Medical school course structures: is there a difference?

When browsing the websites and prospectus documents of medical schools all across the UK, when describing their course structure often there are many words and phrases which are used: PBL, CBL, Integrated, Traditional. What do they really mean? Are they the same at each medical school? Which one suits me best? Well this blog post will hopefully help anyone confused with the course types and hopefully will point you in the direction of the course type which may suit you best.

I will be covering various different aspects of the course in this post including:

• Method of delivery
• Process by which material is covered
• Clinical exposure

please note that you can only compare and contrast courses within these 3 categories. 

Problem Based learning (PBL) and Case Based learning (CBL).

A lot of medical schools in the UK have adopted the PBL method of teaching, originally pioneered in Canada and first introduced into the UK in the 90’s by Manchester medical school. It has a very similar cousin in terms of course structure, this is the CBL method of teaching, pioneered in the USA and adopted by Cardiff medical school recently in the UK.  

Generally PBL and CBL share many similarities and sometimes its very hard to distinguish between the two teaching methods, hence below I am going to group them together when describing what they entail and how they are delivered. I will address their differences in a later section.

What does a PBL/CBL course structure entail?

Most PBL/CBL courses offered by medical schools are very similar, most run on a 1 week/2 week rotation of problems/cases and they follow a set structure as described below.

Students will meet in a small group with a facilitator for the first session of PBL/CBL. The problem/case will then be introduced to the students and they will be given some time to brainstorm their ideas and generate learning outcomes for the case. Some medical schools provide learning outcomes at the start of the case, some provide them for use at the end of the case and some do not give learning outcomes at all.

The students will then continue the week/2 week period by attending lectures, seminars, small groups and labs to fulfil their learning outcomes. As well as the timetabled activity PBL/CBL requires a great deal of self directed study to answer the learning outcomes, hence self motivation by students is very important in a PBL/CBL styled course.

Students will then meet again in their small group with their facilitator to share their ideas and answer their learning outcomes.

Basic outline of a PBL/CBL style course

As I stated before every university has a different take on the PBL/CBL styled course, hence I am going to be doing a blog post specifically about my experiences with CBL as a Cardiff student so you can get the idea of what its really like to study under this curriculum.

Differences between PBL and CBL.

Generally speaking (having spoken to my colleagues at various medical schools) PBL and CBL seem to be more similar than different, but it is important to remember that they are different learning styles and so do have some differences which can be seen.

PBL is described as an open enquiry method which allows students to discuss all topics and tangents of the problem faced with little or no guidance from the facilitator. This can be problematic if the group go off an a tangent, and can sometimes mean that the problem in question will never be answered totally – hence the conclusion may be false. Also with PBL often the learning outcomes are never officially defined and the timetabled teaching may not be as directed to the problems material. One positive is PBL does well to enhance a students problem solving skills.

CBL on the other hand is described as a guided enquiry which targets students to certain areas of the case given to generate specific learning outcomes. Facilitators generally play a more active role in keeping the session on task, and sometimes will bring up topics to guide the session, this means the learning outcomes and outcome obtained from CBL at the end of the case is most likely correct. Timetabled teaching backs up the learning outcomes very well and often official learning outcomes are provided. One downside to CBL is that its less like solving a problem as enquiry is solely directed at a purpose.

Even with saying the above I have seen students who describe PBL exactly the same as how I describe CBL as taught by my medical school, so it completely depends on the school you attend.

Lecture based course styles.

Many medical schools describe their courses as traditional lecture based or even science based, and this can often mean different things at different institutions.

These courses usually have a great deal of focus on the pre-clinical sciences and students follow a rigorous programme of all year lectures, small group and lab teaching. Hence these course types have much less independant study and self inquiry. Lecture/science based courses give students a very strong grounding in the preclinical sciences, but often a lack of early clinical exposure can make the transition from pre-clinical to clinical medicine more daunting.

Process by which material is covered. 

Material can be covered in two main ways for a medicine course:

• Subject-based/traditional: Material is covered in subjects such as anatomy, pathology, physiology, histology etc. These courses are now very rare as the teaching method is not as fluid as the system-based counterpart, but often this method works very well with traditional lecture based courses.
• System-based: material is covered by body system, bringing together anatomy, pathology, physiology and histology to cover each body system individually and in turn. This is the much more popular method used nowadays by medical schools as it is more fluid and proves more logical to the students who undertake it. I personally feel this allows for a more focussed approach and prevents confusion.

 

Clinical exposure.

Nowadays the word ‘Integrated’ is found in most medical schools course description. Integrated means that in preclinical years there will be some clinical contact and for clinical years it means that lectures and small groups will be integrated into their clinical practice. 

Most medical schools now boast some form of early patient contact as it is very important for students to link preclinical sciences with their clinical application as well as develop an evidence based approach to learning.

Very few medical schools now have the deeply defined pre-clinical and clinical years.

 

So what do I look for in a course?

All of the above features can be found in various combinations at the medical schools across the UK, For example my medical school (Cardiff) use an integrated CBL systems based approach, whereas when viewing medical schools I also witnessed a traditional lecture based course with barely any integration. But the important thing is identifying which course is right for you.

The best way to do this is to visit university open days and talk to students on the course your interested in, but below is a general guide of what traits tend to suit each course style:

• CBL/PBL: Enjoys self directed study. Willing to motivate themselves to work outside of timetabled teaching. Likes to share ideas within a group setting to aid their learning. Does not enjoy being ‘Spoonfed’ information to a great extent via lectures. Does not enjoy/feel lectures are a great way of learning for them. Prefers learning within a smaller group. 
• Lecture based: Prefers being spoonfed information. Dislikes self-directed learning. Feels they cannot motivate themselves adequately for self-directed study.

As for integration, it is really the applicants choice as to whether they prefer early clinical contact or not. Most medical schools do now have some form of early clinical contact and less of a distinction between preclinical and clinical medicine, but there are some courses out there which are more distinct (less integrated).

 

This really is a basic outline of all of the course styles for applicants which may be feeling a little confused when browsing medical schools. As I stated before tomorrow I will release a blog post on what its like to follow a CBL/PBL style course and my feelings on that for anyone interested.