Implementation of problem-based learning in a final semester comprehensive nursing course

Problem-based learning is a technique that is becoming increasingly popular in nursing educators in nursing education settings. In the 1980s, Knox and Mogan conducted classic studies on teacher effectiveness as rated by student nurses, graduate nurses, and faculty. They determined that nursing competence and teaching ability were highly rated by both students and faculty to "best" educators. Multiple studies utilizing problem-based teaching styles have revealed that students are highly satisfied with the results of certain characteristics, which promote student learning: self-directed learning, tutor-student interaction, and group learning. This article provides a review of the literature on problem-based learning in nursing education and specifically reviews articles utilizing the Mogan and Knox Nursing Clinical Teacher Effectiveness Inventory. Problems experienced in utilization of problem-based learning are also described.     

The effect of compulsory participation of medical students in problem-based learning

Problem-based learning (PBL) is an instructional method that has attracted many advocates since its introduction in medical education almost 20 years ago. PBL features the use of student-directed tutorials, medically relevant problems to set study objectives, and independent learning. Educators have worried that not all students will do well with this method. This study compared a group of students who had chosen to be in a PBL curriculum with a group who had not, as they undertook a curriculum that contained both PBL and lecture-based courses. Academic performance was virtually identical regardless of learning method. Students slightly favoured the courses that featured the method they had originally chosen, but a significantly larger proportion of students shifted their preference from the lecture to the problem-based approach than vice versa. Students' academic performance does not appear to suffer when they are involuntarily enrolled in a PBL curriculum and many come to prefer this type of curriculum.     

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

OBJECTIVES: To explore the values and assumptions underlying problem-based learning (PBL) cases through narrative analysis, in order to consider the ways by which paper cases may affect student attitudes and values. METHODS: Randomly chosen PBL cases from the first year curriculum at Dalhousie University medical school (n = 10) were coded by 3 independent reviewers attending to narrative components. RESULTS: The cases generally used spare, objective language, used the passive voice, eliminated agency, and employed linguistic markers to encode scepticism about patient reports. There was almost no sense of the presence of the patient as person in these cases in terms of their words, feelings, or their social and cultural context. The almost complete exclusion of the preferences and priorities of the patient was striking. CONCLUSION: The sample is small, the results only suggestive. Yet it appears that the cases used in PBL may unnecessarily, even unintentionally, encourage student detachment from the messiness of real patients' lives and emotions. Positioning a particular way of seeing - the doctor's gaze - as normative renders less visible the choices that are being made whenever an account is constructed. Including multiple voices in a case would complicate that tidy reduction of choices. Ongoing attempts to enrich the case format should be encouraged. At the same time, students may benefit from being taught the skills for critical analysis of the case itself.     

The potential utility of problem-based learning in the education of clinical psychologists and others

Clinical psychologists, like most health professionals, are in essence clinical problem-solvers. However, dealing with mental health problems may necessitate a greater relative reliance upon inductive clinical reasoning during the problem-solving process. To develop a provisional problem formulation mental health professionals may have to make sense of the co-occurrence of complex and poorly delineated problems. Claims have been made, predominantly in the literature on medical education, regarding the utility of problem-based learning (PBL) for achieving aims central to the effective performance of this role. In this article, after characterizing clinical psychology and PBL, we briefly explore the benefits claimed for PBL and assert that the putative cognitive and interpersonal consequences of the approach may be particularly pertinent to mental health practice. Particular emphasis is placed upon the necessity of facilitating effective clinical reasoning, that is, teaching future practitioners how to, rather than what to, think about complex psychopathology. PBL is also considered in the wider context of models of experiential learning and methods for teaching problem-solving. Finally, future research questions are suggested which may provide answers relevant to the facilitation of effective clinical reasoning in all health professions.     

Tutoring in problem-based learning: a teacher development process

Summary: Summary . Undergraduate medical curricula have become increasingly innovative in order to better prepare their graduates to enter practice, with the most notable innovation being the introduction of problem-based learning (PBL). This paper describes Dalhousie University's transition to PBL, from a teacher development perspective.
The paper reinforces the need for a well-designed teacher development process that is carefully implemented and evaluated in order to ensure a successful curriculum change. A seven-stage process for teacher development of tutors at Dalhousie is described, and programme evaluation data are reported from both students' and teachers' points of view. The results from the evaluation are very positive and suggest ways of improving the teacher development process. These improvements are described, as well as future plans in this area.     

Experiences by patients with asthma-like symptoms of a problem-based learning health education programme

BACKGROUND: Eighteen patients with asthma-like symptoms but negative asthma tests, randomly selected, participated in a problem-based learning health education programme. The programme had a multidisciplinary approach and included exercises inspired by cognitive behavioural therapy. OBJECTIVE: The aim of this study was to describe how the patients experienced the programme. METHODS: After termination of the programme, semi-structured interviews with a phenomenographic approach were conducted with 15 of the participants. RESULTS: Two categories emerged, with three sub-categories each. In these, the informants described how they felt solidarity with the group, received confirmation from the other participants and had increased their self-confidence. They had started to look upon themselves and the disorder from a different perspective, they could describe the disorder in words and they had started to use new, conscious coping strategies. CONCLUSIONS: Patients with asthma-like symptoms benefit from taking part in a problem-based learning health education programme. It helps them to reflect upon themselves and the disorder and to use new strategies to cope with it.     

Deep and surface learning in problem-based learning: a review of the literature

In problem-based learning (PBL), implemented worldwide, students learn by discussing professionally relevant problems enhancing application and integration of knowledge, which is assumed to encourage students towards a deep learning approach in which students are intrinsically interested and try to understand what is being studied. This review investigates: (1) the effects of PBL on students’ deep and surface approaches to learning, (2) whether and why these effects do differ across (a) the context of the learning environment (single vs. curriculum wide implementation), and (b) study quality. Studies were searched dealing with PBL and students’ approaches to learning. Twenty-one studies were included. The results indicate that PBL does enhance deep learning with a small positive average effect size of .11 and a positive effect in eleven of the 21 studies. Four studies show a decrease in deep learning and six studies show no effect. PBL does not seem to have an effect on surface learning as indicated by a very small average effect size (.08) and eleven studies showing no increase in the surface approach. Six studies demonstrate a decrease and four an increase in surface learning. It is concluded that PBL does seem to enhance deep learning and has little effect on surface learning, although more longitudinal research using high quality measurement instruments is needed to support this conclusion with stronger evidence. Differences cannot be explained by the study quality but a curriculum wide implementation of PBL has a more positive impact on the deep approach (effect size .18) compared to an implementation within a single course (effect size of ?.05). PBL is assumed to enhance active learning and students’ intrinsic motivation, which enhances deep learning. A high perceived workload and assessment that is perceived as not rewarding deep learning are assumed to enhance surface learning.     

实践性教学方法在健康教育学中的应用

为了优化《健康教育学》课程的教学方法和教学手段,对有助于学生实践能力培养的课程教学改革进行了探索。采用理论与实践教学相结合,课堂教学中运用“参与式教学法”,多种教学形式丰富课堂教学,并拓展教学基地,在真实的环境中开展实践教学。教学改革改进了教学方法,提高了学生的学习积极性,有助于提高学生对基本理论知识的理解和运用能力,有助于学生健康教育实践能力及综合能力的培养,提升了学生开展健康教育活动的技能,有助于实现应用型公共卫生人才的培养目标。     

The effect of communication skills training on patient-pharmacist communication in pharmacy education: a meta-analysis

Communication skills in pharmacy education and practice are increasingly regarded as a crucial component. However, thus far, estimating of the overall communication skills training (CST) effects in a variety of outcomes is lacking. The aim of this study was to synthesize the effects of CST in pharmacy education by performing a meta-analysis of CST studies. We searched MEDLINE, EMBASE, ERIC, CINAHL, PsycINFO, Cochrane Library, Web of Science, Communication and Mass Media Complete (CMMC), key journals, and bibliographic databases. The effect sizes (ESs) were extracted and pooled in random effects meta-analyses. We assessed the quality of the study using the Medical Education Research Study Quality Instrument (MERSQI). From 34,737 articles, 9 studies were included in this meta-analysis. The overall effect size for CST was 0.611 (95% CI 0.327–0.895), and it was statistically significant (p = 0.000). We found based on the subgroup analyses that CST has a large effect size when it used stand-alone courses, lecture-lab based courses, video recordings, feedback, training for 2 or more semesters, hours per week ≥5 h and external assessments. For the CST effect, the effect sizes were ranked in order of confidence, knowledge, skills, and attitudes. The result of the meta-regression is that the total number of attendees is significantly negatively correlated with the effect sizes of the CST. The findings of the present meta-analysis provide evidence that CST in pharmacy education may act as an efficient way to improve the communication competency of students, and it may serve as a guide for pharmacy educators.     

The use of student journals in problem-based learning

This paper describes several examples of the use of journals in a Bachelor of Dental Surgery course. The examples cover: the use of journals in first year subjects and in later-year clinical subjects; the effect of changes in policy and practise as a result of experience with journals; and student views on their experiences with journals. The use of journals offers a means of achieving some of the more important goals of problem-based learning (PBL), particularly those requiring students to reflect upon and evaluate their experiences. When effectively integrated in a PBL course, journals have several functions: to formalize reflection; an outlet for personal feeling; an opportunity for feedback about a student's progress and about the course; to provide the student with a summary of the year's work; and a means whereby students and teachers gain insight into the learning process. However, our experience in Dentistry raises several contentious issues, especially with regard to confidentiality and assessment. We make several recommendations for the effective use of journals based on the need for frequent communication between students and staff, the development of an environment of trust, and the need for staff and student education in journal use.     

The role of basic sciences in a problem-based learning clinical curriculum

BACKGROUND: Very little is known about the use of problem-based learning (PBL) during the later years of the undergraduate medical course and how it influences further acquisition of basic science knowledge. Similarly to many other Faculties, the PBL approach is used at Manchester in years 1 and 2, but more unusually, the curriculum continues to be centred on PBL in the clinical modules. OBJECTIVES: To explore whether and how basic science learning was continued in year 3 of the PBL clinical curriculum. METHODS: 10 of the weekly problems from the two core modules in year 3 were analysed to determine: (a) whether the design teams were using basic science objectives in devising the problems, and (b) whether PBL student groups were setting basic science learning objectives. The basic science knowledge of year 3 and 4 students was also measured. RESULTS: Similar numbers of objectives were being set by the management groups for each weekly problem (Heart, lung and blood (HLB) module, median 15, range 11-20; Nutrition, metabolism and excretion (NME) module, median 13, range 9-21). In the basic sciences, there was a median of 3 objectives per problem (range 0-6) in the NME module, but only 1 objective (0-2) per problem in the HLB module. The objectives set by six PBL groups in each module were analysed. Overall, agreement was reached on 130 occasions (62%) between the design team basic science objectives and those set for themselves by the student groups. In addition, there was a median of 2 (range 1-8) new basic science objectives brought out by the PBL groups that were not listed by the HLB module design team. In the NME module, there was again a median of 2 new objectives (range 0-6). The performance of year 3 and year 4 students in the multiple-choice questions progress test was analysed. For the 65 basic science questions, the year 3 mark was 40.8 +/- 12.3% compared with 57.1 +/- 12.3% for year 4 (P < 0.0001). CONCLUSIONS: (a) The design teams are setting basic science objectives; (b) the working problems are triggering students to set learning objectives in the basic sciences; (c) most of the objectives being set by the design teams are being triggered in the majority of group sessions; (d) the students knowledge of basic sciences increases in years 3-4.     

Clinical teachers and problem-based learning: a phenomenological study

AIM: To explore how clinicians perceive their roles in problem-based medical education, and how closely those perceptions link to the curriculum they teach. METHOD: All 14 general physicians in a teaching hospital took part in 6 semistructured discussions, which were analysed phenomenologically. RESULTS: Third year clinical teaching was described in terms that bore little relation to problem-based learning (PBL). Teachers placed great importance on the social dimension of professional learning. They expressed strongly positive affects towards learners and their learning that they found hard to express as PBL tutors. Their narratives of education were remarkably divorced from modern day clinical practice. CONCLUSIONS: Problem-based method lacked some important conditions for professional teaching and learning. Traditional apprenticeship is unsustainable under present day conditions of practice. There is a need for new educational methods that help the learner to build a professional identity through social interaction with practitioners.     

Evaluating problem-based learning in a multilingual student population

OBJECTIVES: The University of Natal Medical School in South Africa provides training for a student body composed of two groups: one with English as a first language and the other with an African language as a first language and English as the second. A new methodology was developed to evaluate an innovative course using modified problem-based learning techniques in this heterogeneous environment. DESIGN: The learning model proposed required achieving a balance of three components: content, enquiry/learning process and social interaction/group process. A multidimensional system, felt to be consistent with this educational philosophy, was developed using seven different quantitative and qualitative techniques. SETTING: The University of Natal Medical School. SUBJECTS: First-year multilingual medical students. RESULTS: The results revealed that social interaction was highly successful in reducing barriers between the student groups and between students and facilitators. However, the emphasis on group participation may have overshadowed the enquiry process, leading to superficial discussions of problems and feelings of repetitiveness. During the course students and facilitators expressed concern that the innovative assessments used did not assess the course content adequately. While the group presentations and projects were useful exercises for consolidation and group interaction, they did not enable facilitators to identify struggling students. CONCLUSIONS: The outcome of the evaluation stressed the need of achieving an appropriate balance both in the curriculum and assessments of the three components of the learning model, particularly in a setting where student backgrounds and language ability differ. Multidimensional methodology is needed for effective evaluation that promotes critical reflection.     

Profiles of effective tutors in problem-based learning: scaffolding student learning

OBJECTIVES: Research on tutoring in problem-based learning has not focused so far on the variation in tutoring and how this variation can be interpreted by conceptions about effective tutoring. DESIGN: This study focuses on the profiles of tutors generated by means of an instrument, the so-called Tutor Intervention Profile (TIP), and tries to determine which profiles are more or less effective. The TIP contains four dimensions of tutor behaviour: (1) elaboration; (2) directing the learning process; (3) integration of knowledge; and (4) stimulating interaction and individual accountability. SETTING: The medical school of the University of Maastricht, The Netherlands. SUBJECTS: Sixty-seven tutors who run 67 tutorial groups across three units (courses) in the academic year 1996-97. RESULTS: It appeared that high, average and low performing tutors differ in their performance on each of the four dimensions of the TIP. Several different profiles of tutor performance could be distinguished, which were more or less effective. One group of tutors demonstrated a tutor intervention profile that was characterized as relying more on the use of expert knowledge, whereas another group of tutors was characterized as relying more on their abilities to stimulate the learning process in the tutorial group. The tutor intervention profile that was perceived by students as most effective showed high scores on each of the four dimensions, as expected. Notably, a tutor stressing the learning process in the tutorial group was perceived as more effective than a tutor stressing content (expert tutor). This is especially true for a relatively poor scoring tutor. CONCLUSIONS: The results of this study are consistent with research on human tutoring and research on tutoring in problem-based learning.     

The process of problem-based learning: what works and why

Medical Education 2011: 45 : 792–806 Objectives In this review, we portray the process of problem‐based learning (PBL) as a cognitive endeavour whereby the learner constructs mental models relevant to problems. Two hypotheses are proposed to explain how learning is driven in PBL; an activation–elaboration hypothesis and a situational interest hypothesis. Methods Research relevant to these hypotheses is discussed. In addition, research studying the effects of various support strategies used in PBL is reviewed. Finally, we summarise a number of recent studies in which a new ‘micro‐analytical’ methodology was used to trace the process of PBL in the natural classroom setting. Conclusions We conclude that there is considerable support for the idea that PBL works because it encourages the activation of prior knowledge in the small‐group setting and provides opportunities for elaboration on that knowledge. These activities facilitate the comprehension of new information related to the problem and enhance its long‐term memorability. In addition, there is evidence that problems arouse situational interest that drives learning. Flexible scaffolding provided by cognitively and socially congruent tutors also seems to be reasonably effective, as opposed to ‘hard’ scaffolding represented by, for instance, worksheets or questions added to problems. Small‐group work protects against dropout and encourages students to study regularly. Initially, students do not study much beyond the learning issues generated; the development of personal agency in self‐study needs time to develop. The extent of learning in PBL results from neither group collaboration only (the social constructivist point of view) nor individual knowledge acquisition only; both activities contribute equally to learning in PBL.     

Approaches to learning in a problem-based medical programme: a developmental study

In this study we investigate how the introductory phase of the problem-based medical programme in Maastricht affects the study methods of students. On the first day of the academic year, 142 men and women medical students completed the Short Inventory of Study Approaches and again at the end of the introductory period. The study indicates that these study methods are fostered by training in problem-based learning given during the introductory period.