Problem Based Learning (PBL) in Nursing Education

 

C. Srilatha¹, N. Sucharitha², K. Sesha Kumar³

¹Associate Professor, AECS Maaruti College of Nursing, Bangalore.

²Associate Professor, AECS Maaruti College of Nursing, Bangalore.

³Community Health Officer, HWC- Valligatla, Chittoor Dt, Andhra Pradesh.

 

ABSTRACT:

PBL (Problem Based Learning) is an instructional student centered approach which uses carefully constructed clinical problems as a context to define their learning needs, conduct self-enquiry, integrate theory and practice, and apply knowledge and skills to develop a solution to a defined problem. It is the process of acquiring new knowledge based on recognition of a need to learn. The problem comes first without advance readings, lectures or preparation. Problems should be appropriate to the stage of the curriculum and the level of the students' understanding. Scenarios should have sufficient intrinsic interest for the students or relevance to future practice. Problem Based Learning is one of the advanced teaching strategy where the nurse teacher uses in implementation of students curricular/ academic activity with an aim to achieve sound result of students in solving a problem / scenarios. This may be different kind but it should be student oriented, ultimate goal is to improve the strength of students’ knowledge. Presently this type of strategies were practicing much in educational institution, service developments and research areas.

 

 

 

INTRODUCTION:

An instructional student centered approach which uses carefully constructed clinical problems as a context for students to define their learning needs, conduct self-enquiry, integrate theory and practice, and apply knowledge and skills to develop a solution to a defined problem. It is the process of acquiring new knowledge based on recognition of a need to learn. The problem comes first without advance readings, lectures or preparation. The problem serves as a stimulus for the need to know. Based on knowledge and the identified gaps in that knowledge, students determine the learning issues within their own group.

 

They then identify and use a variety of learning resources to study such issues and return to the group to discuss and share what they have learned.

 

History of Problem Based Learning (PBL):

Problem based learning (PBL) was first utilized during 1960s by McMaster University in Canada in the instruction of medical students. Since that time, it has been successfully used as an educational tool for nursing, dentistry, pharmacy, veterinary medicine and public health professional programmes. Knowles defined it as ‘‘a process in which individuals take the initiative, with or without the help of others, in diagnosing their needs, formulating learning goals, identifying human and material resources for learning, choosing, and implementing appropriate learning strategies and evaluating learning outcomes”. Margetson described the link between problem based learning and self identification, followed by students engaging in self learning to solve the problem based learning in the training of healthcare professionals incorporates goals for students that are much broader than the acquisition and application of content. Problem Based Learning (PBL) is expected to influence the ‘‘whole’’ student or at least most aspects of the students’ learning experience.

 

Stimulus for Problem Based Learning (PBL):

Problem Based Learning (PBL) was developed by modeling the process of how we actually learn each day during our working lives. Patients pose a diagnostic dilemma, which results in either a ‘‘patient unmet need’’ where the diagnosis is missed or a ‘‘doctor’s educational need’’ where reference is made to learn from the signs presented. This stimulates the clinician to read around the subject once recognized deficiencies are identified. No-one gives practicing doctors a curriculum, lecture notes or suggested reading for each patient, but we acquire the knowledge and skills that allow us to practice competently from the repeated application of these principles. It is the patients who provide the stimulus for lifelong learning. Students have to recognize the need to maintain learning. Problem Based Learning (PBL) poses these diagnostic dilemmas to students in the form of case-based problems, giving the student the opportunity to acquire knowledge but also a method of applying it and developing a diagnostic technique to implement the newly found knowledge. This represents a more useful form of learning than merely memorizing and regurgitating facts for a multiple choice exam. It can be seen that this approach does not necessarily require an underpinning of didactically taught basic science but rather the student gains basic science information relevant to each particular problem through this self-directed learning.

 

Main Steps:

·       Clarify terms and decide the problems:

Some terms may need clarification; make sure all group members understand the same thing and all members understand the terminology.

 

·       Analyze the problems:

This consists in large part of utilization of students’ prior knowledge, to try and formulate hypothesis to explain the processes that have contributed to this clinical presentation. It commonly becomes a ‘‘brainstorming’’ session. The aim is to encourage all group participants to develop some insight into the underlying issues that might be at play.

 

·       Identify study priorities for the scenario:

Usually, there will be insufficient time to address all the issues raised. This important step entails prioritization of those aspects of the scenario needing most attention—just as in real life.

·       Formulate learning objectives for the problems:

It is usual to draw up a list at this point on which all the group can agree: the objectives upon which the learners will concentrate are set out. It may be helpful to delegate tasks at this stage. The group must also identify what resources will be needed to help answer the questions they have set.

 

·       Individual study:

This step requires a high degree of motivation, if the PBL is to be effective. There are real constraints in finding the time and energy to search out and assimilate the information needed. At this stage, the facilitator must be available when needed to assist with finding the information or to deal with problems in completing the tasks within the given time. In the next session, the group meet and share their findings. It is important that each participant fully contributes, they may make presentations to other group members, lead a discussion, or produce a handout. New questions may have arisen, and the group may decide to ‘‘step back’’ and reanalyze their priorities in this scenario.

 

·       Identify areas for improvement:

In this phase, group members look at how they approached the earlier steps and consider if they have developed new skills as a result of their studies. This reflective activity can be very revealing and is a powerful motivator to further useful clinical learning.

 

What makes a good Problem Based Learning (PBL) Problem?

Problem Based Learning (PBL) only has the potential to be effective if care is taken to set problems that work well with this learning style. The following points must be considered,

·       There should be a neutral description of a realistic and fairly common clinical scenario that needs explanation in terms of underlying principles or processes.

·       There must be the scope for problem solving activity.

·       The problems must be formulated in a clear and concrete manner.

 

There should be a degree of complexity to the scenario that is appropriate to the participants: too simplistic a scenario will not motivate anyone. One of the strengths of PBL is that ‘‘simpler’’ tasks can be allocated to those whose knowledge base or learning skills are comparatively weak, and ‘‘complex’’ tasks allocated to stronger group members, without anyone necessarily being disempowered, within an adult learning environment, it is crucial to acknowledge all contributions to the learning, and responsible participants work within this framework quite easily; An element of medical urgency to the problem helps promote high quality participation for learners whose clinical work role is in the emergency department; Problems raising issues that are often poorly handled by healthcare staff are particularly powerful learning tools.

 

Creating effective Problem Based Learning (PBL) scenarios:

Learning objectives likely to be defined by  the students after studying the scenario should be consistent with the faculty learning objectives. Problems should be appropriate to the stage of the curriculum and the level of the students' understanding. Scenarios should have sufficient intrinsic interest for the students or relevance to future practice. Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge. Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented. The problem should be sufficiently open, so that discussion is not curtailed too early in the process. Scenarios should promote participation by the students in seeking information from various learning resources.

 

Role of Facilitator:

Does Problem Based Learning (PBL) Require A Teacher?

There has been little mention of the ‘‘teacher’’ in problem based learning. PBL differs radically from traditional teaching styles in that it centers on ‘‘problem first’’ learning, rather than the more usual ‘‘subject first’’ way using scenarios to illustrate previously taught material. The leader of a PBL program acts as a facilitator rather than a teacher, using their expertise not primarily to transmit facts, but to provide encouragement and guidance as the participants tackle the problems they have identified. The skill of PBL facilitation is that of knowing when to provide assistance to the group, be it suggesting useful resources they might like to consider or interjecting with thought provoking comments to guide the breadth and depth of learning, without necessarily imparting facts. There has been debate as to whether the facilitator needs to be an ‘‘expert in the field’’ regarding the subject matter being tackled, but the consensus view is that expertise in group dynamics together with supportive enthusiasm is more valuable than deep subject knowledge. This has been a difficult idea for some medical teachers to grasp. This educational tool utilizes facilitators rather than lecturers. The responsibility of facilitators in PBL may include: encouraging critical thinking; fostering self directed learning; monitoring group progress; and creating a learning environment that stimulates group members, generates thorough understanding, and promotes team work.

 

What Instructors Do?

Develop real world, complex and open ended problems such as might be faced in the workplace or daily life. Act as facilitators, making sure students are staying on track and finding the resources they need. Raise questions to student groups that deepen the connections they make among concepts. Strike a balance between providing direct guidance and encouraging self-directed learning.

 

What Students Do?

Address the problem, identifying what they need to learn in order to develop a solution and where to look for appropriate learning resources. Collaborate to gather resources, share and synthesize their findings, and pose questions to guide further learning tasks for the group. The function of the tutor in PBL differs considerably from that of the tutor in conventional tutorials in which the tutor assumes a comparatively didactic role. A major feature of PBL is that learning is student centered in that students take responsibility for identifying and addressing their own learning needs; tutors are required to facilitate this rather than adopt the position of content expert. Facilitation requires understanding of the learning process and primarily involves monitoring of student learning and promotion of effective group function. The student centered learning approach of PBL means that for tutors, content knowledge should be subordinate to proficiency in group facilitation. Thus, effective tutors promote student learning by creating a supportive environment which encourages active participation by all members of the group, by monitoring the quality of learning through questions and feedback and by encouraging the development of students' Meta cognitive skills. Thus tutoring in PBL tutoring has two components: facilitation skill and content knowledge. It may be expected that students would consider the principal strength of clinically qualified tutors to be their greater relevant content knowledge. In contrast, the principal strength of non clinically qualified academic staff to the PBL process would be the facilitation skills derived from teaching experience.

 

Advantages of Problem Based Learning (PBL):

Much of the early work on PBL described its use in the undergraduate setting, particularly the pre-clinical years. There remains little information about its use in postgraduate education. The issue of PBL’s effectiveness is a vexed one because of difficulties surrounding terminology - several literature reviews have discovered that many papers seemingly reporting ‘‘PBL’’ initiatives actually describe activities such as journal clubs or self directed study groups without several of the components of PBL proper . There are further difficulties, as with much educational research, in determining exactly what we mean by ‘‘does it work?’’ If we are asking whether PBL leads to greater participant enjoyment and enthusiasm for learning than more ‘‘traditional’’ methods of medical education, then there is plenty of evidence to support this: PBL learners feel they are being treated as mature professionals who are developing effective and clinically relevant study skills as well as useful skills in problem solving that are vital in their working life. They also value the interpersonal skills that PBL encourages and that are also key to effective clinical practice. There is practically no evidence, however, that PBL participants demonstrate improved clinical competence or have more effective clinical consultations, although it might be argued that in becoming more confident and self aware as professional learners they will presumably become more efficient and enthusiastic in the workplace. These remain broad assumptions, though, and the relative newness of postgraduate PBL accounts for the lack of clarity in this area. PBL provides a potentially challenging, more motivating, and enjoyable approach to medical education, and may promote lifelong habits of self-directed learning.

 

Main features of Problem Based Learning (PBL):

·       Student centered:

It fosters active learning, improved understanding, and retention and development of lifelong learning skills.

 

·       Generic competencies:

Allows students to develop generic skills and attitudes desirable in their future practice.

 

·       Integration:

PBL facilitates an integrated core curriculum.

 

·       Motivation:

PBL is fun for students and tutors, and the process requires all students to be engaged in the learning process.

 

·       Deep learning:

PBL fosters deep learning.

 

·       Constructivist approach:

Students activate prior knowledge and build on existing conceptual.

 

·       Generic skills and attitudes:

·       Teamwork

·       Chairing a group

·       Listening

·       Recording

·       Cooperation

·       Respect for colleagues' views

·       Critical evaluation of literature

·       Self directed learning and use of resources

·       Presentation skills

 

Outcome of Problem Based Learning (PBL):

Knowledge:

Knowledge and test performance have been the most widely researched outcomes. PBL is thought to improve learning and retention of information and Norman and Schmidt, in their review found several studies supporting improved retention of knowledge.

 

Skills:

Since clinical problems provide the basis for learning in PBL it is assumed that knowledge should be better integrated in the clinical setting. Reviews found that PBL students scored comparably or better than traditionally taught peers in clinical skills. Schmidt also reported higher diagnostic skills in Dutch students following integrated or PBL curricula compared to conventional teaching although only part of this variance may be attributable to PBL. At Harvard PBL graduates’ showed higher ratings for humanistic and psychosocial skills and better relational skills.

 

Disadvantages of Problem Based Learning (PBL):

PBL is more expensive than conventional curricula, especially in larger medical schools. In the early literature reviews, PBL graduates tended to rate their basic science background weaker than their conventional curriculum counterparts. These results suggest that PBL may not develop in students an effective cognitive foundation. Other studies have indicated that while students favor PBL curricula, they also express dissatisfaction about a lack of a structure or direction.

 

Tutors who can't “teach”:

Tutors enjoy passing on their own knowledge and understanding, may find PBL facilitation difficult and frustrating.

 

Human resources:

More staff has to take part in the tutoring process.

 

Other resources:

Large numbers of students need access to the same library and computer resources simultaneously.

 

Role models:

Students may be deprived access to a particular inspirational teacher who is in a traditional curriculum would deliver lectures to a large group.

 

Information overload:

Students may be unsure how much self directed study to do and what information to be studied.

 

CONCLUSION:

PBL is an effective way of delivering medical education in a coherent, integrated program and offers several advantages over traditional teaching methods. It is based on principles of adult learning theory, including motivating the students, encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning. Predictably, however it needs more critical analysis and learning skills to understand the problems.

 

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Received on 31.08.2022         Modified on 21.09.2022

Accepted on 31.10.2022       ©A&V Publications All right reserved