When a problem-based learning tutor decides to intervene

Does prior knowledge affect interaction dynamics and learning achievement in digital problem-based learning? A pilot study

Objective

Previous research on problem-based learning (PBL) describes that videotaped observations develop meaningful insights into cognitive processes in tutorial groups. Analysis regarding the amount of prior knowledge on learning achievement has not been investigated in medical education so far, although both are key factors of PBL success. Thus, we intended to analyse videos of digital problem-based learning (dPBL) sessions, focusing on knowledge acquisition and interaction dynamics among groups with different levels of prior knowledge to reveal any distinctions.

Methods

This study employed a pilot design by dividing 60 dental students into twelve subgroups with less or more prior knowledge, determined by a pre-semester multiple choice test (MCQ). The groups engaged in videotaped dPBL cases, which were examined regarding group interactions and tutor effectiveness. The learning achievement was assessed through a post-semester MCQ, an oral and practical exam.

Results

The video analysis showed that dPBL groups with less prior knowledge achieved significantly higher tutor effectiveness and group interaction utterances, but that the percentage of time in which utterances occurred was similar in both groups. Related to the MCQ results, the students with less prior knowledge learned four times more than those with profound previous abilities, but no significant difference was found in the results of the oral exam and practical exam.

Conclusions

The interaction dynamics in dPBL depend on the group's amount of prior knowledge. Especially groups including participants with less prior knowledge seemed to benefit from dPBL in comparison to groups with more prior knowledge. The dPBL groups acquired knowledge in different ways during the courses but, finally, all students arrived at a similar level of knowledge.

Group interaction in problem-based learning tutorials: a systematic review

INTRODUCTION

This review aimed at identifying studies on group interaction in problem-based learning (PBL) and elucidate methods used, factors affecting group interaction and the relationship between interaction and student's learning.

MATERIALS AND METHODS

PubMed, EMBASE, PsycINFO and HighWire were searched (January 1999 to June 2013) using a combination of pre-specified search terms. The search words were also used in searching nine journals in dental and medical education. Also edited research books on PBL were searched. Both qualitative and descriptive studies of group interaction were selected and critically appraised.

RESULTS

Finally, 42 of 10,606 papers were included (35 journal articles and seven from research books). The materials used in assessing group interaction varied depending on the methodology design. Forty-three percent of the studies used video recording to evaluate group interaction. Other studies used indirect approaches such as focus groups, interviews and questionnaires. Factors affecting group interactions were students' and tutors' perceptions, tutor's subject-matter expertise, training students, tutor's group dynamics. There was no conclusive evidence about the impact of interaction in PBL on learning. Most studies were from medicine (64%), and 35 papers were published in the last 10 years. The majority of studies were conducted in Europe, North America and Asia.

CONCLUSIONS

Although there is a progressive increase in publications on PBL group interaction during the last 10 years, there are knowledge gaps and deficiencies in this area and most studies are lacking solid theoretical basis and are descriptive. There is a deficiency in the literature in this area from dentistry and other allied health disciplines.

How do tutors intervene when conflicts on knowledge arise in tutorial groups?

Recent research on problem-based learning (PBL) has shown that students need support when dealing with conflicting ideas in PBL-tutorial discussions. In the present study, we examined tutor facilitation during tutorial discussions, and particularly how the facilitation helped students to collaboratively resolve conflicts on knowledge. The study involved four PBL-tutorial sessions that included altogether 33 first-year medical and dental students. The sessions were videotaped and analysed using qualitative interaction analysis. Our aim was to find out how the tutor interventions encouraged students to elaborate on conflicting ideas, and how the interventions differed between conflict and non-conflict situations. We also examined how the tutors intervened during conflicts about factual or conceptual knowledge. The tutorial discussions included 92 tutor intervention episodes and 43 conflict episodes. The tutors intervened during 24 of the conflict episodes and resolved 13 of these episodes. Generally, the tutors often intervened by confirming what the students had said or by giving explanations, but they rarely asked questions that would stimulate the elaboration of knowledge. During conflicts on knowledge the tutors gave more explanations, but did little to encourage the students to deal with conflicting ideas. The tutors more often resolved conflicts on factual knowledge than conceptual knowledge. The findings suggest that tutor training should focus on promoting tutors' understanding on when to give direct explanations, and when and how to encourage students to collaboratively elaborate on conflicting ideas.

Elaboration during problem-based group discussion: effects on recall for high and low ability students

Although elaboration has been investigated frequently, there is little evidence for the beneficial effect of elaboration in problem-based learning. A controlled experiment tested the effect of elaboration during problem-based discussion on recall. Sixty-seven students observed a video-recorded, problem-based discussion. In one experimental condition, a tutor in the video encouraged participants to elaborate by asking elaborative questions. In a second condition, the tutor asked superficial questions. After the discussion, all participants studied a text with relevant new information. Elaborative questions had no significant effect on recall of idea units from the text, p = .39, η(2) = .01. High-ability students outperformed low-ability students, p = .04, η(2) = .07, but this effect did not interact with the experimental treatment, p = .22, η(2) = .02. Suggestions for further research are presented.

How experienced tutors facilitate tutorial dynamics in PBL groups

BACKGROUND

Problem-based learning (PBL) tutorial are conducted in small groups, and successful learning in such groups requires good group facilitating skills. There is a lack of research on actual skills employed by tutors in facilitating the group dynamics.

AIM

To explore the process of PBL tutorial small groups, focusing on the tutors' actual behavior in facilitating group dynamics.

METHODS

Eight experienced tutors from various departments in medical colleges participated in this research. Forty tutorial group sessions were videotaped. Among the 636 tutorial intervention episodes, 142 of them were associated with facilitating group dynamics. Tutors interventions as well as their recalls were transcribed verbatim. Qualitative research methods were utilized to analyze the data.

RESULTS

There were 10 tutorial group dynamic situations and 48 tutorial skills. Analysis of the tutors' intentions employing these skills in the 10 situations showed that tutors were trying to achieve the following aims: (1) iteration of PBL principles, (2) delegation of responsibility to the students, (3) creation of a good discussion forum, and (4) the generation of a good learning atmosphere.

CONCLUSION

Results from this study provide PBL tutors with a practical frame of reference on group dynamic facilitating skills and stimulate further research on this topic.

Effectiveness of a modified tutorless problem-based learning method in dermatology - a pilot study

BACKGROUND AND AIMS

Problem-Based Learning (PBL) is a student-centred instructional strategy in which students learn in a collaborative manner, the learning process being guided by a facilitator. One of the limitations of conventional PBL in medical education is the need for adequate resources in terms of faculty and time. Our study aimed to compare conventional PBL in dermatology with a modified tutorless PBL in which pre-listed cues and the use of digital media help direct the learning process.

METHODS

Thirty-one-fifth year medical students were divided into two groups: the study group comprising 16 students were exposed to the modified PBL, whereas the control group comprising 15 students were given the same scenarios and triggers, but in a conventional tutor-facilitated PBL. Knowledge acquisition and student feedback were assessed using a post-test and a Likert scale-based questionnaire, respectively.

RESULTS

The post-test marks showed no significant statistical differences between the two groups. The general feedback regarding the modified PBL was positive and the students felt comfortable with the module. The learning objectives were met satisfactorily in both groups.

CONCLUSION

Modified tutorless PBL modules might be an effective method to incorporate student-centred learning in dermatology without constraints in terms of faculty resources or time.

"Could I add something?": Teaching communication by intervening in real time during a clinical encounter

Supervising learners as they communicate often places faculty preceptors in a classic educational dilemma. What should a preceptor do when the learner is not communicating well and is not asking for help? What usually happens, in the authors' experiences, is that the preceptor decides at some point that she or he cannot stand the situation anymore-then interrupts the learner and takes over the conversation. Interrupting in this way, however, comes at the cost of undermining the learner. Thus, the authors have developed an alternative teaching strategy designed for communication tasks such as giving serious or bad news. In the strategy recommended here, the preceptor sets up the possibility that he or she may intervene in the encounter. If the preceptor does intervene, he or she explicitly hands the conversation back to the learner and afterwards debriefs with the learner. The authors designed this strategy to decrease the risk to the patient while maximizing learning for the learner. This strategy offers preceptors a way to teach communication skills more effectively in clinical settings using intentional goal setting with learners, careful observation of the encounter, intervention when the conversation is not going well, and reflective feedback for the learner based on the learner's goals.