Hell on Earth

Problem Based Learning

Lecture is a pleasant, drowsy picnic where you nod in and out of sleep while listening to the far-away drone of bees and the faint ringing of goat-bells as the local peasant girls herd them to the high alpine pastures.

Problem Based Learning is like being sodomized in prison by a big sweaty guy named Ronaldo who has bad breath and hands the size of dinner plates.

Problem Based Learning (PBL) is a system of medical education where instead of following a rational curriculum that lays out the subjects in which you should be proficient in an organized manner and instructing you accordingly, the lunatics are put in charge of the asylum and it is up to them to figure it all out. Of course it sounds good in theory. Its proponents use phrases like “self directed learning” and “team based approach” to disguise the fact that it was implemented primarily to spare professors the onerous burden of teaching poorly attended lectures.

How does PBL work? Well, first let’s imagine a traditional lecture-based curriculum. In this system, during first and second year you attend lectures Monday through Friday which are organized into discrete subjects like Pathology, Microbiology, Biochemistry, and the various other big medical school topics. Some medical schools mix the order a bit by having their lectures “systems based.” In this scheme the lectures of the standard medical subjects are tailored to the particular organ system that you are studying.

If you are on the cardiology block, for example, you might have lectures on heart pathology or heart-specific medications and their properties. I rather like this system, by the way, even if there are some subjects that need to be taught en bloc and not broken up between different systems.

Microbiology comes to mind.

Whatever the case, in a lecture-based curriculum you will usually have a syllabus with concrete learning objectives stating what you need to know to master the material. The fact that lectures are often poorly attended speaks to a strength of this system, namely that you know what you need to learn and can dispense with the inefficiency of listening to somebody else talk about it when you can read about it on your own.

In a PBL curriculum, you are broken into small groups and the learning happens, so they tell me, through interaction and self-exploration.

I remember my first PBL session (My school had a smattering of it). The facilitator started us off by presenting a case and then asking us for a differential diagnosis.

Blank looks from the group.


You have to understand that at this point, two weeks into first year, the only medical experience most people have is the month they spent working at a homeless shelter passing out condoms, free needles, and empathy. It was at this time that most of us probably realized everything we did or claimed to have done on our AMCAS application wasn’t going to help us a bit.

“Um…I think my grandmother had that,” said one of the more adventurous students, “They said it was her heart valve…or something.”

This comment died a silly, embarrassing death in the general silence that followed.

And that’s how it went until the facilitator, clearly relieved to be absolved of facilitating, started to lecture us on the relevant aspects of the case. I suppose this was better than listening to the crickets chirping but much of what we were told in this and many other PBL sessions was presented without the necessary background in medical science which you’re supposed to learn before getting jiggy with medicine. It’s like asking a group of people who have lived on Ramen noodles since high school to whip up a gourmet meal by consensus. The spirit yearns for Beef Wellington but the mind only knows noodles.

Eventually, I suppose, you get the hang of it. You learn to do a quick google search a couple of hours before the session so you can drop a few buzz words and pretend you care. Or you learn how to surrepititiously surf the internet on your laptop while pretending to be feverishly taking notes.

I also suppose that eventually you can learn a lot in a PBL session but it is so damned inefficient.

First of all, I hate studying in a group. It’s bad enough that a good portion of medical knowledge is incredibly boring without having to suffer through your classmates, all of who have different studying styles, trying to get a handle on it. It’s all I could do to read about some things. Listening to an amateur droning about them made me yearn for an ice pick to the brain. Teamwork is perfectly fine, of course, and I understand that “team” is a talismanic word that invokes all kinds of goodness to it’s believer. But not everything has to be a team effort. I brush my teeth and dress myself almost completely without assistance every morning. I even have been known to read the paper in silence without calling all of my friends to tell me what they think.

Second, because people like to hear themselves talk, the alpha-students will quickly eastablish their dominance and you will eventually here something you probably haven’t heard since third grade:

“That’s true, Jane, but how about letting one of the other students answer?”

But that’s actually all right with me. I was always content to zone out and let the titans fight it out among themselves. Either that or I surreptitiously studied my class notes from which were a lot higher yield.

Some medical schools are all PBL. This must be a living hell. You can’t even skip and study on your own because your absence from a small group will be missed. Some are a mix of PBL and lecture. Some are mostly lecture but like a malignant cancer, PBL (like empathy training) has metastasized to the entire body of medical education.

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