Thursday, 10 January 2019

by Elsie Marieanne Sowah, MBBS 2021

It’s around 10:30 and you’re using every last drop of the grade school-inculcated discipline within you to ignore the pink Zorba’s box (baked goods/pastries) on top of the fridge. The last Report Back is underway and your eyes are oscillating between what’s becoming a blue nephron on the board and that pink Zorba’s box. After someone’s added a point and another two people have briefly debated interlobar versus interlobular arteries, Report Back is finally over and the exodus of ‘Break’ takes over: Bathroom, fresh air, snacks, ‘Breaktime chat’ – in any order. One half of PBL is done for the day.

Problem-Based Learning, or PBL, is a ‘student-centered’ form of pedagogy/learning employed by hundreds of university programs, both medical and non, across the world. Problem-Based Learning was founded in the mid-1960s by Barrows and Tamblyn for the medical program at McMaster University in Canada. At its founding the aim was to respond to widespread dissatisfaction amongst students, who found the traditional medical school education unengaging and lackluster[i].

The ethos of PBL is indeed unconventional, as it hinges entirely on a lack of a ‘definitive solution’ and rather emphasizes the process of open-ended problem-solving and exchange as a means of: gaining knowledge, acquiring communication skills, and working productively as a team. The team in question is the small group of students, and the tutor is by definition external to this team by acting as a facilitator, a conduit for the implementation of the PBL structure. The idea is that in learning through this practical and ‘constructivist’ (vs. rote memorization and traditional authoritarian pedagogy) model, students are simultaneously learning and preparing for their future practice.

At the St George’s, University of London programme in Nicosia , PBL comprises a significant proportion of our time and learning. Twice a week for a total of 6 hours, we problem solve, interact with, challenge/be challenged by, and learn alongside 6-7 students from diverse backgrounds and with very diverse and distinct learning styles. A brief caricature of the cast of characters in a PBL Group:

  • The Aloof One. This person is not all there but there enough to give efficient Report Backs. Doesn’t add much during case review. Eager to leave.
  • The Know-it All. This person must add to every single Report Back (RB), sometimes information that’s been said, and gets very frustrated when she/he forgets something during her/his RB. Insists the prevalence of diabetes is 435,245,123.
  • The Instigator. This person must refute almost everything that is said, whether for kicks, or for the sake of playing devil’s advocate, or for the sake of Organ Systems which he/she insists ‘said something different’ that whatever is being said.
  • The Funny Guy/Girl. This person can be a bit much at 9am on a Monday/Tuesday but is really great for diffusing tense situations between the Know-It All and the Instigator. Typically a fan favorite, loved by the tutor and the group.
  • The Team Player. This person is uber-conscious of dominating the discussion, often heard saying “it’s OK, you go”, and jumps at the opportunity to write on the board or log-in to the Case. Solid RB, but “definitely add if I’ve forgotten anything”. Can’t ever really tell if he/she likes the group or not.
  • The Snack Champion. Whatever this person does or doesn’t do during PBL is null and void when it is discovered that he/she is an epic Snack Bringer. A home-cooked traditional meal at 10am? Don’t care if I had breakfast an hour ago! Fancy pastries or Loukou Donuts which might as well be gold to a med student’s palate? Interrupt me as much as you want!

Of course in addition to these staples, there are some  specific wild cards we can’t forget – like the guy/girl who is preparing for the USMLE and frequently spews random (but “high-yield!”) pathologies accordingly, or the person who did four years of undergrad + worked for ages on this specific topic/system and proceeds to school the group accordingly. The list goes on. Yet, somehow, this motley crew finds ways to support one another, create a group culture (to clap or not to clap after each RB?), keep virtual patients alive (as much as possible…), come up with group LOBs (Learning Objectives), not drive the tutor completely up the wall, and usually have a lot of fun.

At this Medical School we are experiencing a unique and particular form of PBL, of which Barrows and Tamblyn would be both proud and, perhaps, apprehensive. With over 20 nationalities represented in a single cohort of students, PBL is simultaneously an academic and a cultural exchange; with students having taken different entrance exams and possessing a wide variety of undergraduate degrees, PBL is an academic exchange that builds on the foundation of a multitude of academic backgrounds; with few to no Cypriot students in the MBBS program, PBL is an academic exchange that (during the break, of course!) also functions as somewhat of a support group (“who should I contact if…?”; “has anyone been to…?”).

‘Our’ PBL setting is thus distinctly colored, and arguably enriched, by the specific context of this international medical program. Ultimately, PBL is not just the core of our curriculum but also, and most prominently, the core of what defines this program — precisely the intersection of academic and cultural education that will uniquely shape our medical education. So Barrows and Tamblyn should not be apprehensive, but rather reassured that the legacy of PBL is thriving in our little corner of the Eastern Mediterranean; here, a group of 7 students from 7 different countries may remember asthma because it was the day that the Instigator redeemed herself by bringing those special cakes from her hometown or, communicate better with foreign patients having had extensive practice deciphering complex medical jargon said in different accents.

Just as the organization TED has become a global phenomenon, having transported its ethos to big cities and small towns all over the world with TEDx, so too have we developed a unique brand of PBL. PBLx SGUL-UNIC is one-of-a-kind, an experience that I am certain we will remember years from now during our clinical practice. At the very least we’ll remember not to miss the pizza party the night before a marathon…