PBL Pearl Vol 2 (#8): The experience of a first time tutor

This week’s pearl is care of Dr. Bruce Rosenberg....he writes about his experience as a first time tutor.....well worth the read....

Dr. Maynard Luterman

***************************************************************************************

Maynard,

We are doing much better after implementing Mike's feedback. Our objectives for Ted Mitchell, the drunk (which might not sound PC but apparently is. As I was recently informed by someone: "I'm a drunk. Alcoholics want treatment.") prior to digesting Mike's comments were boring things like: Anat and Phys of Liver, What is CAGE, etc. We had a pre-case meeting and went to the much more interesting: Why is his belly swollen? Wazzup with the yellow? What should we do to find out where the hematemesis is coming from and once we know, why/how (which led to a great discussion of portal HiBP and varices).

So anat/phys has now become what we refer to as the ante. If you don't have that, you can't even play. Come with enough to be in the game and some days you will be the big guy (with lots of knowledge about the case) and other times you might not be The Guy, but on that day someone else probably will be loaded with knowledge and either way, the game will be exciting and interesting.

We begin answers to our questions with a basic overview of the underlying anat/phys or whatever basic knowledge everyone should have to offer a quick check for everyone that they understand the fundamentals. Since we all agreed to at least do this, the review is very efficient. Then the person who gave the quick overview can either try to answer the question (like Wazzup with the yellow?) or they can ask someone else in the group for their opinion. Mike was right that this stimulates a much more interesting discussion which creates some depth in the otherwise relatively thin layer of general knowledge they have. I have been reassuring them that, over time, they will create more areas of depth in their knowledge veneer and at some point, they will know quite a bit about the whole topic. For now, knowing a little about the whole and a lot about one area (as defined by the case), is what PBL seems to be about. Other than occasional straying (about liver regenesis), we were very focused and all agreed that the process felt a lot better. There was hardly any yawning and only one 5 minute break, which I take as positive signs.

Finally, to emphasize the importance of THIS CASE, we have agreed that, in contrast, each student will identify 3-5 other problems that could be this case but aren't. For example, we are doing the celiac case today. We expect that, when someone looks at Malabsorption Syndrome, there will be 85 differentials. We decided that they should read about differentials as part of their study, but since they can't digest all the information, instead try to pick out a few other problems that could give a young man weight loss and diarrhea over a 1 year period. Clustering of differentials will give them a reference point (Dr Cork) to remember similar conditions, rather than acute or other diarrheas that are not reasonable differential considerations. We are only going to spend a few minutes on this, but it will add some clinical flavor as well as provide a guideline when confronted with voluminous differential choices (find ones like the case and try to learn a tiny bit about them, then broaden your knowledge over the years from that starting point which, if we do the in depth case study properly, will be a well anchored point).

So, that's my report. Whether we are or not, we believe that we are 'getting it' and moving along a better track. Our previous track was more a series of mini-lectures from various students, although in fairness, the 2 failure to thrive cases are less conducive to our improved approach than Ted and subsequent cases.

We have a makeup session tonight and I think everyone is keen to see if we can repeat our positive experience of yesterday. Please thank Mike for me and let him know that his comments did not fall upon deaf ears. Maybe he will be able to attend a later session where we will be able to give him the ole Mac follow up/feedback so that he can fine tune his criticism of later groups (but in fairness, his comments obviously rang clear and we have modified our ways). Anyway, thanks Mike, but I don't have his email address.

In closing, I'm happy to report that my students are still med students at heart, already priming me for some of the answers they gave on their CAE's that I have not yet received for marking. I'm glad that the obsessive nature you and I had to gain admission has not been taken out of the future generation. I'll keep you posted.

Bruce