Using the skills of problem-based learning in healthcare - Term Paper Example

Using the Skills of Problem-based Learning in Healthcare Introduction Problem-based learning in healthcare education no longer has a single universal definition. A great deal of misunderstanding as a result surrounds the interpretation and implementation of this educational philosophy in learning areas. Perceptions vary, and there is considerable difference in perspectives between conventional traditional education and problem-based education. In some institutes, the implementation of education occurs in some specific methods. In some cases, tutorial modes are acceptable as the formats of implementation of problem-based education. In that scenario, the tutors need not be experts in the areas of learning, under consideration by the students in the recent curriculum (Cunnington, 2002, 254-260). The tutors really ensure that students learn how to go through the process of learning. They ensure participation in tutorial discussions. The professional expertise of the faculty members is utilized when they act as resource teachers when the students begin to study their area of expertise. This author is a student of physiotherapy, and hence this discussion will centre on physiotherapy education and learning, and a contrast will be attempted to be drawn between conventional traditional learning and problem-based learning (Colliver, 2000, 259-266). One problem with problem based learning is the word "problem." Problems usually are supposed to have solutions, and, to many, by problem-based learning it is actually meant development of problem solving skills through case-based learning. In contrast to traditional learning through lectures, when problem-based learning is adopted, fewer facts may be memorized than in lectures. It has been estimated that in lectures more than 50% of the course material is forgotten. This indicates the retention of learning is less in traditional method than in the problem-based method (Farrow and Norman, 2003, 1131-1132). It has also been suggested that forgotten information would be having some value, but at the same time, it has been claimed that its loss can be more than compensated by an increase in the level of understanding. However, in the learning environment where there is a mix of science, clinical, or paraclinical education, it has been found that there would also be similar advantages and limitations of problem-based learning (Glew, 2003, 52-56). In such environments, where there is mix of this category, on the one hand, in the graduate school curriculums, the graduate students and their supervisors pursue knowledge, which may involve learning through traditional systems. However, when the same institute has programmes on professional courses, such as, medicine, nursing, midwifery, occupational therapy, and physiotherapy, these programmes will usually involve patient-based education and learning, where clinical skills are involved (Morrison, 2004, 174). Therefore, there would be need for clinical education, which would be based on clinical problems. This leads to a situation of problem-based learning which the learners would appreciate in that it would be difficult to accomplish this with the aid of traditional education (Rangachari, 2003, 192-194). True PBL is not skills oriented-it is understanding oriented. A true problem-based learner would acquire the skill but then proceed to explore and develop an understanding of the subject by individual units of learning. In fact, the method in the clinic-based subjects is skill based, and hence all professionals on clinic-based subjects will have to learn skill sets, so they can possess an in-depth understanding of the problems that the patients face (White, 2002, 419). It is to be remembered that in professional programmes, training time is limited and fixed, so it is the extent and depth of problem-based learning that must vary. Problem-based learning and its implementation and the expectations for it, will differ for purely academic students on the one hand and professional students on the other, although the essence of the activity is the same. It has been emphasized that medical professional education is all about application of knowledge (Higgs and Jones, 2000, 3-14). Traditional tests and examinations are not suitable for student evaluations in problem-based learning programmes. Therefore, the results from these would be either enhancement of understanding or not. Tutorial-based medical programmes that incorporate problem-based learning can have ongoing oral evaluations from their peers and tutors, and there can be more formal evaluation exercises at the middle and end of the programme units (May, 1977, 174). These exercises usually have three components, an initial interview with a tutor to discuss the healthcare problem and establish the envelope for learning, the students' use of any or all resources available to allow him/her to understand those negotiated aspects of problem, and a second interview with the tutor to discuss what the student has come to understand about the assigned problem (Barr, 1977, 262-270). Experience and studies on problem-based learning have shown that despite absence of formal and traditional lecture-based learning, the students undergoing problem-based learning methods do well in the written examinations, even comprising of multiple choice questions. In fact, problem-based learning modes can be applicable for everyone, if promoted and implemented correctly. On the other hand, it has been criticised that there has been no convincing evidence that problem-based learning improves knowledge base and clinical performance (Vernon and Blake, 1993, 560-563). This is based largely on examination results and clinical skills evaluations, while it cannot assess or address understanding. It has also been argued that statistical analyses may be an inappropriate tool for comparing problem-based learning against traditional learning methods or curricula. Criticism of problem-based learning in the medical schools warns about the prevalence of backward reasoning rather than forward reasoning, and this may lead to gap in cognitive knowledge of the learners leading to poor practice outcomes (Albanese and Mitchell, 1993, 52-68). The proponents of problem-based learning are aware of this deficit, and they ascribe it to the very nature of differentiation between the learning needs of academic and professional students. There are innate problems in problem-based learning, which mainly involves problems with implementation and failure to fully understand the nature of problem-based learning on the other hand. It has been recognised that effective implementation of problem-based learning requires student-centred learning that usually degenerates into problem solving when it becomes teacher-centred, whereas pinning for teacher-centred learning indicates a lack of understanding of the true nature of problem-based learning. Although a fundamental flaw in the philosophy of problem-based learning has been suspected to this end, the most likely reason is the resultant of a failure of proper implementation (Schmidt, Dauphinee, and Patel, 1987, 305-315). The presentation of the patients seeking physiotherapy is essentially dependent upon clinical scenarios, and therefore learning of the healthcare professionals should be best based upon these clinical scenarios. Problem-based learning in the clinical professional education has important bearing on such learning processes, but as has been mentioned earlier, these scenarios alone would not fully characterize philosophical tenets or features ingrained in curriculum design (Schmidt, 1983, 11-16). Theoretically speaking, problem-based learning is enhanced by stimulation of prior knowledge, learning in context to enhance retention, and utilisation of discussion to enhance and elaborate knowledge. Applied to physiotherapy learning, a problem-based approach in learning may have several yields. These may include responsibility of the students for the breadth and depth of learning through direction, resources, and feedback. This is build upon the students' prior learning since students bring a wide background of prior learning and experience. This is usually implemented in small groups of students in the clinical setting, and thus interactions will enhance understanding, exploration, discussion, and debate leading to filtration of knowledge and learning into effective clinical practice in that particular clinical scenario (Payton, 1985, 924-928). For each group, there would be a faculty tutor, and his role is to facilitate learning through conversion of information into concepts. Although as it may seem, this pathway is totally isolated from the traditional ways of learning, actually the information is used to comprehend and deal with real-life scenarios integrated from a variety of traditional disciplines (Mattingly, 1991, 998-1005). From this author's experience, the problem-based learning in physiotherapy can occur with several specific features integrated into it. These are an acknowledgement of the base of experience of learners; an emphasis on students taking responsibility for their own learning; a crossing of boundaries between disciplines; an intertwining of theory and practice; a focus on the processes rather than the products of knowledge acquisition; a change in the tutor's role from that of instructor to that of facilitator; a change in focus from tutors' assessment of outcomes of learning to student self-assessment and peer assessment; a focus on communication and interpersonal skills so that students understand that in order to relate their knowledge, they require skills to communicate with others, skills that go beyond their area of technical expertise (Jensen et al., 1992, 711-722). It is implied that for different disciplines, there will be different approaches in problem-based learning, and it would involve a combination of design variables linked to the educational objectives of a particular discipline. As a result, all types of problem-based learning must be evaluated in terms of issues such as the type of problems, assessment methods, learners' autonomy and the way in which teaching and learning occurs. From observations, it can be stated that there are several varieties of forms that can be applicable to varieties of learning disciplines. These are, lecture-based cases, where students are presented with information through lectures and then case material is used to demonstrate that information. It can be case-based lectures, and in this instance, students are presented with case histories or vignettes before a lecture that then covers relevant material. In the case method, students are given a complete case study that must be researched and prepared for discussion in the next class. This can be modified, where students are presented with some information and are asked to decide on the forms of action and decisions they may make. Following their conclusions, they are provided with more information about the case. Sometimes, the design is purely problem based where the students meet the clients with some form of simulated format that allows for free inquiry to take place. Otherwise, it can be closed-loop problem based as an extension of the above, where students are asked to consider the resources they used in the process of problem solving in order to evaluate how they may have reasoned through the problem more effectively. These clearly demonstrate the multi-faceted nature of problem-based learning (Beeston and Simons, 1996, 231-242). It can be assessed from the above discussion that there are certain parameters of problem-based learning that determine the vitality and the complexity of the approach. The nature of learning is complex, and to accomplish that, it would need educational strategies specifically designed according to the need of the clinical discipline concerned. However, it can be distinctly differentiated from the traditional learning in that essential characteristics of problem-based learning that comprised curricula organization around problems rather than disciplines, an integrated curriculum and an emphasis on cognitive skills; conditions that facilitated problem-based learning such as small groups, tutorial instruction, and active learning; outcomes that were facilitated by problem-based learning such as the development of skills and motivation, together with the development of the ability to be life-long learners. This particular interpretation of problem-based learning offers a way of understanding this educational strategy that takes account of the complex nature of learning. At the same time it is an interpretation that encapsulates the differing ways in which students learn in diverse professions and disciplines across a variety of institutions (Coles, 1985, 308-309). It is to be remembered that with advancement of technology and ingress of immense volume of information, there was a perceived need for new medical school curriculum, and it was found that learning, especially as applicable to the health professionals in the making, the most important determining parameter is clinical practice, the driving force being the needs of the patient. The assumption was that principles of learning could be applied to educate the medical or health professionals. In addition, it was expected with advancement of knowledge that there will be increased retention of information, greater application of knowledge in the clinical contexts, and development of life-long learning habits on the part of these professionals. Taking the example of physical therapy course, in this author's experience, there has been application of problem-based learning within the structure of traditional features of learning. This programme used integration of clinical education through a block system, where academic units are followed by clinical placements in the related content areas with integrated objectives. A problem solving approach was used with small group learning in two courses with the goal of fostering the development of clinical reasoning and responsibility for learning. As expected, this would invariably create a forum for students to deal with many problems in patient care issues within a psychosocial framework (Entwistle, Hanley, and Hounsell, 1979, 365-380). In this problem-based learning course, it was a 24-month second undergraduate university physical therapy programme. There were six units of study, and the curriculum plan documented objectives of each of these units. It was evident that content streams were gradually developed throughout the programme. The course comprised of the basic sciences such as anatomy and physiology, theories of physical therapy, research topics, and clinical skills in an integrated manner. This was based on the study of health care scenarios. The major educational event that this writer noted was a series of small group tutorials, in which all students were asked to work through the scenarios. The skill and process of problem solving was not emphasised. In these scenarios, the major goals were to provide a context for learning. It activated this writer's prior knowledge, and in this writer's opinion, it motivated all students, since all students were stimulated to enter into a discussion. There was a clinical skills laboratory, and the learned context of the clinical scenario was well applied. While clinical skills were learned in this laboratory through simulation, the inquiry seminars invoked thoughts and questions and provided answers to many problems that the students had thought of. Moreover, this new programme maintained a strong emphasis on a humanistic approach to patient care, and this added to the development of responsible and critical learners. To foster academic learning, following this problem-based curriculum, a block system of academic study units followed by clinical placements in the content areas those were closely related to this programme. In this writer's opinion, this enhanced the integration of academic and clinical learning. Problem-based learning is an approach in which it is acknowledged that learners should develop metacognitive skills and thus it is expected that students use reasoning abilities to manage or solve complex problems. These notions connect closely with problem-based learning that takes at its core the idea that knowledge is personal. Problem-based learning requires students to gain information through sensory perception as well as by using logic. Applied to the area of learning in physiotherapy, for a given client the logical background of a specific therapy becomes clear to the learner, and while doing so, when a variant clinical situation is the scenario of presentation, the physiotherapist can develop and improvise the treatment regimen for that particular condition. Teaching and learning never represented merely an interpersonal relationship or the expression of feelings; rather, they were always about disciplined inquiry into some aspect of reality (Newble and Gordon, 1985, 3-8). Education should cultivate and develop each person's rationality, enable students to make rational judgments on many subjects and serve the theoretical and practical by combining technical skills, liberal education, subjects and theory. These notions connect with problem-based learning as students attempt to develop knowledge, engage in sustained inquiry and seek to develop practical skills. Reference List Albanese MA and Mitchell S., (1993). 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