The 8 worst people you could be in PBL

By James Stoker

PBL can be a great way to meet new people and make new friends on your course. A good group dynamic can make for some really entertaining sessions and with the right set of people, the learning can feel effortless.

Unfortunately, there is a flipside to this, and you will be exposed to some people who at best, you won’t get along with and at worst, will have you questioning the future of the medical profession. So, here are the 8 worst people you could be in a PBL session with (and why they might not be that bad)

The Textbook

As the name suggests, they will only open their mouth in a PBL session to quote directly from a lecture slide or textbook. “The Textbook” just doesn’t seem to be able to distinguish between learning something verbatim and actually understanding it. You can spot a “Textbook” when you’re not sure whether to be impressed or horrified by someone’s ability to memorise an entire page of Gray’s Anatomy in less than 5 seconds.

While they might sound well informed, they’re not fooling anyone. Everyone will have already read the exact passage they’re spewing out several times that week and hearing it one more time won’t exactly help.

Typically, a “textbook” won’t let anyone else contribute or interrupt. They-just-keep-talking-on-and-on-in-one-incredibly-long-unbroken-sentence-that-never-ends-and-they-make-no-eye-contact-with-anyone-in-the-room-and-never-pause-for-a-breath-so-nobody-can-interupt-them-at-any-point-ever.

This. Is. Infuriating. and the main problem they pose is to the group dynamic. The whole point of a PBL session is to drum up some interesting conversation and discussion, vomiting up information you ate yesterday, is about as appealing as it sounds.

How to stop yourself becoming a “Textbook”:

- Write all your notes in your own words

- Try to explain the concept you’re learning without using any medical terminology (analogies and metaphors are you friend) as this is how you’d explain conditions to a patient in practice

- If you’re wondering why nobody else has spoken for a while… It’s because you’re speaking too much.

How to deal with “The Textbook” in your group:

- Answering questions with very specific answers, things like NICE Guidelines and prescribing data are the Textbook’s forte, so make use of their skills

- Challenge them to think outside the box with some ethics questions

The Zombie

Much like fictional zombies, we can split our med student zombies into two categories.

The traditional (Romero) Zombie:

This slow, shuffling creature struggles to arrive on time to the session (if they make it at all). Their eyes are glazed over and they can barely contribute anything more than a snarl or grunt to the discussion and just their presence is enough to drain the life from everyone else in the room. There are many ways to catch this type of zombism, common causes include hangovers, broken sleeping patterns and bingeing those last 17 episodes on Netflix last night.

The Rabid Zombie:

This Zombie is a lot scarier. They’re fast, twitchy eyed and restless. This is because they stayed up all night cramming the case while consuming at least their entire blood volume in energy drinks or coffee too. They probably arrive early (mostly because they haven’t been home from the library since yesterday) and have a page of notes so messy and scrawled thet you’re questioning whether any of the scribbles are actually real words. The tragedy of this poor soul will become very apparent once the session starts, as while they may have finished the case and genuinely understand it, their brain is in such a sleep deprived, caffeine fuelled mess that they can’t accurately convey any of this to the group. Spouting nonsense at about Mach 3, they hope that the quantity of their contribution can make up for the dismal lack of quality- It can’t.

The common factor between both of these “zombies” is that neither remotely resembles anything human.

How to stop yourself becoming a zombie:

- Don’t get bitten by one

- Make sure you finish the case before the night before the close session.

- If you haven’t finished the case, make sure you’re well read on the areas you have done and catch up in the future.

- Stay well rested and don’t stay out too late before an early start the next day (everyone thinks “it’ll be fine just this once”. It never is. Just go home.)

How to deal with a zombie in your group:

- Treat them like you would an actual zombie, they won’t appreciate being asked to talk too much.

- Check they’re doing okay after the session.

The Mouse and Megaphone

These two truly belong together, the Yin and Yang of volume control (or lack thereof). ‘The Mouse’ never seems to be able to bring themselves to talk, and ‘The Megaphone’ never manages to shut up.

At first glance, a ‘Megaphone’ will seem to have a good grasp of the case material and the ‘Mouse’ will appear to know next to nothing. In reality, the opposite is usually true.

Both of these people contribute very little if anything to the group discussion. Where the Megaphone consistently delivers a high volume of content that has zero value, the mouse is unwilling to give anything at all.

The key factor that makes someone a Megaphone is the ability to talk for minutes on end without really saying anything (or making any sense), producing the human equivalent of desperately trying to reach a word count on an essay (or just pressing the middle button on autocorrect suggestions a few hundred times).

The mouse on the other hand contributes nothing to the group, not because they have nothing to give, but because they’re unwilling to (which is debatably worse). They usually take a corner seat and spend the session giving people scathing glances or rolling their eyes. When they do talk it’s usually concise and accurate, but not particularly stimulating material for discussion.

How to stop yourself becoming a ‘Megaphone’ or a ‘Mouse’:

- If you can’t remember when you last contributed, resolve to answer the next question.

- If you can’t remember the time you couldn’t hear your own voice, shut up.

How to deal with ‘Megaphones’ and ‘Mice’ in your group:

- You can stop a ‘Megaphone’ answering every question by directing one of your learning objectives at a specific person

- Try to draw a ‘Mouse’ out into conversation, they often have interesting contributions to make (as long as you aren’t hard of hearing)

The Overachiever

Having an ‘Overachiever’ in the group can be one of the most disheartening things that can happen. Usually this person has already finished the case before you’ve started, which is just as infuriating as it sounds. They usually contribute very little in the opening session (having already finished that week’s work), so they don’t feel the need to say very much. This means they have plenty of time to lean back and crack a wry, smug little grin whenever anyone contributes anything less than a perfect suggestion. They’re also inclined to give out PBL Case spoilers, telling the group what conditions the fictional patient has or even whether they survive (this really is the med school equivalent of “Dumbledore dies on page 596”, “Bruce Willis’ character is dead” or “Darth Vader is Luke’s dad”).

Their favourite phrases include:

- Um actually…

- I hate to tell you this (the really don’t), but that’s not quite right…

- Are you sure? (followed by a condescending head tilt)

How to stop yourself being an ‘Overachiever’:

- There’s nothing wrong with being prepared. Some people prefer to get ahead on work and that’s fine. The problem arises when they rub their achievements in everyone else’s noses and interfere with the group dynamic. If you have already done the work, don’t feel the need to exclude yourself, but don’t interfere with anyone else’s education.

How to deal with an ‘Overachiever’:

- An overachiever is a tool (possibly the first time that word has been used in positive way to describe them) and can be very useful. Many PBL cases have red herrings and trap ends to send you down irrelevant rabbit holes. The Overachiever has already trailblazed a way for the group and knows where the problems are, this sort of advice is exactly where you should ask them to share, as it may help everyone else with time management.

The Postgrad Posterchild

Many of the people you meet on a medicine course have already completed one or more degree. Their experience and maturity can add a great deal to proceedings. However, some don’t seem to realise that those other degrees have finished now and don’t need bringing up every 7 seconds. Every other sentence starts with the words “on my last degree…”, and invariably ends with “I just think it was better that way”. All the while not realising that it comes across exactly the same as going on a date with someone who just won’t stop talking about how great their ex was (and will end the same way too- alone).

How not to be a Postgrad Posterchild:

- Having another degree is an amazing achievement so don’t shy away from your extra experience and knowledge, just don’t mistake it for a personality (these are sold separately)

How to deal with a Postgrad Posterchild in you group:

- They know the names of all the Cytokines before you even know what a cytokine even is and can reproduce the full coagulation cascade and krebs cycle before the rest of us can even spell them. This is incredibly useful to learn from. Don’t make people the enemy, we’re all here to learn from each other.

The Nepotist

You may at this point in your life be aware that many diseases can be passed on from parents to children by genetics- Cystic fibrosis, Huntington’s disease, certain predispositions to cancer. What you perhaps didn’t realise is that becoming a doctor is also one of these conditions- or at least that’s what “the Nepotist” would have you believe.

Of course, many people are inspired by medical family members, which is a completely valid motivation for pursuing a medical education. But in this case, the nepotist believes that joining the medical profession is their divine right by coming from a ‘long line of doctors’.

Most of their sentences start with something along the lines of “well Daddy’s a GP and he says…”. The nepotist assumes that their opinion matters more than everyone else just because of their association with their medical parents. Unfortunately for them, as far as I (or anyone else for that matter) is aware, you cannot gain any knowledge or experience via osmosis from those close to you (university campuses would be much smarter places if you could).

How not to become ‘the nepotist’:

- Keep your familial anecdotes to the fun or clinically relevant, try not to use your medical family as justification for your own opinions

- Try to remember that your clinical years will be very different to those of your medical relatives, medicine has changed a lot since the 70’s

How to deal with ‘the nepotist’ in your group:

- Someone with medical relatives likely has a wealth of really interesting stories about healthcare, maybe even some historical stories or from other parts of the world. In reality they likely just want to share what they’re passionate about so try hear them out.

You

The last person that will cause problems for you is yourself. Academic communities (especially medicine) are rife with imposter syndrome and feelings of inadequacy. At some point or another everyone has wondered whether they’re ‘good enough’ or ‘keeping up’. That includes people who get all the work done early, don’t do any work, say too much or say too little, seem very confident or not at all. Just the act of getting onto a competitive medical course is something to be proud of (but not too proud of, to all the egomaniacs out there) and everyone in the room always has something worthwhile to contribute, including you.