Comments from a Thai Doctor on PBL and Good Teacher

I've received two e-mails from my friend, Kai, who is a medical doctor working and teaching at a university hospital in Bangkok, Thailand. He allows me to post his comments on this blog. His two comments occured after he read the article "Reform of undergraduate medical teaching in the United Kingdom: a triumph of evangelism over common sense" that I sent to all of you.

1st Comment:
11/01/05- "I am happy to see this article as you know I have never agreed with PBL teaching since I was a medical student. I think the main problem is the teachers themselves who cannot teach the student effectively. They cannot select which parts of knowledge are essential and have to be emphasized. I see most the academic lectures in UK could summarise the essential fact of knowledge within 30 minutes of presentation. Thai lecturers or elsewhere will say the time is not enough for me to lecture. Some of Thai senior teachers in the University just want to follow US academic teaching system which was claimed to be modernised but it's a hell indeed. I am not surprised why basic clinical skill and knowledge (need to be taught and emphasized) of the old generation UK consultants are better than new generation of UK consultants and perhaps US consultant or doctors elsewhere (investigation dependent due to unsecure knowledge). Should we follow US with new teaching PBL?"

2nd Comment:
12/01/05- "However, what I believe (sound not scientific but you cannot refuse!) is only a good teacher will help medical student achieve the goal of medical learning (my personal experience of medical studying). Good medical teacher I mean is the one who pays attention to the students during teaching, who can make everything simple for student (no matter how foolish the student is except mental retard student which is not relevant here in reality) to understand, remember (without forget unless they are demented), and ability to think or solve problem by themself finally. Teachers must know the point that the students are usually not understand and clarify to them. Good teacher should have ability to teach or train poor medical student to be a good one. Moreover, good teachers must have ability to demonstrate how they can apply basic science knowlege into clinical practice (good basic science-clinical correlation).

In general (mean not everyone), PhD non-doctoral scientists who are never encounter in clinical practice are difficult to integrate that. On the contary, Research based doctor who, in their whole life, sit in the research laboratory and know everything in molecular detail well and do not see or touch the patient quite often may also have some difficuty to do so. Perhaps they possibly do not know what the students do not understand and they do not understand why students do not understand as they understand everything themselves too well but cannot explain in lay term. Clinical Medical consultants whose knowledge is excellent in every area but are not willing to teach, in my opinion, are rubbish and are not a medical teacher. However all of these are not significant if you are good teacher. Good teacher, probably rarely found nowadays indeed, is always a good teacher no matter how the curliculum will change. The student or learner will absolutely be the judgement. So, Have we ever shown a consideration to our medical students evaluation or complaint? I think medical teaching process is definitely not the same as other educations especially Su-ko-thai-thum-ma-ti-raj self study programme by post because it determines life and death of people.

Someone in this world will definiely not agree and do not want to hear or face the truth from a past medical student."
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What is my view (pdharmas's) is that PBL is inevitable for most of the universities in Thailand. What we have to do is to make it right. Is PBL we are running "REAL/PURE" or "modified" PBL? If it is the modified PBL, can we guarantee it will not cause damage? Problem-solving (content-based) skill is not the only one goal of REAL PBL. Communication and group-working skills are also the important goals. Even the moral aspect also can be cultivated during the scientific PBL classes; such as how students accept different ideas without hidden internal violence. All of these will help not only improve doctor-patient relationship when the students become a doctor, but also help society better. It would be a failure of PBL if it was only used to stimulate students to search how to solve the case, despite the student-centred, even though we have good content-based instructors.
Complaints from students are very important and should be recorded for further long-term follow-up (evidence-based) and course evaluation.