@BlueMum16
What was you going to say about PBL that I can share with him? TIA
Whenever I see TIA I think transient ischaemic attack ("mini-stroke"). I don't want to induce one of those.
The thing about problem-based learning (PBL) is that I think a lot of students are unnecessarily frightened of it. I have met sixth-formers through outreach work who would be brilliant at PBL but have got spooked by the idea that nobody will give them any guidance on what to learn, which absolutely isn't the case.
Two points before I get onto PBL specifically. First, there are no purely problem-based medicine degree programmes in the UK, just as there are no purely lecture-based ones. All programmes use a variety of learning methods, including a combination of whole-year, large-group and small-group activities, and all involve some amount of self-directed learning. There isn't a medicine degree programme where you will just be told everything you need to know and then asked to regurgitate it in exams. (There shouldn't be any degree programmes in any subject that do this, but I have my doubts about a few.)
Secondly, students often find themselves putting medicine degrees under three arbitrary and misleading headings. These are "traditional", "integrated" and "problem-based". These are absolutely useless as headings. To quote the great philosopher Humpty Dumpty, "When I use a word, it means just what I choose it to mean — neither more nor less" (Through the Looking Glass, chapter 6). With the exception of "freedom", there is no word of which this is more true than "integrated". All medicine degrees are integrated in some way. Most are integrated in terms of academic content, i.e. students learn all the various aspects of a body system or disease process together, rather than having separate courses in anatomy, physiology, pathology, etc., and most are integrated in terms of teaching clinical & communication skills alongside other learning so that students' understanding of medical science is applied in clinical contexts and therefore reinforced. There is variation, and some courses have a lot of the first kind of integration and not much of the second, but there is no course that could not be described as integrated. A predominantly lecture-based course and a PBL-heavy course can be equally integrated, and no more or less integrated than one that a student hasn't identified as "lecture-based" or "problem-based".
Coming back to PBL. This is one form of small-group, self-directed learning. There are others but, again, the names universities give to things don't necessarily give you a very clear idea of what they are. The case-based learning (CBL) used at Bristol and Nottingham, for example, is not something that I would recognise as CBL from descriptions in education research journals. But it's learning based on cases, so it's a reasonable term to use. What it actually is is infinitely more important that what it's called, but there's a lot more work involved in finding this out.
Some sixth-formers have the impression that PBL means reading a case, deciding as a group of students what you need to learn to understand it, going out and trying to find the information, then feeding it back to the rest of the group and hoping that you've got it right. In its purest form, that is perhaps a fair description of the process (apart from the word "hoping"); but it's not what happens on medicine degree courses. The tutor does guide groups: they aren't there to teach but they are there to guide, i.e. to ask questions that they think you haven't addressed and to make sure you don't ignore important topics that you need to learn about to understand the case fully. You do have other learning (including lectures <gasp>) going on alongside the PBL which will highlight important areas you should be researching and will, in some cases, answer some of the questions you've set yourselves. And you do have people you can ask if you're not sure whether you've understood something fully or if - as is often the case in anything medical - you've found different sources that give contradictory answers. A very, very major part of medicine is dealing with uncertainty, and it's something you need to work on from the start.
The two huge benefits of PBL (and there are drawbacks, which I'll come back to) are (a) developing team-working skills, which you can't practise medicine safely or effectively without, and (b) knowing from the outset why you need to learn something. Learning something because someone has told you to, perhaps with a vague promise that it will be important some time in the future, is frustrating and pushes people into a passive learning mode where they just try to stuff their memories with things they can recite in an exam. Learning something to answer a question relating to a person's illness or treatment is more gratifying and, because you are doing it for several questions relating to the case simultaneously, is more likely to be retained because you are building up a picture the illness, how it affects people and how it can be managed rather than just memorising things for the sake of it.
Put yourself in the position of a doctor 10 years in the future facing a new patient. That patient isn't going to be carrying a sign saying "I have an acquired metabolic disorder". You are only going to find that out by asking them questions, examining them, looking at their past history, ordering appropriate investigations and interpreting them. All the way through this you will be asking yourselves questions to work out what your observations tell you and what you need to do next. PBL and other self-directed learning methods are designed to develop this skill (or habit, if you prefer).
The drawbacks are not usually to do with whether students miss important topics. They are more often to do with a lack of certainty over the depth in which to learn things. Once you go into a reasonably complex medical question, it's unlikely that you will ever find a complete, unambiguous answer to it. There is always more you can find out, and understanding of most conditions and their management is perpetually changing. You have to work out when to stop because you have so many other things to learn, too. Obviously, some students are lazy and will do the bare minimum. For many, though, the problem is more likely to be anxiety arising from knowing that there is more to find out and not being sure whether what you have is enough. This isn't usually a question that has a simple answer, and students therefore find themselves asking "Will this be in the exam?", which isn't a helpful approach. And, of course, you are dependent on the other students in your group. But you will always be dependent on your colleagues: again, you need to start developing effective ways of working with them from day 1.
So, thinking about sixth-formers, what should they be taking into consideration? If they already engage in some social learning - e.g. forming study groups, sitting down with a friend to work on a homework task or just talking about things they're studying - they are quite likely to find PBL suits them. If they are bored of being taught - i.e. just sitting & listening while someone else talks - they are quite likely to find PBL is more interesting. In my experience, the only students for whom PBL absolutely doesn't work are the ones who want to learn stuff for themselves only, don't want anybody else to benefit from their efforts and don't trust their colleagues. Those aren't really people we think will be effective or happy doctors anyway. Some students who are especially anxious might also find PBL more difficult than more teacher-directed learning methods, but that kind of anxiety really needs to be worked on at the beginning of medical school because it will become a significant problem later on.