Learning Innovation Unit

The Introduction of Problem Based Learning into a DCU Nursing Programme

By Carol Barron , School of Nursing

Background

In late 2005 the School of nursing at Dublin City University was successful in its bid to the Health Service Executive to run a four and a half year undergraduate degree programme in Children’s and General Nursing. This programme takes in 30 students each year. Healthcare today in Ireland, as elsewhere, is delivered within a rapidly changing environment where the nature of client care is often complex. This necessitates the need for nurses who are competent and capable of critical thinking and problem solving. The emphasis within nursing curricula is, therefore, on the development of higher order intellectual skills and abilities where the nurse acquires the ability to understand, not just acquire knowledge (Lobb and Butler 2009), alongside the development of lifelong learning skills. Problem Based Learning (PBL) is seen as one approach which meets these needs (Rowan, McCourt and Beake 2008). The development of a new programme presented the ideal opportunity to develop a hybrid curriculum where PBL modules could be incorporated alongside more traditional forms of teaching and learning throughout each year of the programme.

This article is a personal reflection on the experience of introducing PBL  into an undergraduate nursing programme which commenced in September 2006, the preparation of staff and students that was required, and the issue of resources needed to facilitate PBL modules.

History of PBL

McMaster University in Canada is credited with first introducing PBL into their medical curriculum back in the 1960’s. This change was initiated due to excessive course content and poor evaluation by the medical students of the links between theory and practice. The inclusion of PBL in full or hybrid curricula then expanded to include other health related disciplines such as nursing in the 1990’s (Wilkie and Burns 2003). The effectiveness of the approach within these domains is now well established as indicated within the meta-review by Albanese and Mitchell (1993). At the same time PBL was incorporated into disciplines within the social sciences (Hartsell and Parker 2008) and sciences (Boyce and Singh 2008).

Closer to home, PBL modules are well established within DCU, such as those on our physics and business programmes. Hybrid PBL curricula are available in UCD’s English literature and diagnostic imaging; NUI Maynooth’s computer science programme; and DIT’s postgraduate certificate in teaching and learning and applied science degree. Finally, the speech and language undergraduate degree programme in Trinity College is run entirely through PBL.

What is enquiry and problem based learning?
Enquiry Based Learning (EBL) is a broad umbrella term used to describe approaches to learning that are driven by a process of inquiry. PBL is usually understood as a spoke of the same umbrella; in other words an approach under the broader category of EBL. As indicated by the name, at the heart of PBL is a problem, some sort of situation requiring an explanation or solution, which is presented to the students as their starting point before any theoretical input. PBL was defined by Barrows and Tamblyn (1980) as:

Woods (1994) defined it as
 

Thus PBL is an approach to learning that shifts the focus from teacher-centred to student-centred education and facilitates self directed learning while encouraging a deeper understanding of the material rather than superficial coverage (Savin-Baden 2008, Smyth 2008).

Students are typically presented with real-life practice based problems which trigger their learning. They then discuss the problem in small tutorial groups. They brainstorm ideas based on their prior knowledge and identify what they need to learn to work on the problem. Students then develop a plan to meet their own identified learning needs. They research those learning needs in their independent study time outside the tutorials. The students can also have fixed resource sessions in each PBL module to support their theoretical knowledge acquisition and learning. When they come back to the next PBL tutorial they share the information they have gathered and integrate their new knowledge into a comprehensive explanation of the problem. While there are numerous differing models of PBL which can vary significantly there are a set of shared characteristics (Figure I).

The problem acts as the trigger for learning. Learning occurs in a small group setting. The lecturer acts as a facilitator to the learning process. Learning is student-centered. Prior knowledge is activated. New knowledge is acquired and integrated. Students take responsibility for their own learning.

Preparing lecturers for PBL

While I had previously used PBL in nursing programmes in the UK, other lecturing staff who would coordinate the PBL modules on the programme had no prior experience of using it, (though the majority had a teaching qualification). Therefore, before the programme commenced, I sought and received financial support from the Learning Innovation Unit to employ an expert in PBL   to run a series of one day workshops, over a three week period, to introduce staff to the philosophy of PBL. The workshops were attended by nine academic staff and were run in Semester 1; the first PBL module was to commence in Semester 2 of the same academic year. The workshops were specifically developed to meet the needs of the first two PBL modules within year 1 and 2 of the new programme. As part of the workshops we focused on problem design for these two modules. The “problems” were designed in combination with the specific learning outcomes for each module. The issues around the appropriateness of various forms of assessment were also explored again for these two specific modules. This served to give the lecturers who undertook the workshops a sense of ownership over the modules.  These workshops also gave everyone the experience of being a PBL student; in other words learning by doing.

Findings from the evaluation of the three day workshop was very positive. Lecturers felt that there was a “key timeframe” prior to them facilitating PBL and the preparation they received was within the time frame. There was also a strongly held view that lecturing staff should “go through the process as students do”, and that “lecturers must undergo PBL to understand PBL”. While the three day workshop was deemed appropriate as an introduction to PBL a need was identified for a follow up workshop once staff had experience in facilitating PBL modules to discuss any issues that may arise e.g. input on managing difficult group dynamics or the evaluation of differing forms of assessment.

Preparing students for PBL

In the first year of the programme when students are introduced to PBL we initially divided the group of students into two groups for the tutorial sessions, in two small classrooms. We subdivided these groups again into two smaller groups and situated them at differing corners of the classroom to give them a sense of space and privacy. Although this exercise calls for two lecturing staff, to act as facilitators, and two classrooms, it is very worthwhile as students introduced initially to PBL need a lot of support to both understand the philosophy of PBL and what is expected of them within PBL tutorials. It is well reported that students with no prior experience of PBL rely more heavily on their facilitators initially as a source of guidance and information (Brandon and Basanti 1997). After the first year, it is not necessary to utilise two members of staff; rather the whole group can be divided into four and placed in a larger classroom.

Two “problems” were presented to students in their first PBL module. The first was a visual collage which was largely an introduction to the process of PBL itself and focused on a minimal number of the module learning outcomes. The second problem, which was in the form of a short video, was more complex and focused on several module outcomes. At the beginning, students had difficulty with the media chosen as they were accustomed to textual information. Initially, the students were seeking the “right” answer and found it both confusing and frustrating that the learning did not follow the format to which they had become accustomed in their secondary level education. Students also receive fixed resource sessions in each PBL module, which is designed to support their theoretical knowledge acquisition. In later PBL modules (Years 2 and 3) the students are given one in-depth practice related problem for each module, which again reflects their modular learning outcomes.

Despite the perceived advantages and benefits of PBL, I do not wish to give the impression that it does not have its difficulties. Every one of the students expressed the view that they have to put more work into PBL modules than more traditional modules. Students initially find PBL stressful, specifically in relation to the time spent searching for relevant resources, uncertainty with regard to the depth and breadth of knowledge required and the obligation upon them to direct their own learning. Similar experiences are well documented in the literature (Carlisle and Ibbotson 2005, Lobb, Inman and Butler 2004) and I would suggest it is also related to the transition from a more didactic approach to learning. However, as the students progressed in the programme their concerns about PBL diminished  although they do still feel that they have to put a lot of work into these modules.

Resources needed to implement PBL modules

I used part of my library budget for new programmes to ensure that students and staff had access to appropriate textbooks on PBL. The budget was divided between textbooks on PBL as a teaching and learning strategy (for lecturing staff predominantly) and books on PBL in children’s and general nursing curricula (for students). These resources were beneficial to the students as they could find out how PBL is used in their particular programme of study. With the high standard and variety of e-journals that DCU subscribes to, there was no need to spend any money. Library staff ran small group sessions for the students on conducting literature searches and searching databases in the context of a PBL curriculum. Similar to the findings reported by Rowan  (2008), it become evident as the programme progressed that the students gained skills in information retrieval and critique and were transferring these skills in other modules throughout their programme.

Physical resources such as small rooms without fixed equipment are necessary for tutorial sessions with small groups and this involved several face to face discussions with the administrative staff within the school. While this small issue may appear inconsequential, it is in fact a very worthwhile exercise. Once the rationale for the requests was discussed with administration staff, there were no issues in being allocated the appropriate room resources and this has followed through year on year once you identify that the module is a PBL module.

Within the classroom itself the equipment required for PBL is low tech: a flip chart, markers and 'bluetac'. Though you quickly learn that if you leave a flip chart stand in a classroom overnight it may well have mysteriously moved to some unidentifiable location by the next day! Therefore I devised a facilitator’s pack which consisted of the flip chart paper and a bag which held the markers and 'bluetac' which I now take with me to all PBL tutorials. 

Conclusion

Both students and staff require initial support when undertaking PBL modules: students are not familiar with this style of learning while staff may not be familiar with the facilitative approached required. The development of practice based problems  to successfully trigger the students’ learning, and achieve the required learning outcomes, is key to a successful PBL module (Barron et al. 2008). As a learning strategy, PBL offers the potential to bridge the theory - practice gap in professional practice, through the recognition and evaluation of practice-based problems (Horne et al. 2006, Price 2003). There are now 120 students in differing years on the Children’s and General undergraduate nursing programme who all undertake PBL modules in each year of their programme. Since the introduction of PBL in the School in 2006, it has now spread to post graduate and Masters nursing programmes.

References and further reading

Albanese, M. A. and Mitchell, S. 1993. Problem-based learning: a review of literature on its outcomes and implementation issues. Academic Medicine. 68pp52-81.

Barron, C., Lambert, V., Conlon, J. and Harrington, T. 2008. “The Child’s World”: A creative and visual trigger to stimulate student enquiry in a problem based learning module. Nurse education today. 28 (8), pp962-969.

Barrows, H.S. and Tamblyn, R.M. 1980. Problem-based learning: An approach to medical education. New York: Springer Pub Company.

Boyce, M. C. and Singh, K. 2008. Student Learning and Evaluation in Analytical Chemistry Using a Problem-Oriented Approach and Portfolio Assessment. Journal of chemical education. 85 (12), pp1633-1637.

Brandon, J. E. and Basanti, M. 1997. An introduction and evaluation of problem-based learning in health professionals education. Family and Community Health. 20 (1), pp1-15.

Carlisle, C. and Ibbotson, T. 2005. Introducing problem-based learning into research methods teaching: Student and facilitator evaluation. Nurse education today. 25 (7), pp527-541.

Hartsell, B. D. and Parker, A. J. 2008. Evaluation of Problem-Based Learning as a Method for Teaching Social Work Administration: A Content Analysis. Administration in Social Work. 32 (3), pp44-62.

Horne, M., Woodhead, K., Morgan, L. 2006. Using enquiry in learning: From vision to reality in higher education. Nurse education today. 27 (2), pp103-112.

Lobb, D. K., Inman, D. R. and Butler, R. G. 2004. Problem-based learning in reproductive physiology. Journal of Midwifery and Women's Health. 49 (5), pp449-453.

Lobb, D. K. and Butler, R. G. 2009. Problem-based learning in a Canadian midwifery programme. British Journal of Midwifery. 17 (1), pp45-47.

Price, B. 2003. Studying Nursing using Problem Based Learning. Basingstoke, U.K: Palgrave Macmillan.

Rowan, C. J., McCourt, C. and Beake, S. 2008. Problem based learning in midwifery–The students’ perspective. Nurse education today. 28 (1), pp93-99.

Savin-Baden, M. 2008. Problem-based learning in electronic engineering: locating legends or promising problems? International Journal of Electrical Engineering Education. 45 (2), pp96-204.

Smyth, R. 2008. Practical guide to problem-based learning online – By Maggi Savin-Baden. British Journal of Educational Technology. 39 (6), pp1142-1142.

Solomon, P. and Finch, E. 1998. Applied Research: A Qualitative Study Identifying Stressors Associated With Adapting to Problem-Based Learning. Teaching and learning in medicine. 10 (2), pp58-64.

Wilkie, K. and Burns, I. 2003. Problem Based Learning; A Handbook for Nurses. Basingstoke, UK: Palgrave Macmillan.

Woods, D.R. 1994. Problem-based Learning: how to gain the most from PBL. Canada: Woods Publishing, Mc Masters University.