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Your obituary to Daniel Federman (BMJ 2017;359:4764) credits Dr Federman with introducing problem based learning to the Harvard medical school in 1985, apparently “based on experience at McMaster medical school in Hamilton, Ontario”. This may well be correct but I wonder if there may have been an earlier influence: Federman worked at University College Hospital Medical School in London from 1957 - 1959 with Eric Pochin where he would have seen ‘problem based learning’ on a daily basis.
Together with fellow students at UCH in the late 50s and early 60s this was the joy of our medical education. Up to thirty-three lectures a week? Certainly not. After a short introductory course there was only one, or sometimes two, lectures each day. In small groups of five or six students we were allocated individual patients to look after during their hospital stay. Attending twice-weekly ward rounds and clinics we took patients’ histories, examined them and presented our diagnoses for discussion with the consultant, members of the team and our fellow students. We scrubbed to assist in the operating theatre, attended x-ray conferences and the post-mortem room, and spent four weeks day and night on-call in the obstetric hospital to attend a minimum of twenty deliveries.
In 1964, having completed just one year of ‘House Jobs’ and working as a lone doctor of a mission hospital in central Africa I was presented one night with a whimpering young woman who had dislocated her shoulder, attended by her husband the village chief, his other five wives and a dozen villagers all armed with knives and spears that glinted in the moonlight. With no x-ray available and general anaesthetic out of the question I considered my options. Recalling an outpatient clinic attended as a senior student I found the solution. The surgeon had quizzed us on the management of dislocated shoulder and, using a fellow student as an example, had taught us in vivid terms the simple but effective Kocher’s manoeuvre. Rehearsing this in my mind I then practiced my problem based learning. With a gentle ‘click’ that seemed to echo through the dark forest the head of the humerus slipped into place – and the patient and her grateful family disappeared into the night. A few months before, recalling what I had learned as a student while holding the retractors during three midnight Caesarean sections, I was able to perform my own first Caesar to deliver a healthy baby boy using spinal anaesthesia. I wonder how a graduate fresh from our British medical schools in 2017 would have fared?
Problem based learning
Your obituary to Daniel Federman (BMJ 2017;359:4764) credits Dr Federman with introducing problem based learning to the Harvard medical school in 1985, apparently “based on experience at McMaster medical school in Hamilton, Ontario”. This may well be correct but I wonder if there may have been an earlier influence: Federman worked at University College Hospital Medical School in London from 1957 - 1959 with Eric Pochin where he would have seen ‘problem based learning’ on a daily basis.
Together with fellow students at UCH in the late 50s and early 60s this was the joy of our medical education. Up to thirty-three lectures a week? Certainly not. After a short introductory course there was only one, or sometimes two, lectures each day. In small groups of five or six students we were allocated individual patients to look after during their hospital stay. Attending twice-weekly ward rounds and clinics we took patients’ histories, examined them and presented our diagnoses for discussion with the consultant, members of the team and our fellow students. We scrubbed to assist in the operating theatre, attended x-ray conferences and the post-mortem room, and spent four weeks day and night on-call in the obstetric hospital to attend a minimum of twenty deliveries.
In 1964, having completed just one year of ‘House Jobs’ and working as a lone doctor of a mission hospital in central Africa I was presented one night with a whimpering young woman who had dislocated her shoulder, attended by her husband the village chief, his other five wives and a dozen villagers all armed with knives and spears that glinted in the moonlight. With no x-ray available and general anaesthetic out of the question I considered my options. Recalling an outpatient clinic attended as a senior student I found the solution. The surgeon had quizzed us on the management of dislocated shoulder and, using a fellow student as an example, had taught us in vivid terms the simple but effective Kocher’s manoeuvre. Rehearsing this in my mind I then practiced my problem based learning. With a gentle ‘click’ that seemed to echo through the dark forest the head of the humerus slipped into place – and the patient and her grateful family disappeared into the night. A few months before, recalling what I had learned as a student while holding the retractors during three midnight Caesarean sections, I was able to perform my own first Caesar to deliver a healthy baby boy using spinal anaesthesia. I wonder how a graduate fresh from our British medical schools in 2017 would have fared?
Competing interests: No competing interests