Traditional Lecture or Problem Based Learning?

Traditional lecture. No question about it. If you are accepted into more than one medical school and can pick between a lecture-based curriculum or Problem Based Learning, flee as if from the Devil himself the PBL school.
For those of you who don’t know, Problem Based Learning is a fancy word for “Seminars.” Instead of sitting in a traditional lecture following a rational plan of study, you will be divided into small groups and, under the supervision of a faculty member, teach youself the material through the highly inefficient process of self-discovery. It sounds good on paper and the medical schools that have embraced it will try to sell it as if it were going to replace sliced bread. In practice however, it can be a nightmarish voyage into a sea of ignorance on a ship full of clueless people who all want to be captain.
Problem-based learning is an admission by medical schools that most of first and second year is self-study. Instead of following this admission to its logical conclusion, that people should study on their own, Problem Based Learning was devised to justify both freeing up faculty to concentrate on their real interests and to not provide lectures while still collecting tuition. If you look at it like that it almost makes sense because otherwise you would have to believe that many highly intelligent people devised an intricate solution to a non-existent problem.
The fierce partisans of PBL (who make Mac users seem tolerant by comparison) will sneer at the traditonal lecture curriculum which they say “spoon feeds” the student. The implication is that those of us who prefer lectures to seminars are a bunch of big fucking babies. Maybe lecture is “spoon feeding” but Problem Based Learning is like throwing the jars of baby food at the baby and laughing as he struggles to open them. Actually, I don’t accept the metaphor. Like I said, it’s all self-study. Many people don’t even go to lecture but study efficiently on their own which is hardly spoon-feeding. The difference is that a lecture curriculum has a rational plan, starting with the basics and working up to more complex topics which is the ideal model for a curriculum. Why this isn’t obvious only shows that the faculty at many medical schools have mutated to a level of intelligence where their giant brains have crowded out the common sense lobe.
What’s the bottom line? Studying in a group is highly inefficient, often highly annoying, and puts you firmly on somebody else’s schedule for a significant portion of the day. Instead of just studying you are asked to become an active participant in someone else’s group dynamic masturbatory fantasy. My medical school dabbled in Problem Based Learning and by the end of a typical three hour group session I was ready to shoot myself in the head.
I cannot say enough bad things about Problem Based Learning. Almost everybody despises it..Podunk or Top Tier?
I am immensely grateful to those who pursue careers in academic medicine, careers that advance the science of medicine and train future physicians, and I am second to none in admiration for the most excellent faculty at my program. With that being said, I have no desire to teach, conduct research, or to become involved with academics once I finish my training. Neither do most physicians for that matter. So with this in mind, what really is the difference between going to your inexpensive, relatively unknown state medical school and a major academic powerhouse?
Not much if you just want to practice clinical medicine. I’m not discounting the value of prestige however. If you want to do a cardiology fellowship at Harvard a medical degree from Yale and a residency at Duke will put you way ahead of some rube coming out of the medical sticks. On the other hand, I rotate at a hospital that most of you have never heard of and probably couldn’t find on a map but it has a cardiology program that turns out first rate cardiologists who have no trouble finding jobs or patients. You just have to know what you want and what you are paying for it. All other things being equal, the more prestigious the program the worse the medical students and residents are treated and the more time you will spend as somebody’s entourage. Consider carefully then your choice. If you know that you want to work at medicine like a regular job it makes no difference where you go and location and lifestyle should trump all other considerations (except for Problem Based Learing).
In the end, it just comes down to what the t-shirt is worth.
Like any rotations?
Sure. I like working in the ICU. I didn’t always, of course, as the ICU is probably the most intimidating rotation for medical students and interns. The patients there are horrifically, almost obscenely, sick and the comforting medical paradigms on which you rely seem to be turned on their heads. This is not, for example, a rotation where you can usually have a polite conversation with the patient and explore, in perfect order, the history and the review of systems. In the ICU the patients often come in with nothing but a vague transfer note and an incomplete list of medications. They can’t talk and there is not always a family member to fill you in on the patient as they head south before your eyes, possibly for the last time.
It is a rotation where you have to do something big, and soon, for most of your patients and this kind of decisiveness is something that doesn’t come naturally. You have to learn, in short, to be the kind of doctor that goes into the patient’s room when something goes wrong, not the kind who leaves the room to get help. Emergency medicine residents tend to like their ICU rotations because this kind of thing is right up our alley. In turn our ICU nurses apparently really like to have the Emergency Medicine residents rotating because we’re not afraid to make decisions and don’t have to call a synod of attendings and residents to do a lumbar puncture or intubate.
How do you feel about pharmaceutical sales reps?
I’m working on an article about pharmaceutical reps. The short answer is that I don’t take gifts from them, don’t need their crappy pens, and as I eat for free at my program don’t need to eat their lunches even if I wanted to (which I don’t). Part of my antipathy is my dislike for bad salesmen which most drug reps are. Give me a good salesman selling a good product in which he believes and with him will I gladly do business. Drug reps however, tend to be smarmy glad-handers peddling products which they do not understand using questionable statistics and glitzy marketing. It’s embarrassing and I cringe to watch a typical drug rep present his little spiel before a noon conference to which he has provided food.