My Review of Problem Based Learning in PA School

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Many PA programs are utilizing a teaching method called problem based learning, or PBL. Most undergraduate programs teach exclusively in a lecture style, so this PBL approach is very new to many when entering into PA school. I graduated from Chatham University’s PA program, where the entire curriculum used a problem based learning approach. Since I graduated, I’ve been asked questions about problem based learning by many prospective PA’s so I would like to give you all the 411.

Webster says problem based learning is a teaching method in which students gain knowledge and skills by working for an extended period of time to investigate and respond to an engaging and complex question, problem or challenge. In PA school, this means instead of someone handing you the information about diseases, as you might expect from a lecture style class, you are expected to figure this information out on your own. When I say on your own, I mean without a teacher guiding you, your classmates are generally great resources to help you as you navigate the medical field. You will be reading books, journals, case studies and listening to audio lectures that you discover.

Let’s give an example of a typically day learning through PBL methods. You’re in your pulmonology unit and you are given a fake 13 year old female patient whose chief complaint is dyspnea. You ask yourself, “what can cause this?” You and your classmates will create a long list of differential diagnoses. This list can range from COPD to toe fracture. I know what you’re thinking.. Why would a toe fracture cause shortness of breath? Well when you’re in PBL world, sometimes you’re totally off base on concepts, but the only way you’ll figure that out is trial, error and research done by you and your classmates after you leave the classroom. So after you’ve brainstormed with your classmates, you take that big long list of differential diagnoses home and research each disease on the list. You are asking yourself, “could my patient have this disease? Why or why not? What other information do I need to diagnose a patient with this disease? What questions should I ask? What tests should I perform?” After you’ve done some research, you show up the next day ready to advance the case. You ask your fake patient more questions about her symptoms, do tests and interpret the results. As you come across concepts that confuse you, you create another list of things to research when you go home. Each case will continue to advance and you will continue to do more and more research until you’ve diagnosed your patient and come up with a treatment plan. By using process of elimination to determine how to appropriately care for your fake patient, theoretically, you should understand many other diseases that your patient could have had. As you do this for many patients, you will ideally understand all major medical concepts and be able to appropriately care for many types of patients.

There are probably a few questions you’re asking yourself.. “Is it really challenging? Is it the best way to learn? Can you really learn everything you need to practice that way? What if you teach yourself the wrong information?” Allow me to answer.

Is it really challenging? Yes. No one will hand you any information. You must parse through the medical corpus by yourself. The first day I went home to do research, I was having trouble navigating primary literature, so I started using google. Everything contradicted itself and no one gave me a straight answer. Overtime, I got much better. By the time I graduated, I was able to find answers very quickly, determine what sources were reliable and determine what information was important. I discovered that because I was so comfortable doing research that when questions I was asking didn’t have clear answers, I knew the information wasn’t relevant so I shouldn’t waste my time digging for hours. Now as a practicing physician assistant, I still look things up that I don’t know, however I am glad that I can easily navigate my resources.

Is it the best way to learn? Well, everyone learns differently, but I will say this was the best way to learn for me. When I was an undergrad and teachers lectured me, I found it extremely easy to memorize information and then regurgitate it for test day. Shortly after test day, I would forget most of the material. I got fantastic grades, but I learned very little because I didn’t really use the information. Through the PBL method, I used the information I learned constantly to solve the cases I was given. I took away 100 times more information in a single didactic year of PA school than all 4 years of undergrad.

Can you really learn everything you need to practice that way? You may not learn everything through PBL, but you will learn the valuable information to make you a physician assistant. You will also learn the skills to be able to obtain more information when you need it. The method does work and if you put in the effort, you will be great out in the real world.

What if you teach yourself the wrong information? It might happen, but fortunately you work in groups. Generally someone will suspect you’re saying something that doesn’t make sense, so you and your group members will take another look at it and realize the correct information. Sometimes things get missed, but either through rotations or life, you’ll hopefully make sense of it all.

Overall, this method can be extremely challenging and frustrating, but you will take away the information and skills to help you become a great practitioner. Keep in mind medicine is always changing. Knowing how to research and extract your own information is likely going to be more valuable in 10 years than a bunch of out-dated facts you memorized.

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