Fostering lifelong learning through curiosity and an inquiring mindset is a foundational tenet at the JMP. The “constructivist” approach of Problem-Based Learning (PBL) is designed to promote independence in the student learning process while also developing the vital communication, teamwork, and clinical reasoning skills they will need as doctors. All the foundational medical sciences including the traditional basic biomedical sciences such as physiology, biochemistry, pathology, histology, pharmacology and the social and behavioral sciences as well, are presented through real patient cases.
Small groups of 8 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 put directly into 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 patient cases as they build deeper medical knowledge and develop more sophisticated clinical reasoning skills. And, 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.
Every 7 weeks students prepare for a summative written knowledge exam and a formative oral cased-based exam, known as Triple Jump, that is explored one-on-one with a member of the JMP faculty or a volunteer community physician. The Triple Jump focuses on how individual students engage in the process of learning through PBL.
By actively engaging in learning through problem solving, students do more than memorize content; they learn how to work together to build a strong web of interconnected information which they use to solve real world problems. Additionally, students master meaningful skills like teamwork, critical thinking, lifelong learning, and communication. From the first day of tutorial, JMP students actively create their own foundational science knowledge as they learn to ask questions, explore, and assess what they know and what they need to learn. These skills are vital to the art and science of doctoring.