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The patient as text: a challenge for problem-based learning.

Nuala P Kenny1, Brenda L Beagan

  • 1Department of Bioethics, Dalhousie University, Halifax, Nova Scotia B3H 4H7, Canada. nuala.kenny@dal.ca

Medical Education
|October 6, 2004
PubMed
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Problem-based learning (PBL) cases often lack patient perspectives, potentially fostering student detachment. Analyzing PBL case narratives reveals how language choices can obscure patient experiences and influence medical student values.

Area of Science:

  • Medical Education
  • Narrative Analysis
  • Linguistic Studies

Background:

  • Problem-based learning (PBL) is a key pedagogical approach in medical education.
  • The narrative structure of PBL cases may influence student perceptions and attitudes.
  • Understanding the underlying values in educational materials is crucial for effective learning.

Purpose of the Study:

  • To analyze the narrative components of PBL cases.
  • To identify the values and assumptions embedded within PBL case descriptions.
  • To explore how these cases might shape student attitudes towards patients.

Main Methods:

  • A narrative analysis of 10 randomly selected first-year PBL cases from Dalhousie University.
  • Coding of cases by 3 independent reviewers focusing on narrative elements.

Related Experiment Videos

  • Examination of language, agency, and patient representation within the cases.

    • Main Results:

    • PBL cases predominantly used objective language, passive voice, and eliminated agency.
    • Patient perspectives, emotions, and socio-cultural contexts were largely absent.
    • Patient preferences and priorities were notably excluded from case narratives.

    Conclusions:

    • The analyzed PBL cases may inadvertently promote student detachment from patient realities.
    • The "doctor's gaze" in case construction can obscure important clinical choices.
    • Enriching case formats with multiple perspectives and teaching critical analysis skills are recommended.