. In PBL, the student learns the foundations of medicine through simulated patient cases.
2. How does PBL work?
In problem based learning, students are broken up into small groups of 5 to 8 students for a given block. In these small groups, students are given roles such as "Doctor", "Patient" and "Scribe." Following the selection of roles for a given case, the students conduct a simulated patient interview using an pre-made history script. Following the history, the group develops a list of differential diagnoses on the whiteboard from the patient history. Following generation of this list, the students are then given the simulated patient's physical exam findings. Again, the group brainstorms more differential Diagnoses and refines their current ones. After refining their differentials again, the group starts a list of "Learning Issues" on another part of the whiteboard. "Learning Issues" are topics or questions that the group does not know the answer to. The development of "Learning Issues" is the key part of PBL since it generates the direction for students to study for that given case. At the end of placing all learning issues on the whiteboard, the group begins brainstorming what tests to order to further rule in or rule out a differential diagnosis. The "doctor" is in charge of ordering tests but the group is required to know the rationale for ordering a test. Once a test is ordered, the group must wait till the next session to receive their test results. This gives the group to time to research their current learning issues. At the end of every group, there is a "Wrap Up" time where students are given an uninterrupted minute or two to express their feelings on the session. Upon the end of the wrap up the session ends and all students are required to go research their generated "Learning Issues." Upon entering the next PBL session, all group members will discuss what they learned as a group and will help each other understand how the information fits together and relate it to the patient. Therefore, the goal of PBL is not to "solve" each case but rather to learn as much from each case as possible.
3. How is PBL moderated and why?
Since Problem Based Learning is a group-directed and self directed form of learning, there must occasionally be a refocusing of of the group when they get off of track from the case. In most PBL groups, there are 2 "Facilitators" sitting in during the discussion. Usually one of them is a clinician (MD or DO) and the other is a professor (PhD). Their role is not to teach during the session but only to guide the group when the discussion gets too far off track. In some programs, they also serve as graders in the sense that you are graded subjectively on your interactions and contribution to the group dynamic.
4. How is grading accomplished in Problem Based Learning?
A majority of PBL programs are pass/fail but a handful of them are numerically graded. Usually a group is individually tested on a master list of "Learning Issues" that they turn in during a 10 week block. Tests in the first year are often essay-based, requiring the student to not only memorize knowledge, but be able to utilize it and articulate it on paper to the grader.
In the second year, most programs will switch to multiple-choice exams in order to prepare their students for the Step 1 USMLE or COMLEX. Their is an advantage and disadvantage to both formats. For example, essay exams require the student to really think through the knowledge being asked, with the drawback being the inability to "Fake it till you make it." Multiple Choice exams require less time to create but often times questions are drawn from professors' master question banks to save time. This can create a mismatch between a group's learning issue and the knowledge being tested.
There is usually a 2nd component to a student's grading in PBL. At the end of each 10 week block, each group member is brought in for an "Evaluation" of his/her performance in the PBL group. The evaluators are asked to rate a student in various categories like "Professionalism" or "Critical Thinking Ability." This is a subjective grading plan but often helps a student's grade if the student actively participates cooperatively in group.
5. What type of student is best for PBL
First and foremost, an extremely self-motivated student is best for PBL. Since PBL requires a great deal of self-study, one must be able to commit to studying without the threat of an impending test found in traditional, lecture-based cirriculums. The ideal student will also be an excellent critical thinker who asks many questions and knows how to seek out his own answers. PBL requires seamless cross-disciplinary linkage between basic science material. You'll be relying on your group mates or your own knowledge to do this.
One must also be able to work cooperatively with others, regardless of their background. You'll be in a diverse group of individuals who have different work experiences, levels of maturity, and strengths. The student who excels at PBL will be able to both contribute his or her strengths to the group while drawing upon his groupmates to help augment his or her weaknesses.
Finally, older, non-traditional applicants with previous clinical experience seem to do well in PBL do to their work ethic and maturity level. These people generally have previous medical experience. We had a physician assistant in our class and he was a great fit for the program as we were able to both draw upon his knowledge and learn the "real" aspects of medicine.
6. What type of students are a poor fit for PBL?
Students who require constant direction for learning:
Let's face it. All of us went to college and have mastered the art of memorizing a bulleted list of material or a powerpoint presentation. If you need a list of topics that are guaranteed to be on next week's test or on boards, you need to stick with the traditional lecture-based curriculum. PBL places less emphasis on memorization and more emphasis on understanding material through discovery. A student who is uncomfortable with having little to no direction from faculty will go insane in a PBL group.
Gunners
A gunner is defined as someone who will do anything to get the highest grade possible at the expensive of his or her classmates. PBL is about group corporation. If you are a gunner, you won't fit well into a PBL setting. First off, you will be absolutely loathed by your current group members which will throw the entire group's learning off. In addition, having a subjective component of your grading will often times work against you as you are seen as "Disruptive" to the group dynamic. Finally, you won't have the comfort of having a definitive list of topics to study for a test. There are usually no old tests to draw upon either so everything is up in the air.
Overly shy individuals
Just like in your 3rd and 4th year, you'll be required to constantly give input during group sessions. Oftentimes, you'll be asked to explain a concept to your fellow group members. This requires excellent communication skills and the ability to effectively articulate your information to the group. If you are looking to hide in the back of the room and "soak in your information" without being noticed, this is the wrong curriculum. Is that to say shy people should not apply? No. Just be ready to shed your shyness really really fast.
If you feel you are self-motivated and ready for a challenge, go ahead and utilize PBL for medical school! You'll have more free-time to study and have a life outside of classes as long as you utilize your time wisely.
