A Handbook for Teaching and Learning in Higher Education Enhancing academic and Practice

Medicine and dentistry
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demonstrable rebound tenderness. There was no organomegaly or ascites. Bowel
sounds were present. Mr Hennessy’s blood pressure was 130/90mmHg, and his
pulse rate was 80 beats/minute. Dr Oshima asked Mr Hennessy to provide a
fresh urine sample. The sample was dark brown in colour. Asked about his stools,
he admitted that he had noticed they had been a bit paler than usual.
Students discuss the implications of the new information and suggest investigations
which might be carried out. They discuss the relevant anatomy of the hepatobiliary tree,
jaundice and the significance of the results.
The students are then supplied with the results of relevant investigations including blood
tests and an ultrasound scan; they discuss the significance of these findings and suggest
what further action should be taken.
An ERCP was arranged which confirmed the presence of several small stones in
the common bile-duct.
The students compare and contrast the techniques for detecting stones. They discuss
informed consent for ERCP and suggest treatments.
A sphincterotomy was performed to remove the stones.
The students discuss what they know about the procedure, alternatives and prognosis.
The case would then develop further with such complications as a post-operative
infection, recurrence of the gallstones or perhaps a subsequent infection with
hepatitis. At each stage, the students draw up a list of topics to research and
feedback on. A single case usually spans three tutorials, and may be up to 20
pages long, depending on its complexity.
Students enjoy this way of learning. They are in control and decide what to
research, and because they all research every learning issue, the debate during
feedback is often at a very high level and enormously stimulating for the staff to
listen to. The different members of the group bring different experiences to the
tutorial, depending on their background knowledge. They feed off each other’s
skills and knowledge. This form of PBL mirrors real life, albeit in slow motion,
and helps the students to think clinically, learn medical terminology and interpret
clinical data (especially since they are supplied with real lab reports, radiological
tests, photomicrographs and patient discharge summaries). At the same time,
the students learn their basic science through these ‘real’ cases. Although their
learning is less detailed, it is much more relevant, deeper and more lasting.
Students have a problem knowing whether or not they have learnt enough in
PBL. They only really find this out when they are assessed. But it is the cases, not
the assessment, that drives the learning. The assessment defines the depth of their
learning. By asking searching questions where students have to reason and apply
their knowledge, they learn to reach beneath the trivial detail and get at the
underlying concepts. That is what PBL is all about. And it’s great fun.