pbl kanada.pdf

7/22/2019 pbl kanada.pdf

1/7

I S S U E S A N D I N N O V A T I O N S I N N U R S I N G E D U C A T I O N

Problem-based learning in a new Canadian curriculum

Erlinda T. Morales-Mann RNRN MAMA

Assistant Professor, University of Ottawa School of Nursing, Ontario, Canada

and Christabel A. Kaitell RNRN MPHMPH

Assistant Professor, University of Ottawa School of Nursing, Ontario, Canada

Submitted for publication 27 July 1999

Accepted for publication 11 August 200022

Introduction

Health care services require nurses who are critical thinkers,

with superior speaking, writing and learning skills, who can

solve problems for which there are often no standard

solutions and no one correct answer. How are these pro-

ciencies achieved? Scientists recommend that a strong theor-

etical base and domain-specic knowledge are needed to meet

the demands of society (Glaser 1988). In addition, cognitive

researchers state that an educator should be as concernedwith `how' one teaches as with `what' one teaches (Bruer

1995). Therefore, a change in the way teachers teach,

grounded in an understanding of how students learn, merits

consideration.

In response to these recommendations as well as to the

challenges of increasingly complex patterns of health care in

Canada and the shift from hospital to home care, the new

curriculum of the University of Ottawa School of Nursing

2001 Blackwell Science Ltd 13

Correspondence:

Erlinda Morales-Mann,

Assistant Professor,

University of Ottawa School of Nursing,

451 Smyth Road,

Ottawa,

Ontario, K1H 8M5,Canada.

E-mail: [email protected]

M O R A L E SM O R A L E S -M A N NM A N N EE .TT . && K A I T E L LK A I T E L L C . A . ( 2 0 0 1 )C . A . ( 2 0 0 1 ) Journal of Advanced Nursing

33(1), 1319

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 designand 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 identied group process and problem solving most often. The most

frequently identied factors that inuenced 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, insufcient practice of facilitator

skills and PBL preparation. To enhance group process, facilitators modelled andshared roles. They fostered student motivation and development through formative

evaluation. PBL produced clear benets 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'.

Keywords: problem-based learning, group process, critical thinking, self-directed

learning, problem solving, group dynamics, group communication, group learning,

group decision making, nursing education.


2/7


3/7

processes needed to be made to enhance the quality of

learning. Adult learners are known to enhance their learning

when given the right conditions to pursue self-direction and

self-evaluation (Knowles 1984). Mature learners benet more

from learning situations who use prior knowledge gained

from life and from previous educational experiences. Instruc-

tion designed to enhance the personal efcacy of students,

therefore, must include self-regulation of learning through

goal-setting and opportunities for self-observation, self-

judgement and self-response (Bandura 1993). Gagne (1985)

discussed the contribution of problem-solving to the adult

learner's need to cope with life problems. If students are to

achieve higher cognitive outcomes and transfer of learning,

they must apply deep approaches to learning, critical thinking,

and cognition of real-life problems and receive feedback on

results (Gagne 1985, Alexander et al. 1991). A powerful

motivator for adult learners is learning that is purposeful and

contributes to fullling personal and educational goals.

Design of the second year PBL course

The second year curriculum was designed to focus on

primary and secondary prevention and address the health

needs of families and small groups. PBL was planned for

groups of nine or less, to address content areas, group process

and conict resolution. In addition, students were to explore

elements of professional practice such as ethical decision-

making, legal implications, collaborative practice and the

role of professional organizations. Neuman Systems Model

(1994) was selected as the framework best suited to address

the health needs of the family.

Working within the parameters of learning outcomes and

required course content, the two teachers responsible for

course design and implementation developed ve problem

situations focused on families. Content included families at

all stages of development. Nursing interventions relevant to

problem situations focused on primary prevention and

secondary prevention. Examples of client situations included

the following: an elderly client with diabetes undergoing

surgery for cataract, a pregnant youth in high school, a child

with cleft lip and palate undergoing surgical repairs, a child

with ear infections and another with asthma whose parentsare tobacco users, and a couple with fertility problems.

Prior to dealing with the problem situations, each facili-

tator with her students was expected to discuss group process

including time management and group rules, norms and

roles. Group rules were to be reviewed for consistency. At the

beginning of the semester, each facilitator was to use the rst

two class meetings to guide the introduction, discussion and

implementation of PBL, using one of the problems. Each

problem of which there were ve, was allotted four to ve

meetings for discussion, from introduction to evaluation.

Each facilitator was to introduce a problem to her group at

designated times. Three problems were to be discussed in the

Fall and two in the Winter semester starting with the least

complex. Each group was to use one of the meetings, usually

the third week, to review research related to the problem. A

record of the problem-solving process plus the collated

research materials was also planned.

Each problem was designed to enable students to learn

specic content. The content areas were health care organ-

ization and nancing, legislation and service guidelines, scope

of nursing practice, primary health care and health promo-

tion. Evaluation of the knowledge gained was to follow

completion of each problem solving exercise.

In selecting an evaluation method for the course, the

concern was with the student's mastery of the objectives in

keeping with the criterion approach that closely matches

adult education principles (Cranton 1989). A passfailmethod of evaluation was deemed supportive of self-direction

and critical thinking. The PBL evaluation tools developed by

Woods (1994) were adopted. These tools evaluated the

student's competency in problem-based learning, student's

behaviours in relation to performance as a group member,

and student's task and morale role performance. The last

10 minutes of each class was to be set aside for reection and

evaluation of group performance. A mid-term and nal self-

evaluation were also planned.

Preparation of facilitators and students

Four professors whose teaching experiences ranged from

teaching large classes to small groups in clinical settings were

assigned as facilitators. Teaching modalities used in large

classes were mainly didactic while clinical conferences were

frequently student-centred. The facilitators had three tasks:

rst, learn about PBL; second, develop an understanding of

the facilitator role: and third, acquire facilitator skills.

Learning the facilitator role in PBL was a challenge.

Although all were experienced in leading clinical confer-

ences, none had any experience as PBL facilitators. Thus,

their preparation focused on developing the prototypicbehaviours of a facilitator within student-centred group

discussions, such as `bringing students out, sharpening their

awareness of interests and skills and the use of insight and

problem-solving to reach goals and avoid blocks' (McKea-

chie 1986, p. 66). Central to the facilitator role is the ability

of the facilitator to break away from teacher-dominated

discussions to those that are truly student-centred. If moti-

vation for and commitment to PBL is to be maintained, every

1Issues and innovations in nursing education Problem-based learning

2001 Blackwell Science Ltd, Journal of Advanced Nursing, 33(1), 1319 15


4/7

facilitator must appreciate its advantages such as the

encouragement of greater student participation and respon-

sibility, and the development of group membership and

leadership skills (McKeachie 1986).

Only one facilitator had any previous PBL experience,

others had minimal knowledge of PBL. Preparation of

facilitators for PBL was through participation in a one day

workshop led by a PBL expert. In preparation for the

workshop, a PBL manual for tutors (Edwards & Hugo,

1996a) and other PBL resources were used. The expert used

questioning as she walked the participants through the PBL

steps. Participants then worked in small groups to formu-

late the two parts of a problem situation (main problem

statement and additional data). Each of the developed

problem situations was examined by the large group for

appropriateness and completeness, with the guidance of the

PBL expert.

At an additional 2-hour session with the PBL expert, all

aspects of PBL, facilitator role behaviours, and problemsituations were examined. Techniques suggested by Woods

(1994), which include àssisting learners to relate subject

knowledge to problems and their solutions and extracting

experience knowledge' (p. 10), were used as guides. PBL

problems and specic directions for their use, such as when

problems are introduced, when additional problem data is

given to students, and the general conduct of the course were

also discussed. Facilitators were directed to devote a few

minutes of the rst two class meetings to discuss or answer

students' questions about PBL. One of the problems was to

be used as exemplar for the PBL process. To foster an attitude

of openness in the students, facilitators were encouraged to

model the exploration of possible solutions.

Initially, some facilitators expressed trepidation at their

`lack of expertise' in the content presented in the problems.

The PBL expert and the course coordinator reassured the

facilitators that their task was to assist students to explore

each problem and then apply relevant knowledge derived

from research and group discussion to problem-solving.

Students were prepared in a 2-hour discussion on PBL with

a PBL expert. Before meeting the expert, the students read the

PBL Manual for Students (Edwards & Hugo, 1996b) and

prepared questions for discussion. As students have to beadept at accessing informational resources to gather relevant,

credible information to solve PBL problems, they were given

a special orientation to the library.

Implementation of PBL

PBL experts recommend groups of ve to six learners and

preferably less than nine (Woods 1994). The plan was for a

maximum of nine students in each group, but because of

economic constraints, the class of 56 students was divided

into ve groups. A total of ve problems were discussed

throughout the year. For each of the problems, the students

progressed through these steps: (1) understanding the

problem, (2) learning about the problem, (3) synthesizing

and applying learning to solve the problem and (4) reecting

on learning (Woods 1994). The rst problem was used as an

exemplar to assist students in understanding PBL.

There were two meetings where facilitators received

support for PBL implementation through sharing effective

management strategies, the use of resources and discussion of

problems. Facilitators acknowledged being tempted to step in

and wrestle control of student discussion or change its

direction. Often, some students wanted to limit exploration,

prematurely settling for ill-considered solutions. Facilitators

encouraged students not to give in to simplistic solutions or

decide prematurely on solution pathways. Through skilful

questioning, facilitators guided students to consider addi-tional, relevant perspectives.

Student outcomes

A few students complained that some of the problems lacked

authenticity because they did not contain ènough' descriptive

data as found in case studies. Owing to the fact that a PBL

problem is not required to contain exhaustive patient data,

some students reported they had to make too many assump-

tions about the patient. Other students failed to appreciate

the iterative PBL process because they preferred a more linear

process.

To determine how students perceived their learning using

PBL, facilitators asked them to respond to four questions.

(70% of 56 students responded). The most frequently

identied ideas or themes, in their order of frequency are

presented as responses (R) to questions (Q). For questions

one and three, several themes were identied from common

elements contained in the responses. Following each identi-

ed theme are select samples of students' responses.

Q1. Describe the thinking processes you used in this PBL

courseR. Problem-solving: Ì used a structured and organized way

of analysing and assessing a problem thoroughly.' `We

brainstormed, developed hunches, identied causal relation-

ships and hypotheses.' `We developed many perspectives,

used our prior knowledge and personal experiences to help

solve the problem.'

Nursing process: `The Neuman nursing theory was used in

the problem-solving.' `We used Neuman as we went through

E.T. Morales-Mann and C.A. Kaitell

16 2001 Blackwell Science Ltd, Journal of Advanced Nursing, 33(1), 1319


5/7

the developmental, physiological, etc. variables and dened

intra, inter and extrapersonal stressors.'

Brainstorming: `Pinpointing new ideas, expanding on

them.' `Brainstorming generated and highlighted new

ideas.'

Research: `Research into particular areas to nd informa-

tion pertinent to the problem.' `Pointing directions for

research after group discussion.'

Critical thinking: Ànalysing and assessing what is true

about the problem.' `Deducting data not suitable in the

context of the situation, ranking data in the order of

possibility.'

(Note: `Brainstorming' and `research' are not thinking

processes; however, students used these words in their

response to question one.)

Q2a. What knowledge did PBL demand?

R. Group dynamics, problem-solving steps, information

retrieval, community resources and Neuman's model.

Q2b. What skills did PBL demand?

R. Research skills, communication skills, team work, critical

thinking and reasoning skills, active listening skills, interper-

sonal skills and organizational skills.

Q3. Describe the difference(s) between what you learned

using PBL and what you learned using other teaching

methods?

R. Group process: `Learned teamwork and effective inter-

action with peers.' `There was growth in communication

skills.'

Self-directed thinker: Ì grew in my ability to be self-

directed, to actively pursue relevant resources and be an

independent learner.' `PBL offered opportunities for reec-

tion, increased critical thinking and independent thinking.'

PBL structure and process: Ìt was important to learn and

understand the PBL structure and process.' `Realization and

acknowledgement that the group will arrive at a number of

solutions to a problem even when some learners would

clearly prefer one solution to the problem.'

Research: `The PBL method provided opportunities and the

motivation to learn and research materials related to the

problem situation, although some content could have been

explored in greater depth.'

Learning through other methods: Às compared to other

learning-teaching methods, such as teacher-led ones, the PBL

method motivated my active participation in my own

learning.' `Sometimes, the content learned in PBL was

supercial, depending on the group's thoroughness in dealing

with the problem situation.'

Q4. What inuenced your learning and performance in PBL?Personal: Enthusiasm, motivation, past experience, commu-

nication skills and conict among group members.

Behavioural: Positive attitude of learners, support given

and received by group members.

Environmental: Group dynamics, team work, group size

greater than nine, active participation of facilitator, time

constraints (Table 1).

Facilitator outcomes

In spite of facilitators' preparation for PBL, some described

their knowledge of PBL and their facilitator role as inad-

equate. Facilitators who were `stressed and anxious', may

have communicated these to students, thus affecting their

1

Table 1 Outcomes: categories of students' response to questionnaire (listed in decreasing frequency)

Thinking

processes used

Knowledge

demanded by PBL

Skills demanded

by PBL

Learning derived

from PBL

Factors inuencing

learning and performance

1. Problem-solving

approach

1. Group dynamics/

group work

1. Research skills

2. Communication skills

1 Group process

2. Structure and

Personal

1. Enthusiasm and motivation

2. Nursing process

according

2. Problem-solving

process steps

3. Team work

4. Critical thinking/

process of PBL

3. Research

2. Past experience

3. Communication skills

to Neuman Model3. Brainstorming

4. Research

5. Critical thinking

3. How toretrieve information

and community

resources

reasoning skills5. Active listening skills

4. Activeparticipation

in own learning

5. Supercial

content on

Behavioural1. Positive attitude of learners

2. Support given and

received by members

Environmental

occasion if

group is

not thorough

1. Group effort/dynamics

2. Team work

3. Group size

4. Active participation of facilitator

5. Time constraints

Issues and innovations in nursing education Problem-based learning



6/7

learning. All facilitators expressed the need for intensive

individual and team preparation to improve their under-

standing of PBL.

Facilitators stated that the effectiveness of the group was

lower when group size exceeded nine students. Quiet students

were a challenge. Assigning each student to report on

research ndings increased participation. A discussion to

remind the group about the various roles that contribute to

group process encouraged quiet students to assume task and

morale roles. When facilitators modelled the sharing of roles

and took on roles, such as an energizer or an encourager role

and relinquished the leader role to a student, quiet students

often participated more willingly.

Student development was fostered through regular forma-

tive evaluation of the group process. In addition, the group

assessed the content learned from each problem. However,

facilitators indicated that the passfail grading method did

not distinguish students who demonstrated excellent group

work, and superior content knowledge from students at onlythe pass level. Facilitators observed that about half of the

students applied effort until they reached a pass level at mid-

term, at which point no further improvement was noted.

About 25% applied consistent effort and continuously raised

their achievement, while another 25% applied little or just

enough effort from the beginning to warrant a pass grade.

Facilitators unanimously endorsed PBL as an effective

learning strategy. The learning outcomes of critical thinking,

self-direction and effective communication were satisfactorily

demonstrated by students.

Discussion

Student preparation for PBL was insufcient. Because our

students were not previously exposed to PBL, allowing more

time in between three meetings for preparation, would have

been more effective. Learning in the social context of the

group (Piaget 1985), can increase students' comfort and

commitment to PBL. Increased preparation will also stimu-

late prior learning, provide guidance, feedback and successful

experience with the method (Gagne 1985).

Facilitators will be less anxious if they were given addi-

tional preparation in the form of workshops and teamdiscussions. All teachers would benet from more practice

with PBL. Students and facilitators expressed their desire to

continue the use of this method, having experienced the

advantages of PBL. The application of PBL in subsequent

years would promote the facilitators' and students' self-

efcacy and expertise in PBL, and generalize this ability to

solve more complex problems. Group process would be

enhanced by limiting group size to nine members or less.

The involvement of second year facilitators with PBL in

future years can build on their previous successes. There

will be two benets: students will have facilitators who are

condent and knowledgeable about PBL and group

process, and the school will avoid the cost of new teacher

orientation.

The faculty adopted an evaluation process that assesses

students on a passfail basis, based on their competency in

PBL and performance as group members (Woods 1994). The

passfail grading was identied by both students and facil-

itators as a problem. The majority of students found that a

passfail grade reduced their motivation. A few students

indicated that they would apply more effort in the course and

consequently learn more, if their grade contributed to their

grade point average. They wanted an evaluation that would

provide clear and specic evidence of their competence.

Because the students invested efforts in PBL, a majority

believed that their PBL grade should `count' towards their

grade point average.

Conclusion

Clear benets for the students from the use of the PBL format

include increased autonomous learning, critical thinking,

problem-solving, and communication skills. Facilitators were

liberated from the traditional role as `content expert and

super consultant' and developed additional skills for facili-

tating the group's critical thinking, problem-solving and

conict resolution. Several recommendations for change and

improvement are offered to support and enhance PBL. These

include the use of PBL in other seminar courses, a reduction

of group size to nine or less, improvement of the preparation

of students and facilitators, adoption of a grading system that

is more appropriate than passfail and the maintenance of a

roster of competent facilitators.

References

Abrahamson S. (1977) Disease of curriculum. Journal of Medical

Education 53, 951957.

Albanese M.A. & Mitchell S. (1993) Problem-based learning: a

review of literature on its outcomes and implementation issues.

Academic Medicine 68, 5281.

Alexander P.A., Schallert D.L. & Hare V.C. (1991) Coming to terms:

How researchers in learning and literacy talk about knowledge.

Review of Educational Research 61, 315344.

Bandura A. (1993) Perceived self-efcacy in cognitive development

and functioning. Educational Psychologist 28, 117148.

Barrows H.S. (1988) How to Design a Problem-Based Curriculum

for the Preclinical Years. Springer Publishing, New York.

Berkson L. (1993) Problem-based learning: Have the expectations

been met? Academic Medicine 68, S79S85.

E.T. Morales-Mann and C.A. Kaitell

18 2001 Blackwell Science Ltd, Journal of Advanced Nursing, 33(1), 1319


7/7

Bruer J.T. (1995) School for Thought. A Science of Learning in the

Classroom. MIT Press, Cambridge, Massachusetts.

Cranton P. (1989) Planning Instruction for Adult Learners. Wall and

Thompson, Toronto.

Creedy D., Horsfall J. & Hand B. (1992) Problem-based learning in

nurse education. Journal of Advanced Nursing 17, 727733.

Des Marchais D.E., Bureau M.A., Dumais B. & Pigeon G. (1992)

From traditional problem-based learning: a case report of complete

curriculum reform. Medical Education 26, 190199.Edwards N., Hebert D., Moyer A., Peterson J., Sims-Jones N. &

Verhovsek H. (1998) Problem-based learning: Preparing post RN

students. Journal of Nursing Education 37, 139141.

Edwards N. & Hugo K. (1996a) Problem-based Learning Manual: A

Tutor's Guide to PBL. University of Ottawa, Ottawa.

Edwards N. & Hugo K. (1996b) Problem-based Learning Manual: A

Student's Guide to PBL. University of Ottawa, Ottawa.

Frost M. (1996) An analysis of the scope and value of problem-based

learning in the education of health care professionals. Journal of

Advanced Nursing24, 10471053.

Gagne R.M. (1985) The Conditions of Learning (3rd edn). Holt,

Rinehart & Winston, New York.

Glaser R. (1988) Cognitive science and education. International

Social Science Journal 40, 2144.

Guilbert J.J. (1985) Les maladies du curriculum. Revue D'Education

Medicale 4, 1316.

Heliker D. (1994) Meeting the challenge of the curriculum revolu-

tion: problem-based learning in nursing education. Journal of

Nursing Education 33, 4547.

Knowles M. (1984) The Adult Learner. A Neglected Species. Gulf

Publishing, Houston, Texas.

LittleP. & RyanG. (1988) Educationalchange throughproblem-based

learning. The Australian Journal of Advanced Nursing5, 3135.

McKeachie W.J. (1986) Teaching Tips: A Guidebook for the

Beginning College Teacher. D.C. Heath, Toronto.

Neufeld V.R. & Barrows H.S. (1974) The `McMaster philosophy': an

approach to medical education. Journal of Medical Education 49,

10401050.Neuman B. (1994) The Neuman Systems Model(3rd edn). Appleton

& Lange, Stamford, Connecticut.

Pender N. (1996) Health Promotion in Nursing Practice (3rd edn).

Appleton & Lange, Stamford, Connecticut.

Piaget J. (1985) The Equilibration of Cognitive Structures. University

of Chicago Press, Chicago.

Reilly D.E. & Oermann M.H. (1992) Clinical Teaching in Nursing

Education (2nd edn). National League for Nursing, New York.

Townsend J. (1990) Problem-based learning. Nursing Times 86,

6162.

Vernon D. & Blake R. (1993) Does problem-based learning work? A

meta-analysis of evaluative research. Academic Medicine 68,

550563.

Woods D. (1994) Problem-based Learning: How to Gain the Most

from PBL. Hamilton. W. L. Grifn Printing, Ontario.

1Issues and innovations in nursing education Problem-based learning


pbl kanada.pdf

Documents

Transcript of pbl kanada.pdf