Set aside those visions of medical students furiously taking notes as a professor gives an in-depth lecture on the biology and chemistry of the human body. This will not be the educational experience for students at the UNLV School of Medicine. Instead, students will learn by playing the role of doctors.
Imagine for a moment that your first patient is 32-year-old Susan Morris. Three friends accompanying Morris say she is there because they noticed scratches and burns on her hands and arms for the past month. The sores don’t bother Morris — they just “appear” while she works in a restaurant, she says. On exam, she has three deep burns on her right fingers, and several ulcers and scars on her left forearm.
As one the UNLV School of Medicine’s students, you’ll work in a small group to treat Morris as a “paper” study. You must identify Morris’ condition and treatment. You now need to determine what you know and what more you need to know; where you might find the additional information needed; and then dig into the appropriate resources to find it. As you dig deeper, your group will learn a lot about Morris’ specific problem and possible treatment. You also will learn how the human body works, the basic chemistry and biology that underlie those processes, what might go wrong, and why.
This process of collaborative learning through group discussion, investigation, and research is called problem-based learning (PBL). The general approach is as old as the first time a teacher recognized students learn best when they solve a problem or work on a project. Remember how your learned United States geography in grade school by making a map? PBL was adapted to medical school training as a better alternative to the standard lecture approach, which often left future doctors disenchanted by rote memorization of facts.
One of the earliest proponents of PBL in medical school curricula is Dr. Barbara Atkinson, founding dean of the UNLV School of Medicine. She first implemented the approach in 1990 at the Medical College of Pennsylvania, now known as the Drexel College of Medicine.
PBL will be the primary approach used in teaching students during their first 18 months of medical training at the UNLV School of Medicine. A significant part of this “Phase 1” education is learning the basic science associated with medicine, such as biochemistry and physiology, the various organ systems of the body, and the diseases affecting those systems.
The PBL approach also teaches students important collaboration and teamwork skills. Dr. Stephen Dahlem, the school’s director of case-based learning, notes that medicine is a social discipline. “You’re constantly dealing with people — patients, family, other care providers, and colleagues at other schools — so learning how to make and maintain these relationships is important to a successful medical career.”
Rather than delivering lectures, faculty members act as “guides," pointing students in the right direction. Each group of students has their own faculty guide, who is responsible for ensuring students meet necessary learning objectives. In the Morris case study, a faculty guide might suggest starting with the question “Why does Susan say she doesn’t feel pain from the wounds?”
The students then might come up with a preliminary list of questions to address: How do people feel pain? How do pain sensation nerves work, and what is their pathway to the brain? What are common abnormalities that can cause people to lose feeling in their arms?
Dahlem notes the faculty guide’s role is to keep the group on task, to push the students’ thinking and analysis when needed, and to quietly observe when the students are performing well on their own. For instance, if the students identify “burns and ulcers” as the problem, the guide could say, “True, they are a problem but why did they happen? She might have held a hot pan or plate but why did she hold it, and not immediately drop it? Why do people drop something extremely hot before they even think about it?”
The PBL approach is iterative. As they receive the results of Morris’ physical exam and lab tests and probe further, students develop a deeper understanding of the patient’s condition, the disease processes underlying the condition, and potential treatments. They also learn more about the basic science pertinent to the case. Dahlem adds that because the students learn within the context of a patient, they can see the clinical relevance of what they learn.
Ultimately, the students put together a presentation that describes the disease, how it is similar to and different from similar diseases, and a suggested course of treatment. In this case, the students might determine Morris’ condition is caused by a spinal cord tumor and recommend surgery to remove it.
“But more than anything” Dahlem notes, “PBL is about exercising thinking strategies, relying on self-directed investigation, and working as a team. And yes, it is fun, too.