Originally Posted by ###

Discussions of PBL can get confusing. It is important to distinguish the mode of delivery (PBL vs lecture) from the organization of the curriculum content (organ system vs academic discipline).

PBL is usually delivered in a seminar type setting. You have a group of about 8 students and a tutor. The content is based on a clinical problem (e.g. congestive heart failure) which raises a range of associated issues with respect to both the basic sciences (pharmacology, physiology, pathology) and clinical sciences (treatment). Basically, you reveal what you don't know by going through the case and identify these as issues that are to be researched before the next meeting. Generally, there are a series of suggested topics that you must cover in addition to specific questions generated by students.

PBL is quite good for subjects that can be organized by problems. For example, you can cover a lot of cardiovascular physiology, pharmacology, and pathophysiology using a set of good cases that cover the most common problems. PBL is not as good for topics that don't present as discrete problems -- general pathology, biochemistry, etc. These subjects are probably best covered by other means (e.g., lecture or self study).

I don't think there are any schools that use a pure PBL type curriculum. I think all of them use some mixture of lecture and PBL cases. I think most schools have about 8 hrs of PBL a week with about 8 hrs of lecture.

Many people have concerns regarding the effectiveness of PBL with respect to USMLE preparation. If you do a search on medline, you will see that a lot of recent research suggests that students in PBL programs compete favorably with those in traditional programs. Many US schools have adopted this type of delivery --at least in part.

The organization of the curriculum is the other important dimension. In PBL schools, the curriculum is organized by system. For example, you study the cardiovascular system, the renal system, etc. In lecture based schools (e.g. the carib), the content tends to be organized by academic discipline - anatomy, physiology, histology, biochem, pharm, etc. The strength of the organ system approach is that all the relevant material is presented at once in a coherent and synergistic manner. I think this approach is good for teaching clinically relevant (i.e., problem based) material. It is less effective for teaching things like biochemistry, general pathology or microbiology which tend to span disciplines. Also, there is something to learning a subject as a coherent discipline (how does a histologist think?) rather than as a smattering of bits and pieces. While both approaches have their strengths and weaknesses, I favor the organ system approach. Many US schools have adopted this as well.

I find most med school lectures to be pretty useless. The material is simple and, if you can read, there is no reason to sit in a seat and have a prof recite stuff that is easily accessible from very good textbooks. I learn best be reading and, as a consequence, I found that it was better to use my time actively studying rather than to sit passively in lectures. I rarely attend lectures. Other students find hearing material helps them. Both systems work -- the key is to do what works for you. At the end of the day, it is between you and the books no matter what system you choose. I found PBL to be much less annoying than lectures.

Originally Posted by ###

Discussions of PBL can get confusing. It is important to distinguish the mode of delivery (PBL vs lecture) from the organization of the curriculum content (organ system vs academic discipline).

PBL is usually delivered in a seminar type setting. You have a group of about 8 students and a tutor. The content is based on a clinical problem (e.g. congestive heart failure) which raises a range of associated issues with respect to both the basic sciences (pharmacology, physiology, pathology) and clinical sciences (treatment). Basically, you reveal what you don't know by going through the case and identify these as issues that are to be researched before the next meeting. Generally, there are a series of suggested topics that you must cover in addition to specific questions generated by students.

PBL is quite good for subjects that can be organized by problems. For example, you can cover a lot of cardiovascular physiology, pharmacology, and pathophysiology using a set of good cases that cover the most common problems. PBL is not as good for topics that don't present as discrete problems -- general pathology, biochemistry, etc. These subjects are probably best covered by other means (e.g., lecture or self study).

I don't think there are any schools that use a pure PBL type curriculum. I think all of them use some mixture of lecture and PBL cases. I think most schools have about 8 hrs of PBL a week with about 8 hrs of lecture.

Many people have concerns regarding the effectiveness of PBL with respect to USMLE preparation. If you do a search on medline, you will see that a lot of recent research suggests that students in PBL programs compete favorably with those in traditional programs. Many US schools have adopted this type of delivery --at least in part.

The organization of the curriculum is the other important dimension. In PBL schools, the curriculum is organized by system. For example, you study the cardiovascular system, the renal system, etc. In lecture based schools (e.g. the carib), the content tends to be organized by academic discipline - anatomy, physiology, histology, biochem, pharm, etc. The strength of the organ system approach is that all the relevant material is presented at once in a coherent and synergistic manner. I think this approach is good for teaching clinically relevant (i.e., problem based) material. It is less effective for teaching things like biochemistry, general pathology or microbiology which tend to span disciplines. Also, there is something to learning a subject as a coherent discipline (how does a histologist think?) rather than as a smattering of bits and pieces. While both approaches have their strengths and weaknesses, I favor the organ system approach. Many US schools have adopted this as well.

I find most med school lectures to be pretty useless. The material is simple and, if you can read, there is no reason to sit in a seat and have a prof recite stuff that is easily accessible from very good textbooks. I learn best be reading and, as a consequence, I found that it was better to use my time actively studying rather than to sit passively in lectures. I rarely attend lectures. Other students find hearing material helps them. Both systems work -- the key is to do what works for you. At the end of the day, it is between you and the books no matter what system you choose. I found PBL to be much less annoying than lectures.

Originally Posted by dr.bum

Australia does not seem to be a very attractive place to study medicine.

a) they charge you a pooh pooh load of money as an international student, just as much, or even more than some American/Caribbean schoools.

b) extremely difficult to get a PR, so you cant even practice in australia right after you graduate

c) hard to get loans

d) harder to go back to the US (especially if your a Canadian)

e) PBL not that respected around the world

I dont get why people just dont go to Caribbean schools or apply to DO schools if their ultimate goal is the US or Canada. And if you do plan to stay and practice in Australia, like i said, it's really difficult, especially considering the fact that most IMGs attend the 4 year programs rather than the 5 or 6 year programs, which are not as well respected. In terms of money, Australian GPs average around 70-90K, whereas in the US one can make a lot more money and get taxed less. I know medicine isnt about the money, but how the hell are u suppose to pay your loans.

Yeah, and for those that want to practice in a rural area in Australia for 5 years and then getting your PR, yeah.....you wont be making more than $45,000(australian) a year.

Conclusions: Australia charges ppl international fees for a meager education, i think you could get more bang for your buck going to India, Pakistan, Phillipines, etc, any asian country with a well respected MBBS program, since your considered an IMG whereever you come from (by the way, most IMG doctors in the US are from India). Australians make it hard for you to practice in their country despite the fact that you have an Australian education. So yeah, if you wanna go to US or Canada, then the best choices are clearly:

1. US or Canadian Med Schools
2. US DO schools
3. Caribbean or Israel
4. India, pakistan, england, ect (countries with well respected MBBS programs)
5. Australia or Eastern Europe (last choice)

Im from New York, but ill be applying to Indian and Pakistani schools since I cant afford the caribbean (and im latin by the way, so dont think im biased towards these places).

Originally Posted by ###

This is in response to dr_bum's comments.

You are confounding a lot of separate issues:

1) quality of Australian education
2) cost
3) ability to get PR or practice in Australia
4) compensation for Australian doctors
4) loan availability
5) ability to return to country of origin

Let me address these in turn:

Immigration issues Most people want to return to their country of origin (US or Canada) so immigration issues are a concern to a relatively small subset of students. And, even if it is difficult to stay in Australia, the option (however unlikely) is still a benefit relative to the caribbean. I am not aware of anyone who wants to stay and practice in Grenada or Dominca. This issue is a red herring.

Canadians are a special category -- my understanding is that they have difficulties returning to Canada no matter where they go to school. Thus, Australia is no worse in this regard than any other alternative. I believe most Canadians end up doing residencies in the US irrespective of where they go to school. Thus, this is the same whether they go to Australia or the carib.

Cost - Australian schools are still cheaper than most carib schools. Because of the decline of the dollar, they are no longer the bargain they once were but they are still competitively priced relative to carib schools.

USMLE preparation. Some people say that Australian schools don't provide a solid education for the USMLE. While it is true that Australian schools are not USMLE oriented, it is not difficult to fill in the gaps and most students do so. Very few Australian students fail the USMLE. I got a 249 which suggests that my training was adequate. I know other people with similar scores. Also, I seriously doubt that I would have done better had I gone to the caribbean.

PBL - Some people consider PBL a disadvantage and others consider it an advantage. It is important to select what is best for you. PBL is effective for some people. In my case, I did a semester at SGU and found that the lectures were an absolute waste of time -- so I rarely went to class. I rarely attended lectures in Australia either. I don't find med school lectures helpful but I recognize this is an individual preference. If you learn best by lectures you should go to a lecture based school. Otherwise, a PBL school can be a good alternative. It is important to know how you learn and to choose the right school. PBL is not right for everyone and you need to do what is effective for you. I am not really sure whether PBL or lecture makes much of a difference. At the end of the day it is between you and the books.

Loan availabiliy All the Australian schools have are eligible for Stafford loans. I believe there are only 3 carib schools that are eligible for Stafford loans. Australian students are also eligible for other sources, similar to carib students. There is no significant difference between Australian schools and carib schools with respect to financing.

Residency I will agree that getting back to the US is a little more complicated from Australia compared to the carib. Carib schools have clinicals in the US which is a (slight) advantage and carib students are a little more connected to the US system. Once again, this is similar to the USMLE in the sense that it presents a few extra hurdles, but nothing insurmountable. While there may be some vocal exceptions, students from here generally do well.

Licensure Unlike many carib grads, Australian grads have no limitations with respect to licensure. Thus, Australian schools are similar to the established carib schools (SGU, Ross, AUC) in this respect.

There are a few minor advantages to Australian schools:

location - this goes without saying. I would not choose a school based on location but, other things being equal, it is hard to beat Australia. Living here has been a wonderful experience.

research - unlike carib schools, the Australian schools are research universities which means that you have opportunities to become involved in research -- which can be a signicant advantage when applying for residencies. This is easily available to those who have the interest. For example, I will add a few papers to my CV during my stay here.

joint degrees - some of the Australian schools have reasonably strong departments in other areas that provide opportunities for joint degrees. For example, I am doing a joint degree in Clinical Epidemiology. These options are either not available or attractive (due to concerns of cost and quality) at carib schools.

Overall, my experience has been very positive. In my case, by switching from SGU, I saved a pile of money (about 90k) and, so far, I am quite satisfied with the outcomes (249 USMLE, publications, joint degree). Obviously, Australian schools are not for everyone; however, for the right person, I think they are a very attractive alternative to the caribbean. Obviously, the acid test is residency placement. I believe that residency placement will be much like the USMLE -- there may be a bit of extra work compared to the carib route, but nothing insurmountable. I am pretty optimistic about my chances.

While I would hardly claim that Australian schools are perfect, I have been generally satisfied with my education here. I also have the unique perspective of having attended both a carib school and an Australian school -- so I can speak with confidence about the differences. I agree that the established carib schools are a reasonable choice; however, I would hardly say that they are clearly superior to Australian schools. For others, the carib may be a better choice. I think the established carib schools and Australian schools are both reasonable choices. In my particular case, coming to Australia was a good decision. For others such as dr-bum, the carib may be a better option. Both groups of schools are acceptable and neither group of schools (carib or Australian) is dominant across all criteria.

Originally Posted by ###

In general, I made sure that I covered the relevant material in standard texts as we were doing a module. Preparation for PBL will cover the high points; however, I usually did a LOT of outside reading. For each subject I often read several different textbooks cover to cover . TWICE. (I am a well known book-aholic). I also made sure that I read ALL the relevant chapters in the standard texts (Guyton, Robbins, etc). I treated PBL as a nice addition to my own plan of study.

PBL will cover most of the clinically relevant stuff; however, you need to develop a plan so that you cover things like biochem, micro, and general path more thoroughly. It is not difficult to do; however, you need to be vigilant and disciplined.

One of the great things about a pass/fail system is that it gives you the latitude to ignore a lot of nonsense and focus on what is important. The key is to use your time well.