Designing, implementing and evaluating an online problem-based learning (PBL) environment--a pilot study

A comparative analysis of online learning versus face-to-face learning approach in problem based learning in dentistry

BACKGROUND

Problem-based learning (PBL), a student-centered approach which has been implemented in many educational institutes worldwide.

OBJECTIVES

This study aimed to evaluate and compare the proficiency of students in 5 key areas of PBL process and assess perceptions of students towards PBL learning using a self-explanatory questionnaire.

METHOD

This cross-sectional study was conducted from March 2020 to September 2022 and evaluated perceptions of 1st year dental students of Batch 2021 (having Face-to-face PBL sessions) and batch 2020 (having online PBL sessions) using a questionnaire. Three similar PBL cases were used, which assessed PBL parameters that included attendance, group dynamics, knowledge, communication skills and preparation. Statistical analysis was performed for all the categorical and continuous variables.

RESULTS

Majority of Distance Learning (DL) group (66.7%) concurred that PBL helped improve their communication skills, decision making power (66.7%), self-directed learning (80%) and promoted interaction with peers (66.7) and teachers (68.9%). The Face -to- Face (FF) group demonstrated better scores (7.7±2.42 & 7.55±2.55) with respect to their attendance and group dynamics (7.44±2.17 & 8.02±2.40) in PBL 1 & 3 as compared to DL group. Overall, better performance in all the 5 key areas of PBL was observed for the FF group versus the DL group.

CONCLUSION

The Distance learning (DL) group displayed a positive attitude and perception towards PBL as a learning strategy whereas Face-to-face (FF) group showed greater performance and proficiency in the key PBL parameters scores.

Online case-based learning in medical education: a scoping review

BACKGROUND

Case-Based Learning (CBL) in medical education is a teaching approach that engages students as learners through active learning in small, collaborative groups to solve cases from clinical patients. Due to the challenges afforded by the COVID-19 pandemic, small group learning such as CBL, transitioned quickly to include technology-enhanced learning to enable distance delivery, with little information on how to apply pedagogical frameworks and use learning theories to design and deliver online content.

METHODS

To extend understanding of online CBL a scoping review protocol following the PRISMA-ScR framework explored the literature that describes the use of online CBL application in medical education and the outcomes, perceptions, and learning theories. A literature search was conducted in January 2022 followed by a subsequent review in October 2022. After peer review using the PRESS guidelines, the CASP appraisal tool was used to assess the rigor of each study design.

RESULTS

The scoping review identified literature published between 2010 and 2022 (n = 13 articles), on online CBL in the field of medical education with 11 observational studies describing student and facilitator perceptions and two randomized controlled studies. Positive perceptions of online learning included a flexible work-life balance, connection with learners, and improved accessibility. Negative experiences of online CBL included poor internet access, a distracting learning environment, and loss of communication. In the studies that collected student performance data, results showed equivalent or improved outcomes compared to the control. The CASP appraisal tool highlighted the deficiencies in most study designs, lack of framework or learning theory, and poor reproducibility of the methods to answer the research questions.

CONCLUSION

This scoping review identified literature to describe the academic outcomes, and student and facilitator perceptions of online CBL in medical education. However, the CASP tool uncovered deficiencies in study descriptions and design leading to poor quality evidence in this area. The authors provide recommendations for frameworks and learning theories for the future implementation of online CBL.

Effect of Patient-Empowerment Interaction Model on Self-Management Ability of Peritoneal Dialysis Patients: A Randomized Controlled Trial

OBJECTIVE

Patient empowerment can be achieved through the PBL model. The purpose of the present study was to evaluate the effectiveness and feasibility of patient empowerment through the PBL model in health continuing education of peritoneal dialysis (PD) patients.

METHODS

From March 2017 to April 2017, a total of 94 participants were randomly assigned to the PBL group and the traditional group, with 47 patients in each group. Patients of the PBL group were divided into 5 study groups; and six PBL health education activities were held. The basic knowledge, self-management behavior, quality of life, anxiety, and depression were assessed among the traditional group and the PBL group. The average follow-up duration was 10.6±1.5 months.

RESULTS

Compared with patients in the traditional group, patients in the PBL group had higher scores of basic knowledges for PD (84.33±3.55 vs 91.19±3.07; P<0.001), higher scores of self-management (61.19±3.71 vs 71.47±2.89; P< 0.001), better scores of quality of life (85.99±14.33 vs 102.64±9.43; P < 0.001), and better scores of satisfaction (90.78±1.32 vs 98.21±1.25; P < 0.001). Furthermore, the scores of anxieties (52.39±4.55 vs 46.46±4.63; P < 0.001) and the scores of depressions were lower (49.95±6.76 vs 45.80±8.77; P =0.01) in patients who participated in the PBL mode of education than in the traditional educational group.

CONCLUSION

The empowerment model of PBL health education can effectively improve the knowledge, skills and quality of life of PD patients.

RELEVANCE TO CLINICAL PRACTICE

The findings identified in this study will help to improve the quality of nursing care and health education for PD patients.

PATIENT OR PUBLIC CONTRIBUTION

The study design involved patients on PD training. The knowledge and skills of PD and quality of life will improve after they participate the PBL health education activities.

Video Didactic Preparation Augments Problem-Based Learning for First Year Medical Students

Problem-based learning (PBL) utilizes a self-directed strategy. This process relies on group participation to succeed. Students without a background in biology or medicine can feel overwhelmed by the complexity of the subject matter and unable to participate in the group learning process. We incorporated curated educational videos in the PBL curriculum to help address this situation. First year medical students participated in this study in the form of a typical PBL session. They were then assessed on basic and clinical science knowledge and their learning experience. Student basic science and clinical knowledge were similar between the student groups. However, the students given a list of suggested videos scored higher in their learning experience, perception of feeling prepared, and participating in the group PBL experience than students who were not given the video list. Results from this study indicate that videos can be utilized to enhance the PBL process.

A comparison of face-to-face and fully online problem-based learning: Student results and staff experiences, 2014-2020

ISSUE ADDRESSED

Problem-based learning (PBL) is a student-directed pedagogy that promotes critical thinking, self-directed learning and communication skills essential for health promotion students and practitioners. This paper reports on student results, student evaluation and staff experience of PBL in the face-to-face and fully online environment in an undergraduate health sciences unit in an Australian university.

METHODS

A single time-point study using quantitative and qualitative administrative student data (2014-2020) and narrative reflection from teaching academics (n = 5) was undertaken. Descriptive, independent t test and bivariate analyses for student results data were conducted; an inductive approach was used to analyse qualitative data and create codes.

RESULTS

Student sample (n = 472) consisted face-to-face (n = 358, 75.8%) and online (n = 114, 24.2%) enrolments. Final Unit Mark was significantly higher for fully online students compared with face-to-face students in 2018 (P = .007) and 2019 (P = .001). Final Unit Achievement was significantly higher for fully online students compared with face-to-face students in 2018 (P = .017) and 2019 (P = .043). Three themes emerged: The PBL approach; Evolution of PBLs; Student skills and competencies.

DISCUSSION

PBL allows students to learn through facilitated problem solving and strong collaborative skills. The face-to-face and fully online PBLs improved the student and academic staff experience, while supporting the development of critical thinking and self-directed research. Further, it supported students to develop their core health promotion competencies; and enhanced the online student learning experience. SO WHAT?: Vital for contemporary, global graduates, the fully online PBL approach allows students to build critical academic and professional skills utilising current information technology relevant for collaborative professional practice.

Piloting a constructive feedback model for problem-based learning in medical education

PURPOSE

Constructive feedback is key to successful teaching and learning. The unique characteristics of problem-based learning (PBL) tutorials require a unique feedback intervention. Based on the review of existing literature, we developed a feedback model for PBL tutorials, as an extension of the feedback facilitator guide of Mubuuke and his colleagues. This study was aimed to examine the perceptions of students and tutors on the feedback model that was piloted in PBL tutorials.

METHODS

This study employed a qualitative research design. The model was tested in nine online PBL sessions, selected using the maximum variation sampling strategy based on tutors' characteristics. All sessions were observed by the researcher. Afterwards, tutors and students in the PBL sessions were interviewed to explore their perceptions of the model.

RESULTS

Three themes were identified based on the perceptions of the tutors and students: cognitive changes, behavioral changes, and challenges of the use of the feedback model. Both tutors and students benefited from improved cognition and behavior. However, the use of the feedback model still encountered some challenges, such as limited sources of feedback data, flexibility and adaptability of the model, content of feedback delivered, students' characteristics and performance, tutors' characteristics and self-perceptions, and supportive infrastructure.

CONCLUSION

The model can be used as a reference for tutors to deliver constructive feedback during PBL tutorials. The challenges identified in using the constructive feedback model include the need for synchronized guidelines, ample time to adapt to the model, and skills training for tutors.

An exploration of speech and language pathology student and facilitator perspectives on problem-based learning online

This mixed-methods study explored the perspectives of second and third-year Speech Language Pathology (SLP) students and facilitators on Problem-Based Learning (PBL) online. As a result of the COVID-19 pandemic, PBL was delivered online for the academic year 2020-2021 via a virtual learning environment. Forty-seven students and five facilitators completed an online survey designed to evaluate the quality of individual and collaborative learning in the PBL online context. All participants had experience of pre-COVID-19 face-to-face PBL. Thematic analysis and descriptive statistics were used to analyse qualitative and quantitative data, respectively. Demonstrated a preference from both students and facilitators to maintain PBL in a face-to-face format. Aspects of functionality offered by the virtual platform assisted in the PBL process, however technical and environmental barriers impeded virtual delivery. Responses suggest that the development of rapport and interactivity levels online are not equivalent to face-to-face PBL, and these factors were perceived by participants to negatively influence the learning process. Perspectives on the role of the facilitator online convey divergent views between second and third years which reflected a change in facilitator style to support more independent learning in line with students' progression through the course. Our findings demonstrate that students and facilitators are open to future implementation of a blended model of PBL. Participants reported benefits such as reduction in indirect education costs and acquisition of a digital skillset. However, our study indicates a preference for enhanced social presence afforded by face-to-face PBL.

Paradigm shift in medical education due to the COVID-19 pandemic: guidelines for developing a blended learning curriculum in medical education

Background: The coronavirus disease 2019 (COVID-19) pandemic has transformed the world's economy, health and education in a blink of an eye. Almost 1 billion learners have been affected across the globe. This has resulted in a paradigm shift to blended learning. Therefore, it was felt necessary to provide practical guidelines for the development of blended curriculum in medical education. It would help to overcome the challenges faced due to unprecedented transformation of medical education on account of pandemic. Methods: Guidelines based on personal experience of the authors and literature search were developed using the complex adapted blended learning system (CALBS) framework. Seven experts developed these guidelines using the nominal group technique. The consent form and literature for CABLS framework was shared with experts. The experts developed the guidelines independently during phase one of the technique. After a given time, phase 2 started with moderator mediated discussion about the individual guidelines developed by the experts. After discussion and mutual consensus four types of guideline ideas were developed. During the third phase the experts ranked the guideline ideas on a scale of 1 to 5. The guideline idea that ranked highest was selected as a final guideline for developing a blended learning curriculum. Results: The group consensus resulted in developing seven guidelines for a blended course or curriculum in medical education. These guidelines are based on a conceptual framework supplemented by expert's own personal experience and current evidence from literature. Conclusions: These guidelines would provide a comprehensive and systematic approach to develop a blended learning curriculum in medical education.

Paradigm shift in medical education due to the COVID-19 pandemic: guidelines for developing a blended learning curriculum in medical education

Background: The coronavirus disease 2019 (COVID-19) pandemic has transformed the world's economy, health and education in a blink of an eye. Almost 1 billion learners have been affected across the globe. This has resulted in a paradigm shift to blended learning. Therefore, it was felt necessary to provide practical guidelines for the development of blended curriculum in medical education. It would help to overcome the challenges faced due to unprecedented transformation of medical education on account of pandemic. Methods: Guidelines based on personal experience of the authors and literature search were developed using the complex adapted blended learning system (CALBS) framework. Seven experts developed these guidelines using the nominal group technique. The consent form and literature for CABLS framework was shared with experts. The experts developed the guidelines independently during phase one of the technique. After a given time, phase 2 started with moderator mediated discussion about the individual guidelines developed by the experts. After discussion and mutual consensus four types of guideline ideas were developed. During the third phase the experts ranked the guideline ideas on a scale of 1 to 5. The guideline idea that ranked highest was selected as a final guideline for developing a blended learning curriculum. Results: The group consensus resulted in developing seven guidelines for a blended course or curriculum in medical education. These guidelines are based on a conceptual framework supplemented by expert's own personal experience and current evidence from literature. Conclusions: These guidelines would provide a comprehensive and systematic approach to develop a blended learning curriculum in medical education.

Lacunae regarding dearth of dissection-based teaching during COVID-19 pandemic: how to cope with it?

Introduction

In view of the ongoing COVID-19 pandemic, anatomy education programs were amended so as to shift to primarily online mode from physical classes. In the whole process, main concern area that has emerged is regarding dearth of physical human dissection sessions. There is enough evidence available in literature to suggest that dissection room is an ideal place to cultivate and inculcate discipline independent skills or humanistic skills among the students. These include attributes in relation to ethical practice, professionalism, communication skills, empathy and compassion. Imbibing these skills are an essential element of medical education curriculum as it is desirable that students exhibit these traits when they begin medical practice. Hence deficiency in terms of exposure to physical dissection sessions can adversely affect training of medical students on a long term.

Methods

A literature search of relevant, peer-reviewed, published articles was undertaken from indexed databases (Medline and PubMed, Scopus, Embase, CINAHL Plus, Web of Science and Google Scholar) for this study.

Results

To counter the pertinent issue in online anatomy teaching program, a few measures have been suggested in this paper based on identification of actual deficit areas in terms of learning and analysis thereof. Live streaming of real time dissection, awareness sessions on human dissection, online interactive learning sessions and reflective thoughts-based exercise can contribute to building discipline independent skills in present scenario.

Conclusion

Incorporation and implementation of these interventions within the realm of online anatomy education programs during COVID-19 pandemic can possibly contribute towards desirable learning outcomes.

Incorporating verbal defense into problem-based learning

INTRODUCTION

The objective of this project was to evaluate the effect of adjusting the solution reporting phase of problem-based learning (PBL) while keeping core components of the pedagogy constant.

METHODS

A PBL course for third year pharmacy students changed delivery of the problem solution from a written format to a verbal defense. Comparisons were made between the written format and verbal defense groups. The primary outcome was the change in the motivation domain of the Motivated Strategies for Learning Questionnaire (MSLQ). Secondary outcomes included evaluation of the learning strategies domain of the MSLQ, changes in MSLQ scores within each group, exam scores, and themes identified using focus groups.

RESULTS

There was no difference in the change of motivation and learning domains between the groups. However, scores in both groups increased significantly from the beginning to the end of the semester for both motivation and learning. There was no difference in exam scores and facilitator confidence between groups. Themes from focus groups who used the written format were appreciation of PBL outcomes, discomfort with the pedagogy, and disconnect of assessments. Themes from the verbal format group were realism, increased confidence, and comments with course logistics.

CONCLUSIONS

No difference in motivation and learning was observed between the groups, although both groups improved over the course of the semester. Changes to PBL approach within the confines of the pedagogy may not impact motivation and learning.

Does blended problem-based learning make Asian medical students active learners?: a prospective comparative study

BACKGROUND

Asian educators have struggled to implement problem-based learning (PBL) because students rarely discuss their work actively and are not sufficiently engaged in self-directed learning. Supplementing PBL with additional e-learning, i.e. 'blended' PBL (bPBL), could stimulate students' learning process.

METHODS

We investigated the effects of bPBL on tutorial group functioning (discussion, self-efficacy, self-directed learning, active participation, and tutor's perceived authority) and students' level of acceptance of the e-learning elements. We compared PBL and bPBL in a medical university in Japan. In the bPBL condition, the tutor's instructions were replaced with online materials and short quizzes. After the course, a 13-item questionnaire using a 5-point Likert scale was distributed regarding the tutorial group functioning of the tutorial group (influence of discussion, self-efficacy, self-directed learning, active participation, and tutors' authority). The mean scores of subscales were compared with analysis of covariance. Knowledge levels were measured using a pre-test post-test design. A multiple regression analysis was performed to explore the association between e-learning acceptance and the subscales related to PBL.

RESULTS

Ninety-six students participated in the study (PBL: n = 24, bPBL: n = 72). Self-efficacy and motivation for learning triggered by group discussions was significantly higher for students in bPBL (p = 0.032 and 0.007, respectively). Knowledge gain in test scores was also significantly better in the bPBL condition (p = 0.026), and self-directed learning related positively to the acceptance of blended learning (p = 0.044).

CONCLUSIONS

bPBL seemed more effective in promoting active learning and improving knowledge, without affecting tutors' authority. Implementing e-learning into PBL is suggested to be an effective strategy in the Asian context.

Update on research and application of problem-based learning in medical science education

Problem-based learning (PBL) is a unique form of pedagogy dedicated to developing students' self-learning and clinical practice skills. After several decades of development, although applications vary, PBL has been recognized all over the world and implemented by many medical schools. This review summarizes and updates the application and study of PBL in medical education through the literature published between 1993 and early 2017. It focuses on understanding real medical PBL courses and ways to improve PBL to achieve better learning outcomes. PBL aims to develop lifelong skills to solve practical problems rather than limiting learning to theoretical knowledge. To achieve this goal, strict and reasonable procedures need to be designed and implemented. Rigorous monitoring and timely feedback and evaluation are indispensable to constant improvements and perfecting of the process. © 2017 by The International Union of Biochemistry and Molecular Biology, 46(2):186-194, 2018.

Persuasive technology in teaching acute pain assessment in nursing: Results in learning based on pre and post-testing

BACKGROUND

Thousands of patients seek health services every day with complaints of pain. However, adequate pain assessment is still flawed, a fact that is partly related to gaps in professional learning on this topic. Innovative strategies such as the use of a virtual learning object mediated by persuasive technology in the learning of undergraduate nursing students can help to fill these gaps and to provide different ways of learning to learn.

OBJECTIVE

To evaluate the results in learning among undergraduate nursing students about assessment of acute pain in adults and newborns, before and after an online educational intervention.

DESIGN

This is a quasi-experimental, non-equivalent study using pre-and post-testing.

SETTING

Federal University of Santa Catarina, Brazil.

PARTICIPANTS

75 undergraduate nursing students.

METHODS

Our study was conducted in three steps (pre-test, education intervention, post-test). Data were collected from November 2013 to February 2014. The educational intervention was performed using online access to virtual learning object about acute pain assessment, which students accessed on their mobile devices.

CONCLUSION

A significant difference was seen in student learning (p<0.001) in the post-test compared with the pre-test results. The students understood the importance of the topic, and were satisfied and motivated by the technology and method applied. The use of persuasive technology such as small mobile devices as mediators of online educational interventions broadens learning spaces in an innovative, flexible, motivational, and promising manner.

To what extent can PBL principles be applied in blended learning: Lessons learned from health master programs

INTRODUCTION

Maastricht University has been actively exploring blended learning approaches to PBL in Health Master Programs. Key principles of PBL are, learning should be constructive, self-directed, collaborative, and contextual. The purpose is to explore whether these principles are applicable in blended learning.

METHODS

The programs, Master of Health Services Innovation (case 1), Master Programme in Global Health (case 2), and the Master of Health Professions Education (case 3), used a Virtual Learning Environment for exchanging material and were independently analyzed. Quantitative data were collected for cases 1 and 2. Simple descriptive analyses such as frequencies were performed. Qualitative data for cases 1 and 3 were collected via (focus group) interviews.

RESULTS

All PBL principles could be recognized in case 1. Case 2 seemed to be more project-based. In case 3, collaboration between students was not possible because of a difference in time-zones. Important educational aspects: agreement on rules for (online) sessions; visual contact (student-student and student-teacher), and frequent feedback.

CONCLUSION

PBL in a blended learning format is perceived to be an effective strategy. The four principles of PBL can be unified in PBL with a blended learning format, although the extent to which each principle can be implemented can differ.

Educational technologies in problem-based learning in health sciences education: a systematic review

Background

As a modern pedagogical philosophy, problem-based learning (PBL) is increasingly being recognized as a major research area in student learning and pedagogical innovation in health sciences education. A new area of research interest has been the role of emerging educational technologies in PBL. Although this field is growing, no systematic reviews of studies of the usage and effects of educational technologies in PBL in health sciences education have been conducted to date.

Objective

The aim of this paper is to review new and emerging educational technologies in problem-based curricula, with a specific focus on 3 cognate clinical disciplines: medicine, dentistry, and speech and hearing sciences. Analysis of the studies reviewed focused on the effects of educational technologies in PBL contexts while addressing the particular issue of scaffolding of student learning.

Methods

A comprehensive computerized database search of full-text articles published in English from 1996 to 2014 was carried out using 3 databases: ProQuest, Scopus, and EBSCOhost. Eligibility criteria for selection of studies for review were also determined in light of the population, intervention, comparison, and outcomes (PICO) guidelines. The population was limited to postsecondary education, specifically in dentistry, medicine, and speech and hearing sciences, in which PBL was the key educational pedagogy and curriculum design. Three types of educational technologies were identified as interventions used to support student inquiry: learning software and digital learning objects; interactive whiteboards (IWBs) and plasma screens; and learning management systems (LMSs).

Results

Of 470 studies, 28 were selected for analysis. Most studies examined the effects of learning software and digital learning objects (n=20) with integration of IWB (n=5) and LMS (n=3) for PBL receiving relatively less attention. The educational technologies examined in these studies were seen as potentially fit for problem-based health sciences education. Positive outcomes for student learning included providing rich, authentic problems and/or case contexts for learning; supporting student development of medical expertise through the accessing and structuring of expert knowledge and skills; making disciplinary thinking and strategies explicit; providing a platform to elicit articulation, collaboration, and reflection; and reducing perceived cognitive load. Limitations included cumbersome scenarios, infrastructure requirements, and the need for staff and student support in light of the technological demands of new affordances.

Conclusions

This literature review demonstrates the generally positive effect of educational technologies in PBL. Further research into the various applications of educational technology in PBL curricula is needed to fully realize its potential to enhance problem-based approaches in health sciences education.