Problem-Based Learning Modules

Problem-Based Learning case studies are divided into four modules, one in each preclinical semester. The first module comprises two sequences of four and six cases respectively. Each of the following three modules comprises three sequences of six to eight cases. On completion of the study of each of these case sequences, an examination, in the style of the medical boards, will be given that will test the students’ knowledge and understanding of the learning issues that they elected to study in association with each case in the sequence.

The PBL cases are based upon real patient cases. The information concerning the patient will be distributed over several pages, which are progressively disclosed to the students, on their request as they work through the case. Initially, the pages covering gender, age, chief complaint, patient history and physical examination are presented one at a time in approximately the same sequence in which the information would become available to the physician. The data provided on subsequent pages of the case will include such information as results of selected laboratory tests and, ultimately, a diagnosis and course of treatment, and are revealed by the facilitator on request from the students.

The PBL Group Tutorial Process

Initially, a PBL case study will require several sessions to complete. At the commencement of a PBL case study, all group members are given the age, gender and chief complaint of the patient. One student plays the role of patient and is given full details of the patient history. Another student plays the role of physician, interviewing the patient to obtain the history, and then obtaining the results of a physical examination from the facilitator. The student group, by now, should have drawn up a range of differential diagnoses — although, before they gain experience, this may be merely a list of affected body systems. They then proceed as a team, to decide what additional information is required in order to understand the patient’s problems, and request various further data from laboratory tests, or diagnostic procedures. The appropriate information is progressively disclosed by the facilitator in response to these requests. This information may be in the form of tabulated data from laboratory tests or, for example, a radiograph or an EKG. (To facilitate this process for the student, supplementary workshops are provided on diagnostic procedures and their applications, interpretation of EKGs and radiological imaging, etc. PBL students also undertake a full course in history taking and physical examination of patients.)

Between the tutorial sessions, students engage in independent study, individually or in groups, addressing the learning issues adopted in the group session. In addition to the required texts, appropriate resources for acquiring this knowledge also include journals, audio-visual materials, the internet, and faculty who may provide further information upon request.

When the group meets for its next tutorial session, one student briefly presents the patient case as one would on hospital rounds. In light of new information brought to the table, the students approach the case again, listing new ideas, and formulating new hypotheses and learning issues, as more case information unfolds. This process is repeated until the definitive diagnosis is reached. In the first semester of the program several meetings may be required to reach diagnosis for a single case. In subsequent semesters this may typically be achieved in two meetings. The student must be mindful that, whilst achieving the definitive diagnosis marks the completion of the case study, this is not the primary purpose of the exercise, which is to employ the case as a vehicle for learning. The broader goals of the PBL modules are to learn and understand the basic medical sciences underlying the cases, and to appreciate their relevance in the clinical situation. Consequently a rapid progression to diagnosis is not to be equated with success.

At the conclusion of each case, a final list of learning issues is agreed upon by the group and is submitted to the PBL administration. The learning issues define the material on which each PBL examination is constructed at the end of each set of PBL cases. The PBL examinations are written in the style of the medical boards, and comprise mostly multiple choice questions, with occasional matching questions.

At the conclusion of each tutorial session, there is a brief round-table wrap-up, when the students indicate what they have found to be valuable in the session, and at the conclusion of each case, students evaluate the case-study experience. On two or three occasions through the study of each of each set of cases, a group oral evaluation occurs, when each member of the group evaluates the performance and contribution of every other member over the course of the whole preceding case.

All faculty members may be consulted outside PBL sessions, and supplementary enhancement is also available, on request to the PBL director, through occasional workshops or enrichment sessions. Orientation workshops are also scheduled early in the program in each of the following areas.

— Laboratory Tests and Diagnostic Procedures

— Immunology

— Interpretation of EKG

— Microbiology

— Pharmacology

Other Coursework

Although approximately 70% of the program is delivered by PBL, it is accepted that some aspects of medical education may require a different or modified approach. Consequently, in addition to some laboratory classes in subjects such as Microbiology and Neuroscience, other courses, such as those in the following list, involve more didactic or directed learning. In some cases they are studied alongside students in the lecture pathway.

— Anatomical Sciences (Gross Anatomy, Embryology and Histology)

— Behavioral Medicine

— Geriatric Medicine

— Healthcare Management

— Human Sexuality

— Introductory Pathology

— Medical Jurisprudence

— Public Health and Preventative Medicine

— Osteopathic Principles and Practice

Yet other topics necessitate more personal, hands-on instruction, or a combination with additional lectures.

— Advanced Cardiac Life Support

— Emergency Medical Support

— History and Physical Examination

— Ophthalmic Examination

— Osteopathic Manipulation

— Sensitive Patient Examination

— Standardized Patients/Skills Laboratory

General Overview

The core of the PBL program is the study of more than 70 clinical cases that occupies most of years one and two. During the first twelve weeks of the program, when the Anatomical Sciences are being studied, student groups meet only once per week for their PBL case-based sessions. After the first twelve weeks, they then meet three times per week through both years up to approximately one month prior to the national administration of the NBOME COMLEX LEVEL 1 Board Examinations. A smaller part of the program is occupied by courses taught by different didactic approaches or more personal “hands-on” methods.