Problem-based Learning (PBL) is a systematic approach to learning which integrates basic science principles with sound medical practices to solve patient problems, that is, treat the patient and cure the disease based on principles learned in the first 4 semesters of medical school.
In working through the patient problems, students will employ the basic science curriculum in a new light in order to review and better understand the anatomy, biochemistry, mechanisms of diseases, epidemiology and biostatistics involved with the cellular biology, physiology, pathology, pharmacology of treatment and possible surgical intervention needed for one to be an expert physician.
The purpose of this approach is NOT necessarily to solve the patient’s problems but to reencounter and relearn the basic sciences from a new viewpoint that is needed for the practice of medicine.
Almost every American medical school uses some form of PBL and curriculum experts see its inherent value on a number of levels;
- Since USMLE questions are more contextual than rote memory recall of facts, this type of curriculum better prepares the students for the exam and its successful completion, a prerequisite for entrance into the clerkships at US teaching hospitals. Many schools in the Caribbean do not offer this enhanced PBL curriculum because they do not have a faculty member or dean who is trained in this particular philosophy of medical education;
- Hospital Medical Education Directors recognize PBL as similar to American curricula and they are more comfortable offering rotations to Caribbean students who have experienced this curriculum. Students are able to respond to attending physician’s questions better than those students with a traditional curriculum resembling an undergraduate disciple oriented curriculum heavy on scope and sequence;
- PBL increases interpersonal skills and interview comfort, the sine qua non of residency selection;
- Students immerse in one system at any given time and encounter that system’s multiple diseases, their differences and similarities.
Because many systems overlap, for example, cardiac and respiratory, they may be included in a disease section. Heart failure, a common problem in every nation is a multi-system disease and should be approached that way to facilitate learning.
During a PBL session students generate a list of possible patient diagnoses based on presenting symptoms. A history and physical (role playing by students as physician and patient) are performed before any diagnostic tests can be ordered. This prevents a shotgun approach to diagnosis and trains the student to eliminate costly unnecessary diagnostic tests.
During the diagnostic process the list of differentials is whittled down. Based on all information gleaned, a possible diagnosis is made, ways of confirming the diagnosis are suggested, treatment recommended, the patient’s response evaluated and new approaches synthesized when needed.
Each patient case comes in multiple pages and pertinent tests are offered to the student. For example, an MRI may be given to students to attempt to interpret. When students reach a sticking point they adjourn for the day, research possible learning issues and return for the next meeting after trying to resolve their own knowledge disequilibrium and nagging uncertainties about the case. Each session typically lasts between 2 and 3 hours.