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

By Dr. Stein

Page 1

The goal of my teaching is to enable medical students and residents to learn how to have a complete understanding of their patients’ clinical problems; this deeper understanding leads to a mature assessment and plan of studies and plan of treatment. This continuous learning, augmented by the many differences in patients’ problems experienced throughout residency, requires a structured method. Hence the principle emphases of my clinical teaching is ‘method,’ by which I mean drilling the resident in collecting clinical data such as medical history, physical examination, and laboratory data; next the resident organizes the collected data into practical problem lists from which he/she develops his/her own clinical assessment (or diagnosis) and plan through one’s own data analysis. This method is not new; it was introduced to the American medical educational system in the 1960’s by Lawrence Weed, MD.* I have observed that Japanese medical students and residents have not been trained to apply this method in spite of recent medical school curriculum alterations. The generic names for this method are: ‘Problem Based Learning’ (PBL), a method used for medical students who discuss a clinical case lead by clinicians using printed(or PowerPoint) clinical cases; or ‘Problem Oriented System’ (POS), a method for medical students, residents and all physicians to present their own patient cases for discussion with other residents and staff, in both written and oral formats.

The techniques I use to teach PBL are :

1. Pre-printed worksheets which provide the structure for the resident to collect and organize the clinical data.The 6-7 pages comprise the standard items used throughout North America for newly admitted inpatients, including history of present illness, past medical history, allergies, current medication, review of systems, physical examination, laboratory data, problem list, assessment, plan of studies and plan of treatment.

2. However, the application of the worksheets is not easy; it requires the resident to receive repetitive tutorials and corrective feedback from qualified instructors, I find that simply distributing the worksheets to the medical students and residents results in incomplete and poorly understood assessment of their patients. Also the medical student and resident needs immediate direct praise and encouragement as he/she slowly learns PBL, an important feature not commonly taught in Japanese medical schools. The tutorial sessions are convenient and comfortable places to express praise to the medical student and residents, Lastly senior residents and staff need assistance in showing medical students and junior residents the best use of the worksheets. Their use is not intuitively obvious. For these reasons I have not include the worksheets in my website nor distribute them freely.
3. Application of medical handbook data to clinical problems has been quite difficult for medical students and residents. Most residents would rather be told the clinical plan by their senior physicians rather than think through the problems for themselves.

4. Evidence-based medicine is simplified for the medical student and resident to use in practical manner; I demonstrate and they practice finding information in handbooks, textbooks and simplified Internet searches . On occasion I encourage detailed Internet literature searches, such as Medline

Continued on POS Page 2

*Weed LL. Medical records that guide and teach. N Eng J Med 1968:278:593-600 and 652-657