A year ago I wrote a column about problem-based learning, in which I said that I thought it was a conceptually brilliant teaching strategy but maybe didn’t live up to all of the hype that surrounds it. Two semesters later, I think it’s time to re-evaluate.To recap, problem-based (or case-based) learning is a strategy in which instead of attending lectures on a topic, students work together in small groups (“tutor groups”) to figure out real medical cases and learn key concepts in the process. The cases are divided into several pages, and we analyze one page at a time. The first page generally introduces the patient and the primary problem. We write down all of the facts on the whiteboard, identify the problems, come up with possible explanations for why the problems are happening, think of a plan of action and identify learning issues that we need to research further. The next time the group meets, we spend around an hour talking about the learning issues from the last time before proceeding with the case.
My complaint last year was that the amount of resources that were available to us for our learning issues was overwhelming. Every book said something in a slightly different way and I thought that it took too much time to find the “right” answer, especially when there were also lectures to review and labs to prepare for. I think what I’ve learned over the past year is that there is rarely a “right” answer to most things. There are certainly wrong ones, but beyond that there are generally several different ways to do / learn about / categorize any one thing. Looking at learning issues this way not only makes them more fun, but also makes tutor group much more rewarding.
In addition to me becoming more comfortable with the processes, there are a handful of important differences in the tutor groups right now compared to the beginning of last year. First of all, first semester of first year is about learning normal anatomy, but not necessarily learning why things work the way they do (physiology). The end of first year and now, however, are all about physiology. Besides the fact that personally I remember things infinitely better when I know why they work rather than only that they work, I think problem based learning is much more conducive to learning mechanisms than facts. When the case presents a cat in respiratory distress, you want to know why her lungs are doing what they’re doing, not what the structure of her lungs are. Realistically you have to know the latter to understand the former, I’m just saying that I feel like I retain more information from physiology tutor groups than the anatomy ones.
Another key difference is that in anatomy, we learned the same facts several times — in tutor group, in lab, in lecture, etc., but in physiology the lectures are sparser and tutor group seems to be an inherently more important part of the curriculum. It’s a little nerve-racking because you never really know to what depth you’re expected to know the material, but it’s also somewhat liberating because you’re free to go into as much detail as you want in order to learn something better.
We’ve also started concept mapping this time around, which is when we set aside time at the end of the case to make a large flowchart that links together all of the things that we’ve learned during the case. Research suggests that concept mapping and problem based learning are supposed to go hand in hand, but it was never something that my anatomy tutor group really ever did. I think it makes a big difference in helping to tie everything together.
I’ve been finding that when I’m in the hospital or on externships I learn an incredible amount from specific cases. So I’ll remember for a long time what lymphoma looks like and how it’s treated because I saw it in Shiloh the golden retriever — I definitely retain it a lot better than just learning about lymphoma in class (although if I were to learn about it in class after seeing Shiloh then I would be thinking about Shiloh in class and would remember it even more). There’s still a little bit of disconnect with this phenomenon when it comes to tutor group cases because we never get to see what the animals physically look like. I can’t remember all of the names of the cases, but I can, however, remember almost all of the problems they had much more clearly than I would have been able to otherwise.
So in summary, it’s taken me a year but I think I’ve finally figured out how to make the most out of tutor group, through a combination of a little growing up and a few inherent modifications to the whole process. Either that or I’ve just been a student for so long (wouldn’t this be 18th grade?) that I’m finally starting to analyze learning as a process instead of just seeing school as a means to an end.
Nikhita Parandekar graduated from Cornell in 2011 and is a second-year veterinary student in the Cornell College of Veterinary Medicine. She may be reached at email@example.com. Hoof in Mouth appears alternate Fridays this semester.