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Understanding Details of Problem Based Learning(PBL),
Problem Oriented System (POS)

by Dr. Stein

PAGE 2

5. Meeting in small groups of 2-8 medical students or residents in a seminar-like atmosphere, I, as the clinical tutor, urge the resident to look up the problem in a handbook and/or Internet to augment his/her assessment and plan. The medical student or resident leads the discussion from his/her worksheets; I guide their thinking about differential diagnosis and plans.

6. Local instructors, who are senior residents and staff physicians, attend the seminars to join the discussions with the aim that the medical student or resident perceives the tutorial session as a 'learning environment' where the medical student or resident can express his ideas freely without adverse judgment from his superiors. Also participation of the local instructors is essential in order for them to acquire the skills in continuing the problem based learning/PBL after I depart. This serves as an in-service workshop/faculty development to acquire improved teaching skills.


7. Bedside demonstrations to deliberate and expand poorly defined aspects of the medical history and practice physical examination skills directly under my supervision are another important component of the PBL.
Diagram of cardiac sounds

8. Case presentations enable the medical student and resident to develop confidence in communicating clinical problems to co-residents and staff-always with gentle supportive praising corrective feedback from me.

9. Medical students and residents need to continuously practice the PBL with corrective feedback to develop proficiency and rapidity. Learning the POS from reading texts is as useful as learning to play the piano from reading a book.


10. The English conversational level of the medical students and residents are usually rather low at first. I have observed that toward to end of the 1 st week, with twice daily tutorial sessions, the medical student and resident progressed very nicely in understanding their patients, as they were able to use the English skills taught them over many years of schooling, buried in their deep brain, and now elevated into use and comprehension.

11. Clinical uncertainty is a fact of life for every clinician. At times it has been called 'the art of medicine.' Senior physicians need to convey to residents, that in spite of promoting PBL/POS, evidence based medicine and other rational strategy, many decisions are made in a uncertain mode. Residents should be able to participate in making such decisions pertaining to a course of action when one opinion, such as a resident's, has no firmer basis than another's opinion, such as staff physician.

12. I consider the evaluation of the patient similar to solving a physical puzzle such as the Rubik's cube: all the parts must fit, vertically and horizontally. There can be no plan without an assessment, no assessment without being included in the problem list(horizontal), every important problem from history, physical examination and laboratory needs to be included in the problem list (vertical).

In conclusion, medical students, residents, staff and medical educators might email me with questions concerning further development of their teaching curriculum, which might include incorporating the features described above plus many more aspects to maximize the learning experience for the residents whereby the residents have an enriched 'learning environment' for the benefit of patients and staff.

If you want to email me, my address is: jerrydoc@ufl.edu