Problem-based learning in Guyana: a nursing education experiment

O'CONNOR J. & CARR A. (2011) Problem-based learning in Guyana: a nursing education experiment. International Nursing Review59, 376-379 Aim: This paper invites the reader into sharing a journey of change through a new curriculum grounded in a problem-based learning (PBL) approach to education in the first year of a diploma nursing programme in Guyana. Background: In Guyana, students are trained using traditional teaching methods: lectures and a single, often outdated, text. The authors had been dissatisfied previously with their students' knowledge retention, critical thinking skills and application abilities. The authors became advocates for change through the introduction of a PBL approach in nursing education within their school. Methods: PBL is quite different from 'problem solving', and the goal of learning is not to solve the problem, which has been presented. Rather, the problem is used to help students identify their own learning needs as they attempt to understand the problem, to pull together, synthesize and apply information to the problem, and to begin to work effectively to learn from group members as well as tutors. Students met in small groups to identify the problem; explore their pre-existing knowledge; generate hypotheses and possible mechanisms; and identify learning issues. Conclusion: Students in their first exposure to self-directed, small group learning can immediately thrive as active learners with minimal guidance and support. The programme was evaluated with the admission and scoring of homework/exams based on the school syllabus for the individual courses; and continual small group oral as well as a final written qualitative evaluation. Specific positive and negative learning factors are addressed.     

Self-Observation and Peer Feedback as a Faculty Development Approach for Problem-Based Learning Tutors: A Program Evaluation

Problem: Good teaching requires spontaneous, immediate, and appropriate action in response to various situations. It is even more crucial in problem-based learning (PBL) tutorials, as the tutors, while directing students toward the identification and attainment of learning objectives, must stimulate them to contribute to the process and provide them with constructive feedback. PBL tutors in medicine lack opportunities to receive feedback from their peers on their teaching strategies. Moreover, as tutorials provide little or no time to stop and think, more could be learned by reflecting on the experience than from the experience itself. We designed and evaluated a faculty development approach to developing PBL tutors that combined self-reflection and peer feedback processes, both powerful techniques for improving performance in education. Intervention: We developed an observation instrument for PBL facilitation to be used both by tutors to self-observe and reflect on own teaching strategies and by peers to observe and provide feedback to tutors. Twenty PBL sessions were video-recorded. Tutors completed the instrument immediately after their PBL session and again while watching their video-recorded session (self-observation). A group of three observers completed the instrument while watching each recorded session and provided feedback to each tutor (peer observation and feedback). We investigated tutors' perceptions of the feasibility and acceptability of the approach and gathered data on its effectiveness in enhancing tutors' facilitation skills. Context: The preclinical medical curriculum at the University of Geneva is essentially taught by PBL. A new program of faculty development based on self-observation and peer feedback was offered to voluntary tutors and evaluated. Outcome: Our results suggest that self-observation and peer feedback, supported by an instrument, can be effective in enhancing tutors' facilitation skills. Reflection on self-observation raised teachers' awareness of the effectiveness of the strategies they used to foster student learning. This motivated a need to change their teaching practice. However, for the changes to become operative, peer feedback was required, providing the cues and strategies needed to improve the facilitation skills. Lessons Learned: Peer coaching was considered feasible and useful to improve tutors' facilitation skills. Evaluating the program made it possible to assess tutors' needs and the reasons underlying their difficulties, and this in turn provided the basis for advanced workshops. Nonetheless, aspects related to logistics and the time constraints of such an individualized approach, as well as the cultural appropriation of peer coaching, might be obstacles that need to be addressed.     

Problem-based learning in a new Canadian curriculum

Problem-based learning (PBL) is a method of group learning that uses true-to-life problems as a stimulus for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences. This article documents the design and implementation of PBL in a second year course in the new curriculum of the University of Ottawa School of Nursing's Generic Program. The learning and teaching experiences of students and facilitators in this PBL course are described. As a way to determine students' perception of their learning using PBL, they were asked to respond to four questions. The most frequently described thinking processes were problem solving, nursing process and group process. When asked to describe the learning they derived from PBL, as differentiated from other instructional methods, students identified group process and problem solving most often. The most frequently identified factors that influenced performance and learning in PBL were positive attitude and group effort. The factors that affected the facilitators' performance of their role were large group size, insufficient practice of facilitator skills and PBL preparation. To enhance group process, facilitators modelled and shared roles. They fostered student motivation and development through formative evaluation. PBL produced clear benefits for students, such as increased autonomous learning, critical thinking, problem solving and communication. For facilitators, PBL was a liberation from the traditional role of 'content expert and super consultant'.     

A problem-based learning trial on the Internet involving undergraduate nursing students

This article describes the application of a nursing educational program developed on the basis of problem-based learning (PBL) and Internet technology, and reports student satisfaction and perceived learning effectiveness. This study was conducted in two phases-the development of a Web-based educational program and the application of this program using PBL strategies to teach undergraduate nursing students. The results showed this program was an effective method of delivering PBL to nursing students and the interaction between tutors and students influenced student satisfaction and learning effectiveness.     

Problem‐based learning in a third‐year pediatric clerkship

A randomized treatment‐control study of third‐year clerks during their pediatrics rotation was performed to assess whether a problem‐based learning (PBL) curriculum assures adequate exposure to pediatric concepts while enhancing the quality of students’ experience. Forty‐five out of 202 medical students were randomly selected to participate in the PBL track. These students attended PBL rounds covering predesigned cases, whereas the control group attended traditional rounds. Curricular content, exam performance, and student satisfaction were evaluated. Correlation of learning issues and essential course objectives was greater than 90%. There was no difference between groups on standardized exam performance. PBL students were more satisfied with the amount of observation by attendings and with evaluations by residents and attendings. We conclude that the PBL curriculum was successfully introduced, curricular content controlled, whereas test performance was preserved and satisfaction with evaluation increased.     

中山医学大学医学院如何推动问题导向学习

自1990年起,中山医学大学医学院根据办学的宗旨、世界医学教育改革的潮流及自身条件,选定推动问题导向学习(Problem-based learning;PBL-)、基础及临床课程整合(Integration of basic and clinical sciences)及成立教师成长中心(Center for Faculty Development;CFD)为本校教改之主轴。有关推动问题导向学习部分,历经(1)探索期(1994～2000):包括观察及学习国内外医学院校引入PBL的过程与经验。本期关键因素包括政府教改政策与评鉴指标,他校实施成果和本校改革决心与条件。(2)准备期(2000-2002):包括促成师生共识,小组老师之训练,教案之撰写与审查,课程整并与学生小组化安排。本期关键因素为教师间共识与其权益维护,课程整合及学习相关配合措施,并为医学预备科学生安排PBL先导课程(学习法与循证医学)。(3)实施期(2000～2004):包括选择高年级临床医学课程率先实施,学生与小组老师分组,实施时段与空间安排以及课程评价。本期关键因素在于实施小组学习的配套措施是否适当。(4)扩展期(2004-2006):将PBL自临床课程延伸至基础医学课程及医学人文课程。此期关键在于基础医学与人文课程老师的共识、教师训练与奖励措施,基础医学课程的整并及PBL计划的评价与改进。(5)精进期(2006～):预计建构PBL网络学习资源与规划在线实施PBL,并完成发展医学教育的器官化模块课程及其配套的PBL和临床技能训练。本校推动PBL的经验,认为PBL,是医学教育中良好的学习模式之一,可行性高且受到学生欢迎,但路途需步步为营,采取渐进改革,并争取老师与同学的认同是实施的关键。     

以问题为基础的学习方法在内科护理学课堂教学中的应用与效果

目的 探讨以问题为基础的学习方法(problem-based learning,PBL)在内科护理学课程教学中的应用与效果.方法 将某大学护理专业30名本科生分成4组,每组由2名导师组织针对脑卒中护理的PBL教学;教学效果评价采用问卷调查法,包括导师对学生表现的评价,学生对PBL课程的评价,以及学生对导师表现的评价.结果 导师对学生表现的评价总分显著提高(P=0.027);学生认为PBL课程中“主持人充分发挥了应有的作用”“有助于培养对文献的检索和利用能力”“有助于培养评判性思维”“有助于培养语言沟通能力”,但没有“足够的时间和精力去做好充分的准备”;学生对导师的评价中,“准备与态度”“交流与反馈”的评分较高,“过程控制”的评分较低.结论 PBL教学方法有助于提高学生的综合能力;导师需要进一步加强对PBL教学过程的控制能力.     

PBL教学法在基础护理学教学中尝试效果的分析

目的：通过PBL教学法培养护生临床实践能力。方法：在2007级护理专业大专护生的基础护理教学中,开展PBL教学尝试,采取组织教学、指定自学内容、自学讨论等步骤组织教学全过程。结果：实践证明,PBL教学法对提高基础护理学的教学质量确有实效;激发了护生的学习动机,提高了对所学知识的理解和记忆。结论：基础护理学用PBL模式可以提高教学效果和培养护生的综合能力。     

Perceptions of radiography students toward problem-based learning almost two decades after its introduction at Makerere University,Uganda

IntroductionProblem-based learning (PBL) has been reported to be a valuable student-centred learning approach across the globe. In PBL students first encounter a problem, which triggers discussion, followed by student-centred inquiry. Makerere University College of Health Sciences has been using PBL for radiography students since 2002. Over the years, the learning landscape may have changed, including the significant disruption of learning by the coronavirus disease 2019 global pandemic. The study aimed at exploring the perceptions of undergraduate radiography students about the PBL curriculum at Makerere University almost two decades after its introduction.MethodsThis exploratory qualitative study involved 18 radiography students sampled purposively, from whom data were gathered using focus group discussions. Thematic analysis was subsequently used.ResultsThree key themes emerged from the data: (1) quality of teaching, (2) curriculum efficiency, and (3) curriculum expectations and rating. All students were generally positive about the curriculum. Most agreed that the curriculum was efficient to a greater extent and had met their expectations and desired objectives. Students, however, faced challenges; for example, with limited learning resources during the learning process.ConclusionThis study highlights the significant role of PBL in enhancing student's problem-solving, critical thinking, literature search, and, most of all, their practical skills. Prioritization of teaching based on practical relevance and learning objectives is of great importance. The radiography students believed that their curriculum program was generally beneficial to them; however, it was affected by limited resources and limited availability of teaching personnel, which needs to be addressed.     

"The Child's World": a creative and visual trigger to stimulate student enquiry in a problem based learning module

Despite the abundance of literature on problem based learning (PBL) [Murray, I., Savin-Baden, M., 2000. Staff development in problem-based learning. Teaching in Higher Education 5 (1), 107-126; Johnson, A.K., Tinning, R.S., 2001. Meeting the challenge of problem-based learning: developing the facilitators. Nurse Education Today 21 (3), 161-169; McCourt, C., Thomas, G., 2001. Evaluation of a problem based curriculum in midwifery. Midwifery 17 (4), 323-331; Cooke, M., Moyle, K., 2002. Students' evaluation of problem-based learning. Nurse Education Today 22, 330-339; Haith-Cooper, M., 2003a. An exploration of tutors' experiences of facilitating problem-based learning. Part 1--an educational research methodology combining innovation and philosophical tradition. Nurse Education Today 23, 58-64; Haith-Cooper, M., 2003b. An exploration of tutor' experiences of facilitating problem-based learning. Part 2--implications for the facilitation of problem based learning. Nurse Education Today 23, 65-75; Rowan, C.J., Mc Court, C., Beake, S., 2007. Problem based learning in midwifery--The teacher's perspective. Nurse Education Today 27, 131-138; Rowan, C.J., Mc Court, C., Beake, S., 2008. Problem based learning in midwifery--The students' perspective. Nurse Education Today 28, 93-99] few studies focus on describing "triggers", the process involved in their development and their evaluation from students' perspective. It is clearly documented that well designed, open ended, real life and challenging "triggers" are key to the success of PBL implementation [Roberts, D., Ousey, K., 2004. Problem based learning: developing the triggers. Experiences from a first wave site. Nurse Education in Practice 4, 154-158, Gibson, I., 2005. Designing projects for learning. In: Barrett, T., Mac Labhrainn, I., Fallon, H., (Eds.), Handbook of Enquiry and Problem-based Learning: Irish Case Studies and International Perspectives. AISHE & CELT: NUI Galway. , Barrett, T., 2005. Understanding problem-based learning. In: Barrett, T. Mac Labhrainn, I., Fallon, H., (Eds.), Handbook of Enquiry and Problem-based Learning: Irish Case Studies and International Perspectives. AISHE & CELT, NUI Galway. ]. This paper outlines the planning, implementation and evaluation of a "trigger" developed for a first year undergraduate nursing module. To meet specific module learning outcomes and to stimulate student inquiry through the learning strategy of PBL, a bright and colourful collage, was constructed. This tool was then evaluated using focus group interviews. Students' perspectives centered round a core theme, 'finding a focus and taking control'. Four categories were identified illustrating students progress from 'initial confusion' to engaging with the 'trigger diversity' before confidently 'exploring their own line of inquiry', thus leading to the 'stimulation of their learning'. Consistent with previous research, we also suggest it is customary for students to experience an initial period of ambiguity as they switch from teacher led to student centered learning [Biley, F., 1999. Creating tension: under graduate students nurses' response to a problem-based learning curriculum. Nurse Education Today 19 (7), 586-589]. One challenge in developing "triggers" is that the process is primarily controlled by lecturers. We suggest that a possible way forward would be to also engage students in the development of "triggers".     

Views of the effectiveness of problem-based learning

AIM: To obtain the opinions of a group of mental health students on the effectiveness of problem-based learning (PBL) within a pre-registration nursing pathway. METHOD: Focus groups were used to generate data and the sample consisted of 14 mental health branch students who, within the pre-registration nursing programme, formed a PBL group. The group met on an annual basis at key junctures during the three-year diploma programme. The focus groups were tape-recorded and the data interpreted and organised by utilising an adapted form of content analysis. RESULTS: Four themes were identified regarding the use of PBL: the students' initial adjustment to PBL; the impact of PBL on their secondment status; the application of PBL in clinical practice; and the students' reflective critique of PBL. CONCLUSION: The discussion of the findings makes suggestions for the utilisation of PBL in future reviews of nursing curricula and outlines the implications for clinical practice. This includes the need to carefully plan the students' initial placement experiences and provide extra support at this stage. In addition, mentor preparation on the use of PBL in practice needs to be extended to ensure flexibility in the PBL process. It should be balanced with formal student support and courses must be planned to incorporate the learning needs of all discipline groups.     

Student, tutor and staff nurse perceptions of the clinical learning environment

The aim of this exploratory study was to describe and compare student nurses (n=142), staff nurses (n=54) and nurse tutors (n=8) perceptions of the clinical learning environment (CLE), and to identify factors that enhanced or inhibited student learning. The setting was a private hospital in Penang, Malaysia. Data were collected using a structured, self-administered questionnaire that consisted of six a priori subscales. Principal component analysis supported a six factor solution and a reduction in the number of items from 44 to 34. Participants' overall perception of the CLE was positive, though there were significant differences in 5 of the 6 subscales between the three groups. For students and their tutors, the most positive component of the CLE was 'supervision by clinical instructors'. Staff nurses reported more favourably on the learner friendliness of the CLE than did students or tutors. Factors that enhanced student learning included students' and staff nurses' attitude towards student learning, variety of clinical opportunities, sufficient equipment, and adequate time to perform procedures. Factors that hindered student learning were: overload of students in the clinical unit, busy wards, and students being treated as workers.     

Student perspectives on problem-based learning in an occupational therapy curriculum: a multiyear qualitative evaluation.

OBJECTIVES: Problem-based learning (PBL) is increasingly being used within health care professional educational programs to develop critical thinking skills via a learner-centered approach. However, few studies have evaluated the effect of participation in a PBL-centered curriculum on occupational therapy knowledge and skill development over time from the perspective of the students involved. This study examined student evaluations of the first three class cohorts participating in a PBL-based curriculum. METHOD: A participatory action design study involving qualitative, student-led focus groups was conducted with 154 students across 2 years of the education program. Fourteen focus groups were audiotaped, and those audiotapes were transcribed by an outside expert, followed by two levels of analysis by program faculty members and a member check by student participants. RESULTS: Themes that emerged from the data analysis related to (a) defining elements of PBL, (b) the role of students and faculty members, (c) learning strategies used by students in a PBL versus traditional education program, (d) the challenges of a PBL approach, and (e) PBL's relationship to clinical reasoning and occupational therapy practice. CONCLUSIONS: Students perceived that a PBL approach adopted consistently across the curriculum contributed to the development of information management, critical reasoning, communication, and team-building skills; however, identified challenges were time and role management, information access, instructor versus PBL expectations and practices, and coping with the ambiguity of knowledge and reasoning.     

师生不同视角下危重症护理硕士专业学位研究生学习方法研究

目的基于导师与研究生不同视角,探讨危重症护理硕士专业学位研究生的最佳学习方法,为研究生的教与学工作提供依据。方法经过查阅文献、相关规范文件,在“危重症护理硕士专业学位研究生学习内容专家函询问卷”基础上,拟定“危重症护理硕士专业学位研究生学习方法”调查问卷,采用方便抽样法选取120名危重症护理硕士专业学位研究生导师、121名危重症护理硕士专业学位研究生作答此问卷,比较导师与研究生不同视角下的最佳学习方法。结果(1)导师建议的学习方法包括自学(18.2%)、课堂讲授(15.1%)、临床查房(13.5%)等;研究生选择的学习方法包括课堂讲授(20.3%)、临床查房(16.7%)、新媒体(13.7%)等。(2)师生在公共理论、科研方法等学习内容对应的学习方法的选择差异明显(P<0.05)。结论无论对于导师还是危重症护理硕士专业学位研究生,教与学的方法多样且存在差异。导师应根据具体学习内容灵活选择教的方法,特别是新媒体技术的应用,并创新课堂讲授形式,开展“对话式”教学,注重引导学生提高自学能力;学生则应根据具体学习内容灵活选择多种学的方法,注重提高自主学习的能力。     

Simulation-based training is superior to problem-based learning for the acquisition of critical assessment and management skills

OBJECTIVE: To determine whether full-scale simulation (SIM) is superior to interactive problem-based learning (PBL) for teaching medical students acute care assessment and management skills. DESIGN: Randomized controlled trial. SETTING: Simulation center at a U.S. medical school. SUBJECTS: Thirty-one fourth-year medical students in a week-long acute care course. INTERVENTIONS: After institutional review board approval and informed consent, eligible students were randomized to either the SIM or PBL group. On day 1, all subjects underwent a simulator-based initial assessment designed to evaluate their critical care skills. Two blinded investigators assessed each student using a standardized checklist. Subsequently, the PBL group learned about dyspnea in a standard PBL format. The SIM group learned about dyspnea using the simulator. To equalize simulator education time, the PBL group learned about acute abdominal pain on the simulator, whereas the SIM group used the PBL format. On day 5, each student was tested on a unique dyspnea scenario. MEASUREMENTS AND MAIN RESULTS: Mean initial assessment and final assessment checklist scores and their change for the SIM and PBL groups were compared using the Student's t-test. A p < .05 was considered significant. The SIM and PBL groups had similar mean (PBL 0.44, SIM 0.47, p = .64) initial assessment scores (earned score divided by maximum score) and were deemed equivalent. The SIM group performed better than the PBL group on the final assessment (mean, PBL 0.53, SIM 0.72, p < .0001). When each student's change in score (percent correct on final assessment minus percent correct on the initial assessment) was compared, SIM group students performed better (mean improvement, SIM 25 percentage points vs. PBL 8 percentage points, p < .04) CONCLUSIONS: For fourth-year medical students, simulation-based learning was superior to problem-based learning for the acquisition of critical assessment and management skills.     

Humor as a facilitative style in problem-based learning environments for nursing students

Although the nursing and education literature confirm that humor has a role to play in the learning experience, there is little evidence available about the impact and the challenges of using humor to facilitate group process and learning in problem-based learning environments for nursing students. In this paper, we explore humor as a style of communication in PBL environments using examples from the classroom. We then propose a range of strategies to build capacity in PBL tutors and to infuse humor into the PBL classroom such as: acceptance that fun and humor are components of the ground rules in the group; appropriate humor and boundaries; mutual story sharing; and creative activities to moderate stress and build coping strategies to thrive in clinical practice. It is timely for nurse academics and researchers to examine the contribution of humor as a facilitative communication style in the PBL environment. Findings could inform evidence-based teaching of nursing students and foster life-long learning and communication skills.     

PBL教学法在护理本科实习护生临床教学中的应用

目的探讨以问题为中心（problem based learning,PBL）教学法在护理本科实习护士学生（以下简称护生）临床教学中的应用效果。方法将120名在眼科实习的护生,按临床实习时间分为实验组和对照组,每组各60名。实验组采用PBL教学法,对照组采用传统教学方法。实习6w后,比较两组护生理论知识和技能等各种考核成绩的差异,并同时调查两组护生对临床教学质量的反馈情况。结果实验组护生理论知识和技能等各种考核成绩均优于对照组,83.33%的护生认为PBL教学法可提高学习兴趣、自学能力、临床思维能力、沟通能力和整体护理能力,与对照组比较,均P〈0.01,差异具有统计学意义。结论 PBL教学法能使护生更好地将护理理论知识与临床实践相结合,提高了护生临床护理理论和操作水平等综合能力,值得在临床护理教学中推广应用。     

A Comparison of Problem-Based Learning and Standard Curriculum Students: Three Years of Retrospective Data

Background: Many, many studies, including three major reviews, that compare problem-based curricula to more traditional curricula, have been published in the last 10 years. No study, however, has looked specifically at a closed-loop or reiterative problem-based approach. Purpose: A 3-year retrospective study was done to compare the academic performance of students in a reiterative problem-based learning (PBL)curriculum with that of their counterparts in the standard curriculum to ensure that the PBL students were not disadvantaged. Methods: Three graduating classes' performance on a number of outcome measures, including the United States Medical Licensing Examination, clinical clerkship, and clinical practice examination performance, were compared. Results: Analyses indicate that students in the PBL curriculum performed at least as well as, and in some instances better than, their counterparts in the standard curriculum. Conclusion: Students in the PBL curriculum, a student-directed curriculum, were not disadvantaged. Of note is their strong clinical performance.     

以问题为基础的教学法在儿科护理实习教学中的应用

目的 探讨以问题为基础的教学法（Probiem-Based Learning，PBL）在儿科护理实习教学中的应用效果。方法 选取在临床实习的大专学生49人，按在校的理论成绩和技术操作成绩，采取整群分层抽样方法，分为实验组和对照组，实验组25人和对照组24人。对照组采用传统的教学模式，实验组采用PBL的教学模式，在实习结束前进行出科考核及问卷调查。结果 两组学生在专科理论知识、健康教育指导和满意度的比较，经统计学分析，均P〈0．05，差异有统计学意义。结论 PBL有利于实习学生获得基础学科知识与临床实践的统一；PBL教学法提高了实习学生的健康教育能力及满意度。