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UC Berkeley / UCSF Joint Medical Program
UC Berkeley | UCSF

Foundational Medical Sciences

Students learn the Foundational Medical Sciences through inquiry-based collaborative pedagogical strategies, namely team-based learning (TBL) and problem-based learning (PBL).

The focus of the first course is on medical physiology through team-based learning (TBL). To maximize the benefits of learning through problem-based learning (PBL) in later semesters, it is important for students to have a common base of knowledge in the body’s normal functioning. This is the case because the complexity of authentic medical cases can be disorienting. The foundation of mechanistic knowledge (i.e., physiological knowledge) will allow students to map and anchor the additional learning necessary to make sense of PBL cases.

PBL is an evidence-based educational strategy aligned with a constructivist philosophy of learning. Our approach acknowledges that clinical reasoning is knowledge-based; for this reason, we support students in initiating their own learning and building mental models of disease that integrate foundational science knowledge within a clinical framework. The four essential elements of learning through PBL are the following:

  • PBL is contextual because the process is centered around the presentation of authentic medical cases to motivate students to identify and address gaps in their own knowledge.
  • PBL is collaborative because students work in teams to make sense of a medical case, identify gaps in knowledge, clarify misconceptions, explain concepts to each other, and generate deeper understanding. Through the process of PBL, students develop the vital communication, teamwork, and clinical reasoning skills they will need as doctors.
  • PBL is constructive because students create their own understanding and learning through discussion, building on each other’s contributions, and the identification and sharing of appropriate learning resources.
  • PBL centers self-determination because students identify their own gaps in knowledge and corresponding learning objectives.

PBL will help you develop competencies in communication, feedback, and teamwork. Please keep in mind that our conversations may not always be easy and that we sometimes will make mistakes in our speaking and our listening; we will need patience, courage, imagination, or any number of qualities in combination to engage our academic sources, our classmates, our faculty, and our own ideas and experiences. Thus, an additional aim of our course will be for us to increase our facility with the sometimes-difficult conversations that arise as we deepen our understandings of multiple perspectives while centering respect for each other and ourselves.

  • Problem Based Learning Process and Principles

    PBL, or problem based learning, is an evidence-based educational strategy aligned with a constructivist philosophy of learning. Our approach acknowledges that clinical reasoning is knowledge-based; for this reason, we support students in initiating their own learning and building mental models of disease that integrate foundational science knowledge within a clinical framework. These foundational sciences include not only the traditional basic biomedical sciences (i.e., anatomy, physiology, biochemistry, pathology, histology, pharmacology) but also the social and behavioral sciences. In our program, PBL looks like this:

    PBL ProcessLearning Principles
    On Monday, a group of 8 students meets for 3 hours. They are presented with a clinical case from real-life medical practice. The case is disclosed progressively, one page at a time.The goal of working around medical cases is for students to create rich and elaborated causal networks that explain the clinical case in terms of the underlying, social, psychological, biological, and pathophysiological processes. Students live the evolution of the case. The clinical context enhances motivation to learn foundational sciences and it provides a scaffold to build integrated knowledge.
    All students participate in the initial analysis of the case scenario and problem(s) definition by voicing their thoughts, previous knowledge, intuitions, and ideas (i.e., brainstorming).Students engage in collaborative learning around medical cases. The group has an expanded working memory capacity, thus overcoming the known limitations of individual working memory.
    Students assume rotating roles including facilitator, time-keeper, scribe, researcher, and participant. The scribe organizes information on a white-board. The essential information to collect includes facts given in the case, hypotheses (possible diagnoses), additional information needed, and learning issues (gaps in knowledge).Students learn skills of team work, collaboration, non-judgmental communication, and feedback. The use of representations provides opportunities for knowledge building and integration.
    Students refine learning issues (LIs) by formulating them as "why" or "how" questions in the context of a synthesis of the problem as understood thus far and a commitment to top diagnoses.The group's discussions reveal areas of disagreement or limited understanding that need to be investigated. This process also contributes to developing the important clinical skill of decision making with incomplete data.
    Students select the most important LIs to be researched after agreeing on the interrelated phenomena that need to be explained. Students feel that they are in charge and have an impact on the learning situation.LIs cover the subject matter underlying the problem and are hence related to the learning objectives of the case. These objectives are known by faculty tutors; they use them to guide students through questions without affecting their self-determination.
    Individual students take charge of one LI to be researched at home. They find and evaluate appropriate resources, take a critical stance, and then select the best ones to post for other members of the group to read. These materials are known as learning objects (LOs).Students learn and apply information seeking skills and reference management. They interact with the learning material more than in an information-gathering or theoretical approach because they relate the new concepts to the problem and everyday experience. These are features of the deep approach to learning possible through PBL. Also, this approach to decision making is critical for clinical practice.
    Students post LOs and read each other's LOs in preparation for the next PBL session.Students learn to assume responsibility for the learning of every member of the group. At the same time, this responsibility is shared.
    Students return on Wednesday ready to engage in a rich discussion. This is the most important and exciting step in PBL. Students begin by re-examining their hypotheses and understanding of the case in light of the new knowledge provided by LOs. The task of the group of students is to explain the phenomena presented in the problem in terms of underlying processes.Group discussions confront learners with alternative ideas and viewpoints they would not have come up with themselves, helping them establish additional meaningful relationships between presented information elements. Unlike simple teach back, the process at this point is about knowledge-building discourse in which there is construction, refinement, and transformation of knowledge. Explanations produced in the context of discussion result in better learning with enhanced long-term memory.
    The progressive disclosure of the case continues after the end of the discussion, and the PBL process described until this point repeats itself.Students reinforce learning processes and principles mentioned above. Furthermore, they use questions to help with goal setting, guiding cognitive processing, activating prior knowledge, focusing attention, promoting cognitive monitoring, and promoting displays of knowledge.
    Students return on Friday for their last 3-hour PBL session of the week, which usually closes the case. The discussion leads to synthesis and establishment of general principles.Students organize prior and new learning around the problem scenario. This aids retrieval of what has been learned when a similar problem or situation is encountered later in professional practice. Students aim to achieve cognitive conceptual coherence by systematizing and integrating the information from the foundational sciences around the clinical case.

    The organizational cognitive framework provided by the foundational sciences anchors the student's incipient clinical knowledge and is the basis of clinical reasoning.
    Lastly, students engage in self and group evaluation of progress and process.Students are trained to cooperate and communicate their knowledge in a clear and logical manner. They also learn to give and accept feedback from each other.

    After 7 weeks, students prepare for a summative written knowledge exam and a formative oral exam, known as triple jump, that focuses on how individuals engage in learning through PBL.

    Evidence from the educational research literature shows that medical students that learn through PBL perform just as well in USMLE step 1 as their counterparts in non-PBL curricula; however, they gain considerable advantages in other domains such as critical thinking, knowledge organization, and social skills. Besides, PBL is just fun; even at three hours per session, students and faculty just love it.

Tutorial

Small groups of 6–9 students meet three times a week for three hours. During that time, students explore clinical cases based on real life patients accompanied by a faculty tutor. In PBL students are in the driver’s seat. Here is an example: on the first day of a case, the session begins with a 72-year-old woman that walks into your clinic complaining of chest pain. At first, there might not be much more information than that. But there is a lot to talk about. JMP students work through this problem by first brainstorming a list of follow up questions. Where exactly is the pain? When did it start? Are there any other symptoms? What is the past medical, drug, and family history? Could the patient have a heart, gastrointestinal, lung or even musculoskeletal problem? More information on a case is progressively revealed, one page at a time, and discussed. Over the course of the session, the case might include more of the health history, lab data, pictures, videos or links to information on the internet. Together, students figure out what they already know and where they may have gaps in their knowledge. Along the way, students will encounter new information that they will have to reconcile with earlier ideas and experience, maybe changing what they have previously discovered, or throwing out information as it becomes irrelevant. Many questions lead to more questions or more knowledge. All of the information and these questions are tracked by a student scribe either on a whiteboard or a shared document online. Many tutorial groups create concept maps to organize their thoughts and mirrors how their brains construct knowledge. All the while, the faculty-tutor supports self-directed learning by facilitating the process, generally staying in the background, and strategically directing the discussion to get students to dig deeper into the material. The tutor also helps make sure that everyone is participating, collaborating, and thinking critically about the problem.

Between sessions, students research topics (we call them Learning Issues or LIs) they assign to themselves. They share their research with the other members of their group who come to the next session having reviewed the material. In the following sessions, students apply their new knowledge to the case and discuss their different perspectives, which results in building new knowledge. This new knowledge is deeper and more connected than most individuals can accomplish by themselves; herein lies the power of the group! Then, they reveal more information about the case, do more research, and apply more information to the problem until finally the diagnosis is revealed.

Over the course of the five semesters of PBL, students will continuously engage with 40 to 50 patient cases which get progressively more complicated as students advance in the curriculum and develop more sophisticated clinical reasoning skills. As in real life, some cases are inconclusive, some are sad, some are victorious, some revisit topics from earlier in the curriculum. Students remember these patients and the knowledge generated around them.

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