“Medical students are being trained to become physicians”  is an obvious truth, but one sometimes overlooked when designing basic science courses.  We are not training anatomists or biochemists, we are developing clinical problem solving physicians.  Let us educate them to that end and let us begin the first day of class. 

Gross anatomy is an ideal subject for developing problem solving skills while learning the basic vocabulary, morphology, and function of the human body.  At Tulane we first emphasize learning essential functional anatomy, and then we apply that knowledge to solve problems of dysfunction.  This thoroughly engages the students who recognize that they are already developing diagnostic skills as they discover the human body.  They view themselves as becoming physicians as they study anatomy.  We present them with problems as soon as they have the barest amount of information required to make some deductions.  This occurs on the first day and is repeated many times thereafter in many different formats.  As we approach the conclusion to study of an anatomical region or system we will present our students with formal Problem Based Learning Sessions (PBLS). These involve an actual clinical case, appropriate for first semester students, for which we have the case history, lab test results, and radiographs.  Fictitious names and circumstances are applied and the case is written in a booklet describing patient complaint and vital signs, history, physical exam results, test results including radiographs, therapy, and conclusion.  These components are each given a separate page in the booklet so that the students can encounter the “paper patient” in the proper sequence as they attempt to diagnose the case.  These PBLS are conducted with groups of nine students and one faculty facilitator and are widely acclaimed by students as being very useful, stimulating, and fun.

This past September we constructed a PBLS using “Standardized Patients (SPs)”  instead of paper ones to lend reality to the case and to begin to equip our students to deal with real patients.  This was a case of subacromial bursitis which the SPs were able to mimic so wonderfully that the students were completely fooled and the facilitators, who knew better, were caught up in the simulation as well.  With the SP, the students were able to obtain the history directly from the patient and to instruct the facilitator in the physical exam.  They worked through the case and arrived at a diagnosis, which they presented to the SP and recommended appropriate therapy.  Once the group completed the problem the SP then broke role and gave the students valuable feedback from the patient perspective.  The students reported this PBLS as extremely stimulating and useful.

In this IAMSE Audio Seminar, the SP PBLS case was presented as a model.  Video clips of a PBLS student group were included to demonstrate the procession through the case.  The resource requirements and training methods required to conduct such cases were detailed in the presentation.