I like PBL

I feel it's about time I had my say about PBL. There has recently been a survey showing that graduates from a PBL medical course are more likely to fail their membership exams (specifically RCGP). Although I can't argue the stats, I can't help but feel that PBL is what you make of it, and for me, I wouldn't have done medicine any other way.

For anyone unfamiliar with the concept of PBL, or problem-based learning, the idea is this- as a group you are presented with a 'case', which is a story detailing the symptoms, investigations and treatments of a patient passing through the healthcare service. These cases are based on the 200 most common clinical conditions, and include hints towards various important medical and non-medical 'cues' to guide us to cover the syllabus. As a group, we would dissect the case and form a list of learning objectives for the week, in order to better understand the problem in hand. For example, a case involving a man presenting with severe indigestion who had an endoscopy and was treated with antibiotics and omeprazole and was a heavy drinker may translate to learning about the anatomy of the stomach, physiology of gastric secretions, ulcer formation, investigation and treatment of ulcers, and alcoholism. Over the course of the following week there will be some lectures/seminars related to these points, there will be time for us to research on our own, and ward time to take histories from patients suffering with similar conditions. We may go to the endoscopy suite and see examples. Perhaps there would be chance to go into theatre and see emergency ulcer repairs. Using this method over the 5 years means we cover all major clinical conditions, their presenting features and how to treat them. We are expected to read around the topic each week and discover the less common presentations or variations. At the end of the week we come together as a group and discuss our findings, ensuring every member of the group understands the main concepts by teaching each other, and sharing ward experience relevant to the case.

This system doesn't work for everyone. Some people want to be spoon fed. Some people can only learn by spending hours with their head in a book and copying out notes. I'm lucky. I learn by discussion, by teaching others and by practical methods. If you stick me in a lecture theatre my mind wanders within a few minutes and I take in the first 1o and last 5 minutes. I accept that the syllabus is often unclear with our PBL course, but I don't expect to be told what's going to be on the exam- as a doctor I will need to have a grounding in everything and an appreciation of the fact that common things occur commonly- I think my course gives me the opportunity to do well in the real world.

My science background is less solid than that of the St Andrews students. My anatomy is not up to scratch. However I understand concepts, I see how drugs work and I am still learning and willing to work on it. Anatomy was not badly taught at Manchester, the demonstrators were fantastic teachers, but it was rarely examined and come exam time psychology took preference to tactically boost your grade. I have fantastic notes on it to go back to whenever I need. And besides, I have no intention of doing surgery.

Manchester doesn't aim to produce research scientists. It aims to produce doctors that are competent, aware of their limits, capable of finding the information they need quickly, and caring. I don't see what's wrong with that.