Anyone doing GEM in UL?

liberal

Hi,

Looking at options now, would love to hear of experiences in UL or any of the other GEM for that matter

Pleo

Avoid UL GEM like a plague

chanste

Hi there,

I started 1st year GEM in UL this year and I think the course is really good. I've no frame of reference to compare it to other courses, but the timetable layout is really good, and from what I hear the biggest difference to other med courses, which I understand are more lecture orientated.

Every week is a new case whereby you try to solve a hypothetical patients problem, for example one case was to do with a man presenting with deafness. So even though its quite a simple problem to any qualified Dr. we go through it pretty much like House and his team would approach a difficult problem (That is, about 10 students from varied backgrounds will try come up with ideas with minor direction from a qualified tutor). So aftre the 1st session your team generates its own learning objectives and the tutor will tell you if you missed anything important. You then go study them and have a 2nd bash at it several days later, with a lecture or 2 from specialists in the relevant fields to reinforce your studies in between.

I've found it incredible how much can be covered this way, because the information you are absorbing is being provoked by the problem session, studied in your own time to give you a broad understanding, and then compounded by lectures, and then if your still mixed up about anything the 2nd session were you throw about ideas and things you've learned among your group will usually iron out a few misunderstandings.

The weekly cases are also chosen very well so that it is the perfect mix of coming across things again just in the nick of time so it isn't being forgotten.

As for workload, pretty much everyone complains that it is too much, and most of our class will spend large amounts of time in the library.

I think the Problem Based Learning style of the course has worked for me very well though I have heard other people say that they wish there was a little more didactic lectures for the more complicated things which can be very difficult to study on your own. I benefit from the constant requirement to keep up, because you would be very much noticed if you went into the weeks 2nd or 3rd session without preparing.

BTW it is still quite a new course (we currently do not have 4th years), and its reputation has yet to be established so some might see this as a bit of a gamble, but it uses a curriculum designed by St. Georges in london which seems highly reputed, and we do benefit from having lectures from their Profs from time to time by video conference.

Anyhow I fear I've been waffling on a bit so I hope that helps.

Steve

chanste

Pleo wrote: »

Avoid UL GEM like a plague

Why do you say that?

ORLY?

chanste wrote: »

So even though its quite a simple problem to any qualified Dr.

The PBL case maybe, the anatomy mini-cases not so much, they're tough.
Your synopsis is quite good. I'm a second year and like the setup - no regrets.

Pleo wrote: »

Avoid UL GEM like a plague

chanste wrote: »

Why do you say that?

Perseveration, not good.

Pleo wrote: »

aviod trinity like a plague

tallaght01

The biggest success of the PBL curriculum, in my view, was convincing students they aren't being ripped off.

A study published recently in the UK asked consultants and registrars their opinions on the recent med graduates, and most felt that they weren't prepared for the wards when they qualified.

I would argue that's the view of a lot of doctors out there.

Not the students' fault, but the unis need to wise up a bit. making the course easier does no one any favours at all. It's not even fair on the students who are really struggling when they qualify.

chanste

tallaght01 wrote: »

A study published recently in the UK asked consultants and registrars their opinions on the recent med graduates, and most felt that they weren't prepared for the wards when they qualified.

But isn't that the motivating factor behind why they changed the curriculum? I mean I'm sure PBL existed in some form or other for a long time, but the way UL/St. George's course is laid out is pretty new, and the entire 1st 2 years pivots around these cases.

tallaght01 wrote: »

I would argue that's the view of a lot of doctors out there.

Not the students' fault, but the unis need to wise up a bit. making the course easier does no one any favours at all. It's not even fair on the students who are really struggling when they qualify.

I think there is a sense on our course that we are really still at the stage were we have yet to prove ourselves, but as I said I think our course is bitch hard though it may have been harder for people who went in and done the 6 year course straight off. I've no frame of reference to make that judgement, but then neither does anyone who has gone through the 6 year course.

I'm sure people will judge the students on the course purely as students who couldn't get 580 points, but I know it is harder to pass the GAMSAT than to repeat the leaving and get those points (based on having taught 4 LC subjects - the LC is a piece of piss compared to GAMSAT), so I hope in time it will be taken seriously, I mean the fact that everyone on the course has had to get a 2.1 degree before coming in is something (even if not as much as it used to mean)

tallaght01

It's nothing specific to your course. But if you ask docs with no connection to the uni about PBL, most will tell you it's not working well. That study I talked about was quite recent. IN fact, in the UK, there has been a sharp move away from teaching by PBL at some unis because of how badly the students were prepared. In one hospital where I worked, the consultants sent a letter to the Dean of the local med school pleading with them to stop teaching by PBL.

It's a tough course, PBL or not. But it's about what you achieve at the end of it.

The issue people have with GAMSAT is that about 1 in 3 or 1 in 4 (depending on where you are) people who sit it get offered a place. Plus there's evidence that GAMSAT score has only a moderate correlation with med school performance, whereas even things like HPAT/UKCAT correlate better. There was a study a while back showing that the average GAMSAT entrant scores lowest on the "reasoning in biological sciences" (I think that's the name of the section) part of the test. That's a worry.

That's one of the reasons the likes of oxford/cambridge/trinity are not mad on GAMSAT. In fact it was discussed at a big medical education conference a while back.

But we've had all this before. No one wants to hear it. I doubt I would if I was starting a PBL course. The universities have an interest in GEM, so no one is going to lose out. In fact, it's going to expand.

Pleo

chanste wrote: »

Why do you say that?

Just to get people to respond to this thread, because I am also interested in this topic very much. I have no experience whatsoever of any GEM programs in Ireland.

ORLY?

tallaght01 wrote: »

The biggest success of the PBL curriculum, in my view, was convincing students they aren't being ripped off.

A study published recently in the UK asked consultants and registrars their opinions on the recent med graduates, and most felt that they weren't prepared for the wards when they qualified.

I would argue that's the view of a lot of doctors out there.

Not the students' fault, but the unis need to wise up a bit. making the course easier does no one any favours at all. It's not even fair on the students who are really struggling when they qualify.

A UK study - link?

Recent grads aren't prepared for the wards? There is no delineation between traditional and PBL students there. It can't possibly be inferred that the respondents thought that PBL students were particulary under prepared.

You should know yourself that for every study saying one thing there is often another saying the opposite...

"Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums. Importantly, though, students from PBL curriculums seem to have better knowledge retention."

Link

On being ripped off? I don't get it - it's generally accepted that PBL is more costly to implement than a traditional course.

Link

and

Another

Finally, where are you getting the notion that the courses are easier?

tallaght01

ORLY? wrote: »

A UK study - link?

Recent grads aren't prepared for the wards? There is no delineation between traditional and PBL students there. It can't possibly be inferred that the respondents thought that PBL students were particulary under prepared.

You should know yourself that for every study saying one thing there is often another saying the opposite...

"Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums. Importantly, though, students from PBL curriculums seem to have better knowledge retention."

Link

On being ripped off? I don't get it - it's generally accepted that PBL is more costly to implement than a traditional course.

Link

and

Another

Finally, where are you getting the notion that the courses are easier?

I don't have the link on this coputer. I can post it tomorrow if you like. It's in the journal Postgraduate medicine. But it was from the Trent deanery, where Nottingham supplies most of the graduates from it's PBL course.

Of the three studies you linked. Two were 17 year old reviews (as opposed to original data). One made no conclusion about the standard of PBL students. The other said specifically that PBL had not made improvements, despite being more costly. The 3rd is from 2003, when PBL had only being going a short time, and the article needs a sign in, so I'll look at it later. But, we should be using the latest evidence when we look at research.

The reason i say PBL students get ripped off is because they get less access to tutors, and have to do much more of the work themselves.

Again, I'm sorry if that this will offend people. I did PBL for a year, and they got rid of it. It was balls. It was much less productive than actual teaching. Having said that, I think PBL could be useful along with lots of teaching. BUt many of the unis only have med students in for 10-15 hours per week now. They used to 3-35 hours of teaching. This use of PBL with only a couple of lectures per week is what worries a lot of doctors.

EDIT: Just saw the 3rd article. It's an 7 year old opinion piece with no reference list.

ORLY?

The second two articles weren't intended to show that PBL is better than the traditional method, just that the motivation for implementing it isn't financial.

You say that the grads in the study you were talking about are from Nottingham PBL, so they're not being simultaneously compared to controls from traditional courses but just to past performance as the doctors can remember it? So, it is possible that standards in both streams could be declining, that the doctors have recall bias, that they are biased against the PBL methodology etc? Is it true that the sample only represents one university? It could be more representative of the uni than the overall system? I would be interested in seeing the article if you can find the link please. Here is a study from the States showing that one PBL course has students that score significantly above average on the USMLEs step 1 and 2 and were rated in their clinical years as significantly better than traditional students in a range of areas...

Link

It doesn't prove anything on the overall effectiveness of PBL, it's probably as open to criticism as I'm sure the study you're talking about is.

2Scoops

tallaght01 wrote: »

Plus there's evidence that GAMSAT score has only a moderate correlation with med school performance, whereas even things like HPAT/UKCAT correlate better.

It's not surprising that GAMSAT score correlates poorly with med school performance since this correlation necessarily excludes people with a GAMSAT score below the cut-off. For a strong correlation, X and Y have to vary. What's far more surprising, to me at least, is that HPAT or UKCAT correlate better - can you remember where you came across this info??

tallaght01

ORLY? wrote: »

The second two articles weren't intended to show that PBL is better than the traditional method, just that the motivation for implementing it isn't financial.

You say that the grads in the study you were talking about are from Nottingham PBL, so they're not being simultaneously compared to controls from traditional courses but just to past performance as the doctors can remember it? So, it is possible that standards in both streams could be declining, that the doctors have recall bias, that they are biased against the PBL methodology etc? Is it true that the sample only represents one university? It could be more representative of the uni than the overall system? I would be interested in seeing the article if you can find the link please. Here is a study from the States showing that one PBL course has students that score significantly above average on the USMLEs step 1 and 2 and were rated in their clinical years as significantly better than traditional students in a range of areas...

Link

It doesn't prove anything on the overall effectiveness of PBL, it's probably as open to criticism as I'm sure the study you're talking about is.

Well, the statistical significance is pretty well open to criticism, in fairness! PLus performance in USMLE is one indicator. Where doctors on the wards have been having the problems is with ward-readiness. If you just google "PBL is the best" you'll find stuff all day. But I said doctors were worried about PBL grads, and that's what the Trent deanery shows. It has a big proportion of Nottinghham students. BUt there are also students from lots of other unis. I've not seen any decent studies in the recent literature backing up the claim that PBL is better.

2Scoops wrote: »

It's not surprising that GAMSAT score correlates poorly with med school performance since this correlation necessarily excludes people with a GAMSAT score below the cut-off. For a strong correlation, X and Y have to vary. What's far more surprising, to me at least, is that HPAT or UKCAT correlate better - can you remember where you came across this info??

The entry results for GAMSAT vary reasonably significantly, so I don't think it would be unreasonable to assess correlation. Though my own gut feeling is that there is nothing about GAMSAT or HPAT that would make it correlate well with performance.

I wish I could. I'll look back though my work stuff and see if I can find it. But, essentially, GAMSAT seemed to have no real correlation, whereas HPAT style exams had a mild correlation. I read it ages ago, but I'll do my best to get it for ya.

EDIT: Here's the Nottingham one:

http://pmj.bmj.com/cgi/content/short/85/1009/582?q=w_pmj_current_tab

2Scoops

tallaght01 wrote: »

The entry results for GAMSAT vary reasonably significantly, so I don't think it would be unreasonable to assess correlation.

The entry results don't vary that much at all, from what I've seen on this forum. The percentile curves indicate that most entrant's scores cluster about the cut-off and once they score a few points points above that, they're out in the 99th percentile! That tells me that nearly every entrant got within 2 or 3 points of the cut-off, with only a few people getting high scores and a vanishingly small # of people getting very high scores. That kind of distribution does not bode well for a significant correlation with med degree performance. :pac:

tallaght01 wrote: »

I wish I could. I'll look back though my work stuff and see if I can find it. But, essentially, GAMSAT seemed to have no real correlation, whereas HPAT style exams had a mild correlation. I read it ages ago, but I'll do my best to get it for ya.

Thanks man. I honestly find that fascinating and would like to read it, but no worries if you can't find it.

tallaght01 wrote: »

http://pmj.bmj.com/cgi/content/short/85/1009/582?q=w_pmj_current_tab

Back OT, I have no strong opinions on PBL. Personally, I don't think I would like it as a student. It just seems like a 'gimmick' or something. But whether it makes a difference in graduate quality, I have no idea. The paper above reveals little; I'd like to see a comparison between PBL students vs. traditional lecture-based etc.

tallaght01

2Scoops wrote: »

The entry results don't vary that much at all, from what I've seen on this forum. The percentile curves indicate that most entrant's scores cluster about the cut-off and once they score a few points points above that, they're out in the 99th percentile! That tells me that nearly every entrant got within 2 or 3 points of the cut-off, with only a few people getting high scores and a vanishingly small # of people getting very high scores. That kind of distribution does not bode well for a significant correlation with med degree performance. :pac:



Thanks man. I honestly find that fascinating and would like to read it, but no worries if you can't find it.



Back OT, I have no strong opinions on PBL. Personally, I don't think I would like it as a student. It just seems like a 'gimmick' or something. But whether it makes a difference in graduate quality, I have no idea. The paper above reveals little; I'd like to see a comparison between PBL students vs. traditional lecture-based etc.

I agree that the range is small. Like I said, it only took 1 or 2 points above average to be offered a place in the last few years. But the results for entries certainly differ by up to 10/11 points. But the point is that, for a new system to be introduced when there's a relatively good system in place, it should have an evidence base. That doesn't seem to be there. The point is that there is no correlation there, or a very mild one. The reasons for that are debatable, but the evidence still isn't there.

The Trent paper was used to illustrate the fact that docs don't think graduates are ready for ward work when they're graduating these days. It's a mix of GEM/PBL/tradition students. But the fact that most fo the students come from a PBL background is reasonably significant. It's also true to say that, if you're looking for reasons why the unior docs are not performing as well, then changes to the curriculum would have to be high up on the suspicion list.

At the end of the day, though, the attitude of docs on the wards seems to be that there's a problem with medical education. Certainly in the UK and Oz.

I'll try and find some kind of reference for those correlation studies. I'm on a day off, but need to go into work anyway, so I'll see what's still on my hard drive.

Apologies to the person who started this thread wanting to know if UL is decent. I'll let you get back to that :P

2Scoops

tallaght01 wrote: »

But the point is that, for a new system to be introduced when there's a relatively good system in place, it should have an evidence base. That doesn't seem to be there.

The LC? I would love to see a correlation of LC points with med school performance! :pac:

tallaght01 wrote: »

The Trent paper was used to illustrate the fact that docs don't think graduates are ready for ward work when they're graduating these days.

Devil's advocate, but maybe they would have felt the same 10 or 20 years ago? There is no comparison there with prior rates of SpR/consultant satisfaction with 1st years.

tallaght01 wrote: »

At the end of the day, though, the attitude of docs on the wards seems to be that there's a problem with medical education. Certainly in the UK and Oz.

The grumpy old man effect? There were similar concerns when I was working in Irish hospitals... in the 1990s!

Personally, I would point at the quality of tutors these days before I would point at the curriculum.

tallaght01

2Scoops wrote: »

The LC? I would love to see a correlation of LC points with med school performance! :pac:



Devil's advocate, but maybe they would have felt the same 10 or 20 years ago? There is no comparison there with prior rates of SpR/consultant satisfaction with 1st years.



The grumpy old man effect? There were similar concerns when I was working in Irish hospitals... in the 1990s!

Personally, I would point at the quality of tutors these days before I would point at the curriculum.

The system that "worked" was the LC/bit of grad entry/traditional curriculum. Ireland has been producing high quality doctors for donkeys years. I just wondered why that had to change.

I've thought long and hard about the grumpy old man effect. But at the end of the day PBL was brought in to give us high quality grads. So, whether the previous cohort were worse or better, I don't think people on the ground feel that PBL are delivering high quality grads. So, at best it may be no worse. But it costs a lot more. I've not met anyone in the hospitals who thinks they're better.

But I've never seen the discontent that I've seen in the UK. They've made the intern year 2 years long, and the amount of responsibiity given to interns is pretty tiny, which I think is very telling (though, there needed to be a redress of the balance where interns were completely abandoned, in fairness)

ORLY?

tallaght01 wrote: »

Well, the statistical significance is pretty well open to criticism, in fairness! PLus performance in USMLE is one indicator. Where doctors on the wards have been having the problems is with ward-readiness. If you just google "PBL is the best" you'll find stuff all day. But I said doctors were worried about PBL grads, and that's what the Trent deanery shows. It has a big proportion of Nottinghham students. BUt there are also students from lots of other unis. I've not seen any decent studies in the recent literature backing up the claim that PBL is better.

The statistical significance? P value <0.01, seems pretty significant to me? Did you look at the paper or my post? It isn't just based on USMLEs (stage 1 and 2 by the way) but on the opinions of doctors on the wards who rated the PBL students higher in most categories again with a P value <0.01. I'll have a look at the Nottingham paper when I get a chance.

If I google "PBL is the best" I'm entirely sure I'll get exactly what I'm looking for, as I will if I google "PBL is crap". This was my initial point - a dogmatic stance should not be taken either way on the basis of a study like the one you listed or the one I did. It's likely that neither system may be better, the quality of each individual uni will be more of a factor. Even if one system is better it's likely that the literature wouldn't be able to prove it either way, which is what's been shown right here in this thread with two conflicting studies.

tallaght01

ORLY? wrote: »

The statistical significance? P value <0.01, seems pretty significant to me? Did you look at the paper or my post? It isn't just based on USMLEs (stage 1 and 2 by the way) but on the opinions of doctors on the wards who rated the PBL students higher in most categories again with a P value <0.01. I'll have a look at the Nottingham paper when I get a chance.

If I google "PBL is the best" I'm entirely sure I'll get exactly what I'm looking for, as I will if I google "PBL is crap". This was my initial point - a dogmatic stance should not be taken either way on the basis of a study like the one you listed or the one I did. It's likely that neither system may be better, the quality of each individual uni will be more of a factor. Even if one system is better it's likely that the literature wouldn't be able to prove it either way, which is what's been shown right here in this thread with two conflicting studies.

EDIT: was embarrasingly looking at a different paper when I wrote this reply!!!!

But the Missouri paper was looking at small numbers, and USMLE.

I don't know about the effect of PBL on USMLE scores. I know their med school was producing lower than average USMLE scores before PBL was brought in. Plus the results comparing the old curriculum with the national average weren't statistically significant, so it's hard to compare.

Looking at the amounts of people in the 95t centile etc, they're talking about the difference between 1 and 2 people, or similarly tiny numbers.

I think GAMSAT/PBL etc have to prove themselves. i think the onus is on them, because of the costs involved.

I don't think there's any way you can say they have a good evidence base behind them. Plus there's lots of (highly anecdotal) evidence that the docs on the wards think we're getting worse grads, as is evidenced by the much reduced responsibility of new interns.

But, it's here to stay. The unis have invested too much in it. I still teach all types of student without prejudice. Though I know the traditional grads are of a higher standard in my experience.

i just think you should have lots of evidence on which to base change, especially when you're changing a good system.

My worry in all of this is that I've always been concerned about patient care. But the report (can't remember what it was called) that urged change in medical training, did so to improve access to medical training. I'm all in favour of improving access for the brightest kids. I'm not in favour of reducing the requirements to the extent that 1 in 3 people sitting GAMSAT in some years are being offered places, with 2 points above the average.

But we've had all this before, and I know people don't agree with me. Like I said, if I was entering med school now, I wouldn't want to hear it either.

ORLY?

tallaght01 wrote: »

Only a minority of the p-values were below .05 when they were showing the pre-PBL results for USMLE, so how do we know what we're comparing?and there were no confidence intervals if I recall correctly. PLus you were dealing with literally handfuls of students. Very small numbers to make any assumptions about PBL.

Most of the time before PBL, the scores were not significantly different to the national average, but one year they were significantly below. After PBL they were significantly higher 6 out of 9 times and never significantly lower. The number of years before and after the transition isn't the same but I'd say that's because the USMLEs started in the early 90s.

On the confidence intervals - there wouldn't be any. They're not trying to determine population parameters (the mean score and distributions for the USMLEs are known) but comparing one distribution to another.

I agree that the numbers are way too small and unrepresentative to make any inferences (assumptions is the wrong word) about PBL in general, but perhaps not to infer that PBL at this particular uni was a success. Of course there could be a whole load of confounding variables that aren't accounted for.

To be dismissive of this study and yet to be using one that doesn't even contain the phrase PBL (as in the Nottingham one) as evidence against the entire PBL process is a sign of an irrational bias imo.

tallaght01

ORLY? wrote: »

Most of the time before PBL, the scores were not significantly different to the national average, but one year they were significantly below. After PBL they were significantly higher 6 out of 9 times and never significantly lower. The number of years before and after the transition isn't the same but I'd say that's because the USMLEs started in the early 90s.

On the confidence intervals - there wouldn't be any. They're not trying to determine population parameters (the mean score and distributions for the USMLEs are known) but comparing one distribution to another.

I agree that the numbers are way too small and unrepresentative to make any inferences (assumptions is the wrong word) about PBL in general, but perhaps not to infer that PBL at this particular uni was a success. Of course there could be a whole load of confounding variables that aren't accounted for.

To be dismissive of this study and yet to be using one that doesn't even contain the phrase PBL (as in the Nottingham one) as evidence against the entire PBL process is a sign of an irrational bias imo.

No, my stance is very simple.

You can't present a small paper where some of the results are significant, but the results they're comparing it to aren't, and take much from it.

The onus is on the GAMSAT/PBL people to show us why this is a better course. That paper doesn't do that. None of the papers I've seen do, either.

So, we have a course that is more expensive to run, is often easier to get into and we don't know if it's any better.

Yet we do have one large study showing that docs don't think the new grads in the UK are ready for life on the wards. The major change in the curriculum in the UK has been GEM and PBL. Most of the grads they were surveyed about were PBL and/or GEM.
It would be nice to compare groups. But in the absence if this, you should be able to show us that GAMSAT/PBLers are quality grads. But the feeling on the ground seems to be that is not the case.

The only comparative trials I've seen recently showed PBL to be less effective.

http://www.ncbi.nlm.nih.gov/pubmed/19785777?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_MultiItemSupl.PMC_FreeArticle_ad&linkpos=2&log$=pmcad6_article

I saw another study recently where the students self-reported better understanding of epidemiology principles, but performed no better in tests. Was in a journal called academic medicine, I think.

The only meta-analysis I've seen was ancient and seemed to show PBL students performing worse.

http://www.ncbi.nlm.nih.gov/pubmed/8323649?dopt=Abstract

These studies all have obvious limitations.

But the point I'm making is that a good new curriculum that's producing better doctors should have a solid evidence base. But that is not the case. There is nothing out there for docs like me who see the differences in the knowledge of the traditional students compared to the new types.

I just don't see how we're getting any bang for our buck.

As an aside, University of sydney have published a nice review of some of the literature, which is worth a read.

http://www.medfac.usyd.edu.au/forstaff/usydmp-admissionsreview/Medicine_Admissions_Review_Report.pdf

They reckon pre-admission GPA is the best predictor. GAMSAT is a weak indicator of academic performance, but a reliable way to rank students.

liberal

tallaght01 wrote: »

No, my stance is very simple.

You can't present a small paper where some of the results are significant, but the results they're comparing it to aren't, and take much from it.

The onus is on the GAMSAT/PBL people to show us why this is a better course. That paper doesn't do that. None of the papers I've seen do, either.

So, we have a course that is more expensive to run, is often easier to get into and we don't know if it's any better.

Yet we do have one large study showing that docs don't think the new grads in the UK are ready for life on the wards. The major change in the curriculum in the UK has been GEM and PBL. Most of the grads they were surveyed about were PBL and/or GEM.
It would be nice to compare groups. But in the absence if this, you should be able to show us that GAMSAT/PBLers are quality grads. But the feeling on the ground seems to be that is not the case.

The only comparative trials I've seen recently showed PBL to be less effective.

http://www.ncbi.nlm.nih.gov/pubmed/19785777?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_MultiItemSupl.PMC_FreeArticle_ad&linkpos=2&log$=pmcad6_article

I saw another study recently where the students self-reported better understanding of epidemiology principles, but performed no better in tests. Was in a journal called academic medicine, I think.

The only meta-analysis I've seen was ancient and seemed to show PBL students performing worse.

http://www.ncbi.nlm.nih.gov/pubmed/8323649?dopt=Abstract

These studies all have obvious limitations.

But the point I'm making is that a good new curriculum that's producing better doctors should have a solid evidence base. But that is not the case. There is nothing out there for docs like me who see the differences in the knowledge of the traditional students compared to the new types.

I just don't see how we're getting any bang for our buck.

As an aside, University of sydney have published a nice review of some of the literature, which is worth a read.

http://www.medfac.usyd.edu.au/forstaff/usydmp-admissionsreview/Medicine_Admissions_Review_Report.pdf

They reckon pre-admission GPA is the best predictor. GAMSAT is a weak indicator of academic performance, but a reliable way to rank students.

hi tallaght

my biggest defence of the PBL is that when PBL students finish 2nd year they the go into the clinical phase (or what every one calls the last 2 years of med) along with the students from the five year course who have just finished 3rd year. I imagine these two years make or break good doctors so its reassuring that the statue quo is maintained.

There is holes in the GAMSAT,

for example

S1 50
S2 90 (imagine someone that had 2 template essays and got lucky)
S3 50
Score: 60 (prob get any college in Ireland)

S1 62
S2 60
S3 59
Score: 60

Which would u prefer? I'm the 2nd guy btw

In the case of example 1 the person MIGHT not be accepted to some UK unis (eg Notts/SGL) as they examine the results to see if someone aced one section and is week at the others, in Ireland the Fianl Score is treated like LC points, they have absolute value

MicraBoy

liberal wrote: »

hi tallaght

my biggest defence of the PBL is that when PBL students finish 2nd year they the go into the clinical phase (or what every one calls the last 2 years of med) along with the students from the five year course who have just finished 3rd year. I imagine these two years make or break good doctors so its reassuring that the statue quo is maintained.

There is holes in the GAMSAT,

for example

S1 50
S2 90 (imagine someone that had 2 template essays and got lucky)
S3 50
Score: 60 (prob get any college in Ireland)

S1 62
S2 60
S3 59
Score: 60

Which would u prefer? I'm the 2nd guy btw

The UK uni's have minimum cut offs for each section of 55, so a candidate wouldn't get jack in the first example in the UK. I find it bizarre that isn't the case in Ireland.

liberal

I read somewhere that when GEM is producing graduates at full capacity there wont be enough spaces for Interns, and that a CAO style centralised placement system will be established allocating on the basis of merit, anyone hear anything like this? Ireland 2 France 0 you heard it here first

tallaght01

liberal wrote: »

hi tallaght

my biggest defence of the PBL is that when PBL students finish 2nd year they the go into the clinical phase (or what every one calls the last 2 years of med) along with the students from the five year course who have just finished 3rd year. I imagine these two years make or break good doctors so its reassuring that the statue quo is maintained.

There is holes in the GAMSAT,

for example

S1 50
S2 90 (imagine someone that had 2 template essays and got lucky)
S3 50
Score: 60 (prob get any college in Ireland)

S1 62
S2 60
S3 59
Score: 60

Which would u prefer? I'm the 2nd guy btw

I don't know what the sections are. But I just think that the scores are a bit low to gain entry, insofar as it only takes one or 2 points above the average to get in.

I don't want to dwell n your personal results, as the last time we had this debate, people got very offended. I don't think GAMSAT/PBL people will fail med school. I just think medical school admission should be very very difficult, in order to produce a high standard of doctors, which Ireland always had.

I also think the academic staff owe it to students to spend a lot of time teaching them, rather than having GPs/public health docs/nephrologists taking the cardiology PBL groups (this happened to me!).

I think the PBL structure could be ok when heavily supported with teaching. But that doesn't happen. Some places are only doing 15 hours per week. I know we suffered much less actual teaching when they piloted PBL with us.
PLus someone started this thread to ask about UL.

MicraBoy

liberal wrote: »

I read somewhere that when GEM is producing graduates at full capacity there wont be enough spaces for Interns, and that a CAO style centralised placement system will be established allocating on the basis of merit, anyone hear anything like this? Ireland 2 France 0 you heard it here first

liberal there is a whole other thread somewhere on the boards discussing that issue (the number of intern places available in years to come, not the fact that we are going to kick France's arse on Saturday)

tallaght01

liberal wrote: »

Ireland 2 France 0 you heard it here first

Not without Andy Reid, my man :P

ORLY?

tallaght01 wrote: »

No, my stance is very simple.

You can't present a small paper where some of the results are significant, but the results they're comparing it to aren't, and take much from it.

The onus is on the GAMSAT/PBL people to show us why this is a better course. That paper doesn't do that. None of the papers I've seen do, either.

So, we have a course that is more expensive to run, is often easier to get into and we don't know if it's any better.

Yet we do have one large study showing that docs don't think the new grads in the UK are ready for life on the wards. The major change in the curriculum in the UK has been GEM and PBL. Most of the grads they were surveyed about were PBL and/or GEM.

Small paper? The entire graduating class of over 10 years are looked at, it's no smaller than the one you linked. The methodologies for both papers are very similar, but one makes conclusions on the effectiveness of PBL in a particular college the other tries to make conclusions about the entire educational system in the UK with no direct mention of PBL. They're both interesting and both open to criticism, I'd be scpetical about using either to draw conclusions about PBL as a whole, but you are convinced that the Nottingham one makes a case against PBL - that's just a leap beyond what's actually there.

Your stance and opinion are obvious, no harm there, but when it clouds your ability to look objectively at studies it isn't helpful and leads away from proper scientific appraisal of data and leads to more reliance on feelings.

To the OP, I'll get back a bit to UL, I really like it. You'll be pushed, believe me, but the motivation in the class (my year anyway) is unreal. Realistically, on top of anatomy tutorials, lectures, clinical skills and PBL time you'd want to be putting in 7/8 hrs a day/night and some weekend time to really cover everything they expect, but everyone puts in that kind of time, it just becomes instinct.

liberal

MicraBoy wrote: »

The UK uni's have minimum cut offs for each section of 55, so a candidate wouldn't get jack in the first example in the UK. I find it bizarre that isn't the case in Ireland.

its 55 in s2 then above 50 in one other sec

MicraBoy

liberal wrote: »

its 55 in s2 then above 50 in one other sec

55 in S3 surely?

liberal

My 2 cents if I may,

The goal of GEM is to teach Medicine a diverse group of people that have made an adult decision to pursue a career as a doctor. Selection is based on previous academic performance in wide range of areas. Assesment of candidate is basede on their ability to reason in the social and life sciences, to deal with complex unseen information and to perform mentally under pressure. To me this seems fairer and wiser than basing selection on a condidates ability to study, memorise and level of discipline.

From what I can see, undergraduate medicine has a lot of intelligent, self-driving and will-succeed-at-anything people, but it also has alot of dopes with no social skills or any idea of life outside of med. Giving a new crop of people a swing off the bat can only be a good thing, if PBL turns out be be a crock of ****e I'll go off and live with the Himalyan Mountain People like I've always wanted to

Keane and Dunne will score

liberal

MicraBoy wrote: »

55 in S3 surely?

oh sorry

its 55 s2 and then 55 in s1 or s3 and then 50 in the remaining one

tallaght01

ORLY? wrote: »

Small paper? The entire graduating class of over 10 years are looked at, it's no smaller than the one you linked. The methodologies for both papers are very similar, but one makes conclusions on the effectiveness of PBL in a particular college the other tries to make conclusions about the entire educational system in the UK with no direct mention of PBL. They're both interesting and both open to criticism, I'd be scpetical about using either to draw conclusions about PBL as a whole, but you are convinced that the Nottingham one makes a case against PBL - that's just a leap beyond what's actually there.

Your stance and opinion are obvious, no harm there, but when it clouds your ability to look objectively at studies it isn't helpful and leads away from proper scientific appraisal of data and leads to more reliance on feelings.

.

Yea, but it's ONE medical school, in fairness, with all the problems that entails in taking anything from it.

The Trent study, for what it's worth, had no "sample size" of medical students. It surveyed doctors attitudes to graduates in a deanery.

They're not comparable.

But the point stands, that we have no decent evidence so far that this new system workers.

That really has to be the bottom line here, and it forces some of us to make our decisions based on experience and anecdote.

locum-motion

Pleo wrote: »

Just to get people to respond to this thread, because I am also interested in this topic very much. I have no experience whatsoever of any GEM programs in Ireland.

I was waiting with interest to see if you'd justify your post.
You're now admitting to posting a controversial post just to get a reaction.
IMO, that's trolling, and it gets you a warning from me. Do not do it in this forum again.

Lassiecomehome

tallaght01 wrote: »

They've made the intern year 2 years long

Just to clear this up, the Intern year has not been made 2 years long. The first 2 years out of medical school have been linked. FY1 (Foundation Year 1) is analagous to Intern year and FY2 to house officer. The two years are linked so you know where you will be working for 2 years from graduation forward e.g. in what speciality. You are fully registered after the FY1 year as is an Irish trained doctor following their Intern year.

tallaght01

Lassiecomehome wrote: »

Just to clear this up, the Intern year has not been made 2 years long. The first 2 years out of medical school have been linked. FY1 (Foundation Year 1) is analagous to Intern year and FY2 to house officer. The two years are linked so you know where you will be working for 2 years from graduation forward e.g. in what speciality. You are fully registered after the FY1 year as is an Irish trained doctor following their Intern year.

But you're not fully registered in the UK until you've completed both years, as far as I remember.

Certainly when we had FY2s we were treating them as interns. though that may not have been the same in general medicine and gen surgery. We had FY1s and FYs in paeds doing the same job.

But I don't know what the official line on that was supposed to be.

Lassiecomehome

tallaght01 wrote: »

But you're not fully registered in the UK until you've completed both years, as far as I remember.

You remember wrong. You have full registration with the GMC after completing FY1

tallagh01 wrote:

Certainly when we had FY2s we were treating them as interns. though that may not have been the same in general medicine and gen surgery. We had FY1s and FYs in paeds doing the same job.

FY1s don't work in specialities like paeds, obs & gynae, ICU, A&E, psychiatry to name but a few. Those specialities are restricted to FY2s as it is thought (rightly) that you should have some more experience as a doctor before you undertake responsibility in them. FY1 you study a minimum 4 months of general medicine and general surgery. The remaining 4 months are spent doing further general medicine or surgery depending on your rotation e.g. you might have 4 months in a geriatric unit or rheumatology hospital. My particular rotation involves 6 months of both general medicine and surgery. If you did work with FYs in paeds it is likely they were FY2s who hadn't done paediatrics in 3 years and probably were like interns in your eyes. I am doing 4 months in neurosurgery as an FY2, although I will be a fully registered qualified doctor it is likely I will be doing much the same tasks on such a rotation as an FY1 and not the actual neurosurgery

tallaght01

Lassiecomehome wrote: »

You remember wrong. You have full registration with the GMC after completing FY1



FY1s don't work in specialities like paeds, obs & gynae, ICU, A&E, psychiatry to name but a few. Those specialities are restricted to FY2s as it is thought (rightly) that you should have some more experience as a doctor before you undertake responsibility in them. FY1 you study a minimum 4 months of general medicine and general surgery. The remaining 4 months are spent doing further general medicine or surgery depending on your rotation e.g. you might have 4 months in a geriatric unit or rheumatology hospital. My particular rotation involves 6 months of both general medicine and surgery. If you did work with FYs in paeds it is likely they were FY2s who hadn't done paediatrics in 3 years and probably were like interns in your eyes. I am doing 4 months in neurosurgery as an FY2, although I will be a fully registered qualified doctor it is likely I will be doing much the same tasks on such a rotation as an FY1 and not the actual neurosurgery

We always had FY1s/PRHOs in paeds and paeds surgery. Anaesthetics and A+E had them too. So did psych, I think. I don't know if they kept them, as I left the UK after about one year of that system.

And like I said, we put them on the same roster with FY2. But that may be because we, along with about 90% of the docs in the UK, had no clue what an FY was, or an ST1 etc.

I still don't to be honest. I just can't get my head around MMC and the current system. And I don't know who it benefits.