Problem-Based Learning (PBL): Conceptions and Approaches of Undergraduate Students of Nursing

Students perceive skills learned in pre-clerkship PBL valuable in core clinical rotations

Purpose: Problem-based learning (PBL) is an instructional method widely used by medical educators that promotes an environment in which students effectively learn the foundational knowledge and skills that are prerequisites for graduation. This study evaluated medical students' perceptions of the helpfulness of skills acquired in PBL to core clerkship rotations.Methods: A 25-item survey was designed to assess students' perceptions of skills learned in PBL that were helpful on core clerkships and transferable to the clinical setting. A random sample of students with at least 8 months of clerkship experience were invited to complete the survey.Results: Of 68 students, 35 (52%) returned questionnaires. Results suggest a clustering of themes based on their perceived value. Skills learned in PBL that students rated most highly as helpful or very helpful during core clinical rotations include: comfort discussing concepts, identifying key information, presentation skills, interpersonal skills, diagnostic thinking, finding information, self-awareness, and organizing information. Other items rated highly included: forming questions, time management, primary literature (engaging with published original research articles), and leadership. The skills acquired in PBL were associated with multiple competency domains.Conclusions: Although conditions of the pre-clerkship curriculum are substantially different from the learning environment of clerkship rotations, skills learned in PBL are perceived as applicable to authentic clinical training.

Update on research and application of problem-based learning in medical science education

Problem-based learning (PBL) is a unique form of pedagogy dedicated to developing students' self-learning and clinical practice skills. After several decades of development, although applications vary, PBL has been recognized all over the world and implemented by many medical schools. This review summarizes and updates the application and study of PBL in medical education through the literature published between 1993 and early 2017. It focuses on understanding real medical PBL courses and ways to improve PBL to achieve better learning outcomes. PBL aims to develop lifelong skills to solve practical problems rather than limiting learning to theoretical knowledge. To achieve this goal, strict and reasonable procedures need to be designed and implemented. Rigorous monitoring and timely feedback and evaluation are indispensable to constant improvements and perfecting of the process. © 2017 by The International Union of Biochemistry and Molecular Biology, 46(2):186-194, 2018.

Dental students' perception of their approaches to learning in a PBL programme

AIM

To compare dental students' perceptions of their learning approaches between different years of a problem-based learning (PBL) programme. The hypothesis was that in a comparison between senior and junior students, the senior students would perceive themselves as having a higher level of deep learning approach and a lower level of surface learning approach than junior students would. This hypothesis was based on the fact that senior students have longer experience of a student-centred educational context, which is supposed to underpin student learning.

PARTICIPANTS AND METHODS

Students of three cohorts (first year, third year and fifth year) of a PBL-based dental programme were asked to respond to a questionnaire (R-SPQ-2F) developed to analyse students' learning approaches, that is deep approach and surface approach, using four subscales including deep strategy, surface strategy, deep motive and surface motive. The results of the three cohorts were compared using a one-way analysis of variance (ANOVA). A P-value was set at <0.05 for statistical significance.

RESULTS

The fifth-year students demonstrated a lower surface approach than the first-year students (P = 0.020). There was a significant decrease in surface strategy from the first to the fifth year (P = 0.003). No differences were found concerning deep approach or its subscales (deep strategy and deep motive) between the mean scores of the three cohorts.

CONCLUSIONS

The results did not show the expected increased depth in learning approaches over the programme years.

Problem-based learning: student learning experiences and outcomes

The aim of this article is to examine processes occurring within problem-based learning (PBL) courses (inside the black box) by contrasting these processes with outcome-based studies (from outside the black box). We review meta-analyses of input-output studies of PBL in comparison with traditional approaches and provide a summary of qualitative, phenomenographic and factor analytic analyses of student experiences when studying health sciences (dentistry and medicine) using PBL curricula. Results from meta-analyses showed PBL courses were preferred for the long-term retention of course content, short-term retention involving elaboration of new information and the application of clinical skills and reasoning. Traditional approaches were favoured for short-term retention of course content that did not require any elaboration. The qualitative studies reveal a diversity of student views about the concept of PBL pedagogy and approaches to learning in PBL curricula. They show that the ways in which students approach their studies in PBL in health sciences are closely related to how they conceive of PBL and that these dimensions are closely related to how the goals and standards of PBL courses are perceived.

Problem-based learning tutors' conceptions of their development as tutors

BACKGROUND

The quality of student learning in hybrid problem-based learning (PBL) programs depends on PBL tutors' being effective in their role.

AIMS

To explore PBL tutors' conceptions of their role and how they grow and develop as tutors, and map tutors' views to an emergent hierarchy of conceptions.

METHOD

Participants were 29 tutors who had tutored in at least one 'block' of study in academic years 1-2 in the first half of 2007 in a 4-year, graduate-entry hybrid PBL medical program. Qualitative phenomenographic analysis was used to categorize tutors' written responses.

RESULTS

Four qualitatively different categories of conception of the PBL tutor role emerged. Categories increased in complexity and more complex conceptions included the preceding view. Analysis of tutors' conceptions of how they grow and develop as tutors also revealed four categories of increasing complexity. There was homogeneity in the relations between levels of sophistication in conceptions of the tutor role and developing as a tutor.

CONCLUSIONS

To help tutors become more effective in their role, development programs may need to engage tutors in thinking about how they develop as teachers, and in particular encourage them to solicit their own face-to-face student feedback.

"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. <www.nuigalway.ie/celt/pblbook>, 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. <www.nuigalway.ie/celt/pblbook>]. 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".

Problem-based learning in dental education: what's the evidence for and against … and is it worth the effort?

All Australian dental schools have introduced problem-based learning (PBL) approaches to their programmes over the past decade, although the nature of the innovations has varied from school to school. Before one can ask whether PBL is better than the conventional style of education, one needs to consider three key issues. Firstly, we need to agree on what is meant by the term PBL; secondly, we need to decide what "better" means when comparing educational approaches; and thirdly, we must look carefully at how PBL is implemented in given situations. It is argued that PBL fulfils, at least in theory, some important principles relating to the development of new knowledge. It also represents a change in focus from teachers and teaching in conventional programmes to learners and learning. Generally, students enjoy PBL programmes more than conventional programmes and feel they are more nurturing. There is also some evidence of an improvement in clinical and diagnostic reasoning ability associated with PBL curricula. The main negative points raised about PBL are the costs involved and mixed reports of insufficient grounding of students in the basic sciences. Financial restraints will probably preclude the introduction of pure or fully integrated PBL programmes in Australian dental schools. However, our research and experience, as well as other published literature, indicate that well-planned hybrid PBL programmes, with matching methods of assessment, can foster development of the types of knowledge, skills and attributes that oral health professionals will need in the future.

Students' conceptions of constructivist learning: a comparison between a traditional and a problem-based learning curriculum

This study investigated students' conceptions of constructivist learning activities in a problem-based learning (PBL) and a traditional curriculum. We examined whether students who have chosen for a problem-based curriculum have different conceptions of constructivist assumptions compared to students who have chosen to be enrolled in a traditional, lecture-based curriculum when they enter university. Although constructivism represents an influential view of learning, studies investigating how students conceptualize this perspective have not been conducted before. A structural equation modelling approach was adopted to test the hypothesized model in both student populations and to calculate latent means. Results suggested that students in the PBL environment agree more on constructivist assumptions of cooperative learning and the use of authentic problems, while students in the traditional curriculum acknowledge the importance of motivation to learn more. It is discussed that conceptions of constructivist learning activities can act as an important moderator of PBL effects and should be considered in examining the effects of PBL and probably in all comparative education research.

Conceptions of problem-based learning: the perspectives of students entering a problem-based medical program

Effective learning in higher education is associated with students' perceptions of clear goals and standards of an educational program. In programs using problem-based learning (PBL), students' conceptions of what PBL is about could determine how well they perceive the clarity of goals and standards of their program. In this study the authors aim to investigate the relationship between the nature of first-year students' conceptions of PBL and their perceptions of the clarity of goals and standards of a graduate-entry, problem-based medical program. Results are that most students conceive of PBL as mainly working collaboratively to solve and understand a problem, and place less emphasis on PBL as learning independently. There is no relationship between students' conceptions and perceived clarity of course goals and standards. It is suggested that teachers not only need to help students develop their understanding of what PBL is about but also need to help students learn how to self-regulate their learning in PBL programs.

Differences in students' perceptions of learning compulsory foundation biochemistry in the health sciences professions

Student approaches to learning vary from surface approaches to meaningful, deep learning practices. Differences in approach may be related to students' conceptions of the subject, perceptions of the learning environment, prior study experiences and performance on assessment. This study aims to explore entering students' conceptions of the unit they are about to study and how they intend to approach their studies. It involved a survey of 203 (of 250) first year students in a cross disciplinary unit in the Faculty of Health Sciences. They were asked to complete an open-ended response survey, including questions on what they thought they needed to do to learn biochemistry and what they thought the study of biochemistry was about. A phenomenographic methodology was used to identify categories of description for the questions. The paper will describe the categories in detail, the structural relationship between the categories and the distribution of responses within categories. The study reports a relationship between conception of the topic and approaches to learning. Students with more complex and coherent conceptions of the topic report that they were more likely to adopt deeper approaches to study than those with more fragmented conceptions. However, compared to previous studies, a surprisingly high proportion of students with more cohesive conceptions still intended to adopt more surface approaches. This may reflect the particular context of their learning, namely in a compulsory unit involving material for which most students have minimal background and difficulty seeing its relevance. Implications for teaching such foundation material are discussed.

The Effect of Problem-Based Learning on Nursing Students' Perceptions of Empowerment

This study tested Kanter's structural empowerment theory within a university nursing student population. Differences in perceptions of empowerment among nursing students enrolled in either a problem-based learning (PBL) or a conventional lecture learning (CLL) program were examined, as well as the relationship between perceptions of structural empowerment in the learning environment and feelings of psychological empowerment. Participants completed measures of structural and psychological empowerment adapted to educational settings, as well as measures related to exposure to various learning strategies in their programs and clinical problem-solving abilities. Students in the PBL program (n = 41) had significantly higher perceptions of structural and psychological empowerment than students in the CLL program (n = 67). Regardless of academic program, structural empowerment was strongly positively related to psychological empowerment. The results of this study are the first to support the applicability of Kanter's theory to nursing education settings.

A student learning perspective on teaching and learning, with implications for problem-based learning

Over the last 20 years or so, there has been a substantial development in our understanding of how and what university students learn in their courses (here meaning a component of a programme) and programmes of study. This research has shown that rather than there being a direct connection between the way teachers teach and design their courses, and the quality of their students' learning outcomes, the relationship is indirect. The way students perceive and understand their learning context and the way they approach their learning in relationship to these perceptions have been found to be major intervening factors between teachers' teaching and students' learning outcomes. Their perceptions are, in turn, constituted in relation to their prior experiences of teaching and learning and what is designed for them to learn. In this paper, some of the key findings of this research and how it can be related to a problem-based learning (PBL) perspective in higher education are outlined. In particular, it is argued that the variation in students' perceptions and understanding of what PBL is about is fundamental to the way they approach their studies and to their learning outcomes.

On the Fast Track speeding nurses into the future: A two-year bachelor of nursing for graduates of other disciplines

It has been suggested in nursing literature that a bachelor's degree should be the pre-requisite to professional nursing education and registration. The perceived advantages of graduates entering the nursing profession led faculty in the School of Nursing La Trobe University to introduce in 1997 an innovative two-year Bachelor of Nursing (BN) program, believed to be the first in Australia, for graduates of other disciplines. A problem-based learning (PBL) approach was selected to facilitate the teaching learning process. Data to evaluate the progress of the accelerated students were collected by examining their previous degree background, conducting a focus group discussion mid year and comparing the students' academic results with those completing the traditional three-year course. Findings indicate that students in the accelerated course were highly motivated but experienced significant stress. In part the stress emanated from the need to identify their own learning needs. However, despite their concerns most accelerated students scored at least as well both clinically and academically as traditional students. Moreover, in six of the seven final year subjects each group studied the accelerated students performed better.