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Old School vs New Tricks

Luciali72x722Lucia Li -- "Nothing that is worth knowing can be taught."

One of my first-year supervisors told me that I’d be lucky if I remembered even 20% of the stuff I learnt in medical school. I think he was intending to cheer me up, but I remember thinking that if I was going to forget 80% of what I learnt, I really hoped it would be that stuff about ribosome units and mitochondria, and not the stuff about hearts and brains.

The first 3 years of our course are filled with lectures and lab-work, and the sum total of patient contact in those years is about 12 hours. Some of this basic science is a bit more obviously relevant than other parts… anatomy and physiology and pathology. Others still seem a bit obscure. Whilst I lost sleep as an undergrad trying to remember Gibbs free energy equations, my friends at other medical schools lost sleep over cases on heart attacks.

Inevitably, people ask what’s the point? The current drive is towards making medical courses more directed and cuddly, with the 4 new UK medical schools all providing integrated courses. Buzzwords such as "Problem-Based Learning", "Student Selected Components", etc., pervade. When the GMC (the UK professional regulatory body for doctors) came to inspect the Cambridge course, they asked us a lot about what we thought about the heavily scientific nature of the course and its relative paucity of early clinical experience. Apparently, we surprised them with our enthusiasm, prompting them to ask, "Did they pick you guys [to meet us] because you’re so positive?" No, actually.

Why wouldn’t we be supporters of our course? First of all, I’d imagine most of us knew what we were getting ourselves into when we applied, and most of us have enjoyed Cambridge because of, not in spite of, its scientific nature.

Second, I really believe that all this emphasis on early clinical exposure is a bit overrated, whilst science is underrated. You don’t make medical advances without research and scientific principles, and you can develop a bedside manner and good examination skills just as easily at the age of 21 as at the age of 18.

Diversity of experience should be celebrated in medicine, and part of that is the differing medical course styles. Yes, until a year ago, I knew more about guinea-pig hearts and Drosophila genetics than about how to examine a patient. But, as long as you’re competent at the bedside, I doubt anyone really cares where you graduated from 10 years down the line. Besides, all those random facts come in pretty useful in pub quizzes…

September 26, 2008 in Lucia Li | Permalink


Once again Lucia confirmed the fact that she's my favourite blogger on The Differential. That's for your brilliant way of posting.

Most medschools arround the globe direct less importance on basic science research. They'd rather leave it to other graduation courses (like biotechnology or biochemistry) or direct most efforts on studies toward clinics and that have a clear practical application. That's probably a fact in most universities (even though cambridge seems to place them in a more balanced fashion, given the impression I had from reading the post). That researches that are already few, therefore, can be seriously threatened by PBL, since the inicial cycle of the course is always linked to clinics somehow, and professors tend to focus on clinics. I agree with Lucia that knowledge is build as bricks on a wall, you can't go further if there's no support on its basis. Most people would agree that this is probably one of the worst points of PBL.

Now, I disagree with you in relation to this early contact with clinics being harmful. Instead, I believe this is what makes PBL so special and gives it advantages in relation to traditional courses. This early patient approach makes students have less fear of "the first patient", because we go gradually during 4 years(at least in my school) exploring how we take information out of the patients and link it together to form our diagnostic hypothesis, and treat them. In traditional courses I'd have serious problems trying to link what I'd studied in anatomy, with propedeutics and with patients complains all at once suddenly when I started intership.

There's a professor of mine who says "Being in medschool is inevitably like being mentally raped, but then you can choose either all the way in greedly as in traditional course or slow and nicely as in PBL". I'm not sure wheter all of you got what he meant, but it's still a fun quotation regardless of anything.

Posted by: bandaid | Sep 28, 2008 6:11:23 PM

I don't know about other medical schools but ours (The Fiji School of Medicine) follows PBL and I personally find this method of learning better than the conventional one............. being introduced to clinical practice from Year 1 makes bedside learning far more easier as you progress through the years..... and it's also fun interacting with patients at such a young age....... especially at the SOPD clinics for diabetics and hypertensives...... and PBL also helps us correlate our theoretical learning with the whole disease process occuring in an actual patient.........
so that the basic sciences of anatomy, physiology and pathology are not just a jumble of facts and processes in the head.

Posted by: fijimedstud | Oct 2, 2008 7:54:50 PM

After reading your article Am kind of certain that many medical schools have taken on PBL. Am in Uganda at Makerere University and this is the curriculum that we follow these days.
As much as I find it hectic and incoherent, I dont have enough knowledge about the old conventional method of learning. Certainly in Uganda we do have alot of challenges, even after 6years since its induction it still looks like a new program with alot of hitches.

one thing is certain though, the ability to apply sciences in the medical field is certainy easier and with enough discipline, PBL sure makes good doctors.

Posted by: Ismael | Oct 3, 2008 8:45:11 AM

hullo! :) i come from a traditional type school (much like cambridge because we follow the UK system and graduate with MBBS as well).

i think it's well put - you can develop a good bedside manner at 18 or at 21 - good bedside manners are only dependent on how hard you try. it's not something impossible to achieve although there're many different ways to get there! :)

PBL has its benefits, i won't disagree. but the traditional way has it's benefits too - you may argue that it makes clinicals hell for the way we have to fit bits and pieces into each other to form a whole picture, but that only prepares your mind for work, because medicine is never a straightforward thing, entirely.

PBL does help greatly in patient exposure and making you more sure of talking to patients, sure. but when you're a doctor, usually patients will be clamouring to talk to you (about their complaints), as compared to when you're a medical student and they may not be so willing!

take both with a pinch of salt - no way is perfect :)

Posted by: ditzydoctor | Oct 6, 2008 9:05:33 AM

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