PROBLEM
BASED LEARNING AT THE FELLOWSHIP LEVEL: NEW CHALLENGES
Carlos M. Isada, Steven M. Gordon, Andrew Fishleder.
PURPOSE: Problem Based
Learning (PBL) is widely used at the undergraduate medical education level. However, due to time constraints and
competing clinical responsibilities, traditional PBL has had limited
application at the graduate medical education level.
METHODS: In 2001 a
PBL-based core curriculum was implemented in the fellowship training program in
infectious diseases at the Cleveland Clinic, replacing a traditional lecture-based
curriculum (LBC). The PBL group consists
of 6-7 fellows and one preceptor, four one-hour sessions per week. Cases are presented as diagnostic unknowns including
radiographs, photographs, and pathologic material. Fellows initially analyze
the case independently, completing a standardized form which is later scored. Subsequent PBL sessions are open-ended discussions.
RESULTS: Fifteen
fellows have completed the PBL curriculum to date. Each year, approximately 60 clinical cases
are presented, with 70% derived from preceptors’ own patients, 20% abstracted from
the literature, and 10% miscellaneous. Several modifications in PBL format were
required after the initial pilot program: open-ended discussions were limited
to one hour per case, “homework” assignments were discontinued due to competing
clinical demands; allotted time increased from 50 to 200 hours/year; supplementary
problem vignettes were required emphasizing basic science, epidemiologic
investigations (e.g. simulation of a hospital infection outbreak), antibiotic
development, and professionalism .
CONCLUSION/FUTURE DIRECTIONS:
PBL curriculum can be implemented for
fellowship training, but requires significant time-commitment and
modifications.