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KEYWORDS: Problem Based Learning, Nursing Education, Teacher, Student.
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.
· 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.
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.
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.
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.
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.
· 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.
PBL facilitates an integrated core curriculum.
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:
· Chairing a group
· Respect for colleagues' views
· Critical evaluation of literature
· Self directed learning and use of resources
· Presentation skills
Outcome of Problem Based Learning (PBL):
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.
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.
More staff has to take part in the tutoring process.
Large numbers of students need access to the same library and computer resources simultaneously.
Students may be deprived access to a particular inspirational teacher who is in a traditional curriculum would deliver lectures to a large group.
Students may be unsure how much self directed study to do and what information to be studied.
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
A and V Pub Int. J. of Nursing and Medical Res. 2022; 1(1):13-17.