TBL stands for Team Based Learning and PBL stands for Problem Based Learning. They are both essentially methods of teaching that involve students working together in groups to navigate clinical scenarios.

If you have been researching programs, you may have noticed that these group-based approaches to learning have become pervasive in physician assistant and medical school curricula. There is a great deal of debate and research going on right now to establish the advantages of this type of education over traditional lecture. And many programs argue over which form of group-learning is better: TBL or PBL? Penn State is actually a school divided since the PA program uses TBL while the medical program uses PBL. And, yes, I have witnessed literal arguments between the faculty and students of each program over which one is better.

I am not getting in the middle of that argument (it sounds exhausting). Instead I’ll give you an idea of my experience with TBL and then do my best to explain how PBL is different.

Let me start by saying that I enjoy Team Based Learning (TBL). When I came to interview at Penn State I was invited (along with the other candidates) to sit in on a TBL class and participate. To my surprise, it became one of the main reasons I chose Penn State over other schools.

Every program runs their TBL class a little differently, but reading the descriptions on various program websites, the essential elements appear to be the same. This is how our program does TBL:

-Prior to class we are given a reading assignment. Generally this is a 15 page article from an academic publication (such as the New England Journal of Medicine) summarizing the evidence behind the clinical guidelines for a specific disease. However, sometimes our assignments come in the form of a PowerPoint or Grand Rounds presentation.

-At the beginning of each class we take a quiz called the iRAT (the individual Readiness Assurance Test), which asks us approximately 15 detailed questions about our assigned reading.

-Then we divide into groups and take the exact same quiz over again (the gRAT, or “group” RAT). This involves reading each question out-loud and then debating with our group members over the answers. Each group has a scratch-off card that immediately lets us know if we are right or wrong (on certain days it feels more like a lottery ticket).

-Then we spend the rest of the class doing clinical cases. Essentially the instructor presents us with a case scenario (along with lab values and relevant imaging) and then asks us focused clinical questions about the case. For example: “What medication should you prescribe?” This requires your group to not only decide on a diagnosis but also know how to treat the disease in question.

-After 5 minutes of discussion, we are presented with multiple choice options (hopefully the answer you have in mind is an option). Then one group member holds up a card, labeled A-E, to vote on the answer.

-If there is consensus among the groups, we are told the correct answer (or that we are all wrong). However, if there are conflicting opinions, then the groups have to argue it out. The instructor participates throughout this process to guide discussions and clarify misunderstandings. Students tend to get passionate about their answers and there are often heated arguments. But the discussions are always educational and on-point.

TBL class feels like Team Trivia at the local bar, except that unfortunately no alcohol is involved. It can be a lot of fun, though. Considering most classes involve PowerPoint and lecture for hours at a time, it is a wonderful break from the monotony.

Also TBL is great preparation for clinical year. Remember that when rotations start, your preceptors will rarely ask you questions like “What are the signs and symptoms of hyperthyroidism?” Instead, they are going to have you see a patient. And if the patient presents with signs and symptoms of hyperthyroidism, they are going to expect you to recognize that and include it on your differential. The question you are going to hear more often is, “Okay, so what do you want to do for this patient?”

TBL teaches you to think clinically so that, when you are presented with real patient encounters, you have more than just a knowledge bank to work with. Also, it teaches you to function in a team, which is exactly the direction that healthcare is going. Team based healthcare (TBH?) is the wave of the future in medicine.

So that is how TBL works (at least in our program). I will do my best now to explain PBL and how it is different.

-The first major difference is that in Problem Based Learning (PBL) the students are encountering material for the very first time. There are no pre-readings and they have ideally never studied the disease in question.

-Students meet in groups with a workbook full of patient encounters. There is a faculty member present to make sure that the students are progressing and meeting their objectives. The role of this faculty member is to act as a facilitator who supports and guides the students in their own learning, not to teach or direct learning.

-One student reads aloud the case scenario and fields questions (armed with information provided in the book) from his/her group members about the patient. The questions and answers are meant to mimic an actual patient encounter (e.g. “when did the pain start?” to which the presenter replies “it started about a week ago”).

-Another student takes notes on a dry erase board for the group. Together, the group garnishes a complete history and physical exam from the simulated patient encounter. Meanwhile, they create a thorough differential diagnosis and mark possible diagnoses as being more or less likely based upon developments in the case.

-As the group works through the patient encounter, they are expected to recognize where there are gaps in knowledge for the group members (perhaps the students realize they are unaware of the side effects of a medication). These gaps in knowledge are used to generate a list of clinical questions called ‘learning objectives’ (e.g. what are the side effects of Metoprolol?).

-At the end of the session, the students divide up the list of learning objectives that they just created, and each student is responsible for independently researching his/her topic.

-At the next session, each student spends a few minutes teaching the other group members about their learning objectives from the previous encounter. The professor or supervisor in their group then provides them with a list of learning objectives that were created by the faculty. This is compared to the student list to see if they discovered all of the correct objectives. Any unmet objectives will be researched before their next meeting.

-Finally, the students are expected to give each other feedback about their performance as members of the group. Students are also asked to make comments about their own personal performance. The idea is that students will become self-reflective practitioners and will learn how to better give and receive constructive criticism.

That (in a small nutshell) is my understanding of PBL. Obviously, these are two very different approaches to group learning.

One yields a clinical reasoning experience that is very similar to a true patient encounter and requires that students drive their own learning. The disease that is presented in these experiences is brand new to the students, with the idea that the students will become better life-long learners if they practice researching unfamiliar encounters on their own (PBL).

The other approach delivers entire case presentations up front and then uses focused clinical questions to generate challenging and in-depth discussions among the class. The material in these cases has recently been studied and the cases are meant to reinforce known material by having students interact with it clinically and on a higher level (TBL).

Whichever you think you might prefer, both TBL and PBL are fantastic and innovative ways of teaching medicine. If the program you are interested in includes either one of these methods in its curriculum, I would consider that a huge PLUS when applying. Move that school up the list on your differential because it will be a benefit to your education.