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.
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.