PBL (and why all hope is not lost)

My PBL experience in medical school was less than ideal. The factors contributing to this were both internal and external. I found myself often travelling a long way for a very short session, where the expectations place on students were low and the level of excitement - on the part of both teachers and students - was minimal. I found that my own detachment with the process and my own sense of being stretched for time led me to prepare and consolidate less than I should have, and as a result I did not benefit as much as I could have from the sessions.

There is a discussion elaborated in the literature regarding what makes a good PBL session. One element is social and cognitive congruence - that is, the ablility on the part of the tutor to relate to the student and think and communicate at the student level. I can certainly identify times where this was done - at least in part - and where I felt it motivated me to participate more in the discussion. It is suggested in the literature that this state of congruence is a strong predictor of student engagement. There is also a discussion of the role of expertise and how much the tutor should offer. Apparently, offering expertise leads the student to study less and potentially acheive more. It is possible that offering some degree of information may in fact be helpful, at least for very early learners, as establishing a scaffold can direct students to use their reading time in a more efficient manner. This should not, however, undermine the most important aspect of PBL: working through the case.

The biggest issue that worked against me in PBL was the detachment of all parties from the discussion. After all, PBL is about social interaction in the learning environment. It demands that all individuals contribute to the discussion (and it is invariably improved by the presence of snacks). This leads me to consider that rather than emphasizing only the main learning objectives of each case and the task of information finding, PBL could serve as an important opportunity to teach medical students how to get interested: how to engage with a case. I found the moment I began to function in a clinical environment in clerkship I was immediately engaged in information finding, critical thinking, and collaboration. If we push students in PBL to really wrestle with the case, to come up with investigation and management plans, to consider what still needs to be known, and to preempt issues that might arise, we will not only foster more engaging sessions for student and tutor alike, but we increase the level of preparedness of medical students to think around real cases when they enter the clinical environment.

-Sarah