Educational Approach Educational Approach and Quality:and Quality:

Does PBL support quality Does PBL support quality learning outcomes?learning outcomes?

Tracey Winning Tracey Winning

School of DentistrySchool of Dentistry

The University of AdelaideThe University of Adelaide

Educational Approach Educational Approach and Qualityand Quality

ObjectivesObjectives

To share knowledge and experience To share knowledge and experience of learning and teaching in PBLof learning and teaching in PBL

review published outcomes of PBLreview published outcomes of PBL

Why PBL?Why PBL?Quality Student ExperienceQuality Student Experience

Student-centred focus Student-centred focus 1, 21, 2

Improve integration of basic science and clinical Improve integration of basic science and clinical education education 1, 21, 2

Develop skills, understandings, Develop skills, understandings, qualities and dispositions qualities and dispositions appropriate to employment:appropriate to employment:33

life-long learning, critical thinking and decision life-long learning, critical thinking and decision making, independent working, teamwork, flexibility, making, independent working, teamwork, flexibility, oral communication, time management, planning and oral communication, time management, planning and organisational ability organisational ability

Evidence-based decision making approach for Evidence-based decision making approach for patient managementpatient management 4 4

1. Institute of Medicine, 1995; 2. General Dental Council, 2002; 3. The Pedagogy for Employability Group, HEA, 2006; 4. Institute of Medicine 2003

Why PBL?Why PBL?Learning Theories Learning Theories : Social constructivism: Social constructivism

Meaningful learning is most likely with: Meaningful learning is most likely with: 5, 6, 75, 6, 7

– authentic, real activities,authentic, real activities,– modelling and coaching, ie, how to think and act as a modelling and coaching, ie, how to think and act as a

practitioner,practitioner,– interactions: ‘inquiry and exploratory talk,’interactions: ‘inquiry and exploratory talk,’ 8 8– collaboration: students and staff,collaboration: students and staff,– reflection: content and strategies,reflection: content and strategies,– working independently: staff step back.working independently: staff step back.

Co-construction of new knowledge for ‘real-world’ Co-construction of new knowledge for ‘real-world’ contexts, linked to prior knowledgecontexts, linked to prior knowledge. .

These elements inform the design of problem-based learning (PBL) These elements inform the design of problem-based learning (PBL) with the aim to support meaningful student learning. with the aim to support meaningful student learning. 99

5. Brown et al. 1989; 6. Savery & Duffy, 1995; 7. Brophy, 2002; 8. Wells, 2002; 9. Dolmans et al., 2005

What is PBL? What is PBL? 10, 1110, 11

PrinciplesPrinciples Problem = organiser Problem = organiser

for learningfor learning

Learner-centredLearner-centred

Educational approach Educational approach (not a method)(not a method)

CharacteristicsCharacteristics Problem = authentic professionally relevant situationProblem = authentic professionally relevant situation

Encountered firstEncountered first

Student responds as practitionerStudent responds as practitioner

Students involved in deciding what, how to learnStudents involved in deciding what, how to learn

Construct own knowledge & understandingConstruct own knowledge & understanding

Guidance/scaffolding provided by teacher as a Guidance/scaffolding provided by teacher as a ‘facilitator’ of learning‘facilitator’ of learning

Multiple learning and teaching methodsMultiple learning and teaching methods

Organised around problem: small groups, collaborative Organised around problem: small groups, collaborative & independent research, peer learning and teaching, & independent research, peer learning and teaching, reflection and self-managementreflection and self-management

10. Barrows 2000; 11. Charlin et al., 1998

What is PBL?What is PBL?

Educational OutcomesEducational Outcomes 1010

Systematic approach to patient and analysis of their Systematic approach to patient and analysis of their situationsituation

Contextualised and integrated knowledge, skills, Contextualised and integrated knowledge, skills, behavioursbehaviours

Self-directed (independent) learning skills, lifelongSelf-directed (independent) learning skills, lifelong

Team skillsTeam skills

Motivating, enjoyable learning experience Motivating, enjoyable learning experience

10. Barrows 2000

PBL Package PurposePBL Package Purpose

Package must provide Package must provide opportunity for opportunity for students to: students to: 1212

Think and act as practitionerThink and act as practitioner develop new, professional knowledge, skills and behaviours develop new, professional knowledge, skills and behaviours apply new, professional knowledge, skills and behavioursapply new, professional knowledge, skills and behaviours

Develop learning skillsDevelop learning skills collaborative, independent studycollaborative, independent study discussion and critique of learningdiscussion and critique of learning

Is there support that PBL can achieve these Is there support that PBL can achieve these educational outcomes?educational outcomes?

12. Adapted from PROBLARC 2000

Outcomes: Systematic Outcomes: Systematic

approach approach to analysis of to analysis of patient situationpatient situation

Developing systematic enquiry skills:Developing systematic enquiry skills: Graduates self-rated as better at problem-Graduates self-rated as better at problem-

solving skills solving skills 1313

Improvement in clinical reasoning strategy Improvement in clinical reasoning strategy more accurate hypotheses and coherent more accurate hypotheses and coherent explanations with basic science knowledge explanations with basic science knowledge 1414

Improved diagnostic ability with PBL using Improved diagnostic ability with PBL using clinical contexts clinical contexts 1515

13. Schmidt et al., 2006; 14. Hmelo, 1998; 15. Schmidt et al., 1996

Outcomes: Contextualised Outcomes: Contextualised

and integrated and integrated knowledge, skills, behavioursknowledge, skills, behaviours

Basic and clinical science knowledgeBasic and clinical science knowledge

Critical thinking, logical argument (eg explain, Critical thinking, logical argument (eg explain, test, justify their assumptions, knowledge, test, justify their assumptions, knowledge, reasoning)reasoning)

Communication/interpersonal skillsCommunication/interpersonal skills

Preparation for practice and clinical skillsPreparation for practice and clinical skills

Outcomes: knowledge, skills, Outcomes: knowledge, skills, behaviours 1behaviours 1

Basic and clinical science knowledgeBasic and clinical science knowledge Several reviews have reported equivocal outcomes Several reviews have reported equivocal outcomes

re basic science knowledge development re basic science knowledge development 16, 17, 1816, 17, 18

Better skills in applying knowledge Better skills in applying knowledge 1818

Significantly better performance on Medical Board Significantly better performance on Medical Board exams (I & II) exams (I & II) 1919

Critical thinkingCritical thinking Higher critical thinking disposition which was Higher critical thinking disposition which was

maintained (to a lesser degree over maintained (to a lesser degree over subsequent 2 y) subsequent 2 y) 2020

16. Albanese & Mitchell, 1993; 17. Vernon & Blake, 1993; 18. Dochy et al., 2003; 19. Hoffman et al., 2006; 20. Tiwari, et al., 2006

Outcomes: knowledge, skills, Outcomes: knowledge, skills, behaviours 2behaviours 2 Communication /interpersonal skillsCommunication /interpersonal skills

High levels of communication skills in PBL graduates High levels of communication skills in PBL graduates (self (self 13 13 and clinical directors/co-workers and clinical directors/co-workers 21, 2221, 22) )

Preparation for practicePreparation for practice Graduates felt better prepared than their peers from Graduates felt better prepared than their peers from

conventional curricula conventional curricula 2323

Graduates self-rated as better at professional skills Graduates self-rated as better at professional skills (eg physical examination) (eg physical examination) 1313 and were rated above and were rated above average by clinical directors average by clinical directors 2222

Better clinical periodontics performance in OSCE (NS Better clinical periodontics performance in OSCE (NS difference for examination of patient) difference for examination of patient) 2424

13. Schmidt et al., 2006; 21. Rolfe and Pearson, 1994; 22. Dean et al., 2003; 23. Mennin et al., 1996; 24. Rich et al., 2005

Identifying own learning needs and resourcesIdentifying own learning needs and resources

Information literacy skills (eg identify, locate, evaluate Information literacy skills (eg identify, locate, evaluate and use information)and use information)

Identifying and utilising appropriate learning processes Identifying and utilising appropriate learning processes (eg self-testing, concept maps, diagrams, teaching (eg self-testing, concept maps, diagrams, teaching others, applying knowledge to novel situations)others, applying knowledge to novel situations)

Developing time management and organisational skillsDeveloping time management and organisational skills

Monitoring and evaluating learning processes and Monitoring and evaluating learning processes and outcomesoutcomes

Outcomes:Outcomes:Self-directed learning Self-directed learning

IdentifyingIdentifying needs and resourcesneeds and resources:: > 60% (average) learning issues match faculty-identified > 60% (average) learning issues match faculty-identified

learning issues; identify other relevant learning issues learning issues; identify other relevant learning issues 25, 2625, 26

plan and undertake research in own time, using self-plan and undertake research in own time, using self-identified resources identified resources 2727

InformationInformation literacy skillsliteracy skills Graduates self-rated as better at self-directed learning Graduates self-rated as better at self-directed learning 13, 2213, 22

and using information resources and using information resources 1313

Outcomes:Outcomes:Self-directed learning 1 Self-directed learning 1

13. Schmidt et al., 2006; 22. Dean et al., 2003; Schmidt et al., 2006; 22. Dean et al., 2003; 25. Dolmans et al., 1993; 26. Sigrell et al., 2004; 27. Blumberg 2000

Outcomes:Outcomes:

Self-directed learning 2Self-directed learning 2 Learning processes/approachesLearning processes/approaches

PBLPBL associated with learning for meaning (deep) associated with learning for meaning (deep) 28, 29, 30, 28, 29, 30,

3131

DevelopingDeveloping time management and organisational time management and organisational skillsskills

Graduates self-rated as better at planning, efficiency Graduates self-rated as better at planning, efficiency and time management and time management 13, 22 13, 22 and rated highly by clinical and rated highly by clinical directors directors 2222

MonitoringMonitoring and evaluating learning processes and and evaluating learning processes and outcomes:outcomes:

Updating of current knowledge for practice Updating of current knowledge for practice 3232

13. Schmidt et al., 2006; 22. Dean et al., 2003; 28. Coles, 1985; 29. Newble and Clarke, 1986; 30. Vu 13. Schmidt et al., 2006; 22. Dean et al., 2003; 28. Coles, 1985; 29. Newble and Clarke, 1986; 30. Vu et al., 1998; 31. Richardson et al., 2007, in press; 32. Shin et al., 1993et al., 1998; 31. Richardson et al., 2007, in press; 32. Shin et al., 1993

Outcomes: Team SkillsOutcomes: Team Skills

Group function: Group function: Group dynamicsGroup dynamics

Working relationships (eg respect, trust, valuing, etc); Working relationships (eg respect, trust, valuing, etc); Communication (eg negotiation, discussion, giving and Communication (eg negotiation, discussion, giving and

receiving feedback); receiving feedback); Conflict management, (eg trouble-shooting dysfunctional Conflict management, (eg trouble-shooting dysfunctional

groups: domination, non-participation, exclusion, ‘short-cutting’, groups: domination, non-participation, exclusion, ‘short-cutting’, ‘sponging’)‘sponging’)

Group processGroup process Roles & responsibilities (eg leader, scribe, researcher, Roles & responsibilities (eg leader, scribe, researcher,

recorder/ administrator); recorder/ administrator); Monitoring and evaluating group functioning; Monitoring and evaluating group functioning; Organising Organising

Outcomes: Team SkillsOutcomes: Team Skills

Group dynamicsGroup dynamics Graduates self-rated as better collaboration skills Graduates self-rated as better collaboration skills 13, 2213, 22

Group processGroup process Graduates self-rated as better at skills required for Graduates self-rated as better at skills required for

running meetings running meetings 1313

13. Schmidt et al., 2006; 22. Dean et al., 200313. Schmidt et al., 2006; 22. Dean et al., 2003

Outcomes: Outcomes:

Student satisfaction Student satisfaction

improved enjoyment, student interaction, and improved enjoyment, student interaction, and flexibility in their programs flexibility in their programs 16, 30, 33, 3416, 30, 33, 34

overall satisfaction strong for PBL experience overall satisfaction strong for PBL experience 35 35

and better cf with conventional curricula (CEQ) and better cf with conventional curricula (CEQ) 3131

16. Albanese &Mitchell, 1993; 30. Tiwari et al., 2006; 31. Richardson et al., 2007, in press; 33. 16. Albanese &Mitchell, 1993; 30. Tiwari et al., 2006; 31. Richardson et al., 2007, in press; 33. Rohlin et al., 1998; 34. Townsend et al., 1997; 35. Lyon and Hendry, 2002. Rohlin et al., 1998; 34. Townsend et al., 1997; 35. Lyon and Hendry, 2002.

ConclusionConclusion Evaluation of PBL indicates achieving some of Evaluation of PBL indicates achieving some of

educational outcomes; these link to quality educational outcomes; these link to quality higher education learning outcomeshigher education learning outcomes

Issues in interpreting results due to variable Issues in interpreting results due to variable implementations of PBL and limited use of implementations of PBL and limited use of theoretical basis: need clear definition of theoretical basis: need clear definition of programme processes to assist in programme processes to assist in interpretation interpretation 10, 1110, 11

Research needed to identify key elements of Research needed to identify key elements of context that are required to achieve PBL context that are required to achieve PBL outcomes outcomes 99

9. Dolmans et al., 2005; 10. Barrows 2000; 11. Charlin et al., 1998

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