"The more you did, the more it made sense": Problem-based learning to improve early evidence-based practice in an undergraduate physiotherapy professional programme.

Abstract

Listen

Translate article

Evidence-based practice (EBP), which integrates clinical reasoning skills, research evidence, and patient preference, has become standard in curricula for health care professional programs. Students however perceive EBP as difficult and often irrelevant to clinical practice. A problem-based learning (PBL) approach is trialled in an early stage module where EBP knowledge and skills are stated learning outcomes. Prior to this, the content-based approach to EBP teaching and learning received negative student feedback. The impact of delivering EBP through PBL is evaluated by comparing 5 standard Likert feedback scales and open-ended question responses relating to the EBP instruction in the module before and after a PBL approach was implemented. The impact of a PBL approach on EBP profiles is further examined under domains (relevance, sympathy, terminology, practice, and confidence) of the validated Evidence-based Practice Profile Questionnaire. All mean Likert scores relating to subject understanding, relevance of assessments, achievement of learning outcomes, teaching, and overall module satisfaction improved when the PBL approach was compared with the lecture-based format (p<0.05). Student comment post-PBL continued to identify EBP as a difficult concept, but now comments on the teaching and assessment approach were mainly positive, addressing the collaborative nature of PBL, identifying EBP, communication and team-working skills acquired, praising the real life, practical application of EBP taken, and commenting on improvement in EBP self-efficacy. Within group change in the Evidence-based Practice Profile Questionnaire following a PBL approach identified significant improvement in EBP domains of terminology (mean change 3.38; p<0.001); practice (mean change 16.5; p<0.001), and confidence (mean change 10.1; p=0.008). Conceptual links, based on constructivist underpinnings of PBL and EBP, are developed in the paper. Using mixed methods evaluation, PBL is effective at promoting early EBP. Students identified with the interactive, collaborative, and experiential nature of PBL to EBP instruction.