Problem-based Learning Facilitators Research Articles

Faculty Experiences: Virtual versus Traditional Problem-based Learning during COVID-19 in a Saudi Medical College

Abstract Background: The COVID-19 pandemic has forced a fast change to new teaching approaches based on online education. Problem-based learning (PBL) was one of the modified teaching strategies. The current study sought to examine faculty perceptions of virtual versus traditional PBL during the COVID-19 pandemic at a Saudi medical college. Methods: This is a retrospective cross-sectional study conducted at King Saud University’s College of Medicine. We compared the perceptions of faculty members who facilitated traditional face-to-face PBL in 2019–2020 and virtual PBL in 2020–2021. An online survey with demographic and practice data was distributed. The faculty’s perception of PBL facilitation, student learning, and overall satisfaction was investigated using a 5-degree Likert scale: 15 items grouped into three main areas. All of the questions were written in a way that compares traditional and virtual PBL. Mean scores were determined for all parts, and the findings were reported as mean standard deviation, with scores of 3 and above considered positive, and scores of <3 considered negative. The data were analyzed with SPSS version 25.0. Results: In the study period, 57 faculty members facilitating PBL replied to the survey (response rate 67.85%). There were no gender variations in the representation of participants (male 56.1%, female 43.9%), and they come from a variety of basic and clinical departments. The majority of participants (91.3%) have more than 2 years of PBL facilitation experience, and 64.2% have received training in both virtual and traditional PBL facilitation. The faculty assessment of facilitating virtual PBL was favorable as overall satisfaction, with the mean of the components in the satisfaction section being 3.67. In terms of facilitation preferences, we discovered that despite the amount of effort involved in facilitating traditional PBL sessions (mean = 3.47), their motivation to facilitate traditional PBL was higher than that of virtual PBL (mean = 3.33). Faculty perceptions of students’ learning in PBL were more traditional, with the mean of the items in this section (such as students’ motivation, participation, and group dynamics) being higher (3.616). Conclusions: The faculty’s satisfaction with their abilities to properly facilitate virtual PBL sessions did not detract from their motivation to be in direct personal interaction with students during PBL sessions. To ensure faculty care about students’ learning in virtual PBL, their perception had to be correlated to their learning outcomes.

Teaching Skills Training for Pre-clinical Medical Students Through Weekly Problem-Based Learning Teaching Topic Presentations and Directed Feedback

ProblemMedical students commonly encounter scenarios in which they are charged with teaching medical content, but studies find a paucity of teaching skills training especially in the pre-clerkship phase of undergraduate medical programs.InterventionVideos lessons were created to instruct on five teaching skills identified as useful for presenting short lessons on medical topics: effective learning objectives, appropriate lesson complexity, audience engagement, relevance to practice, and resource selection. A rubric was generated to assess the performance level of each teaching skill.ContextFirst-year medical students viewed the video lessons and were instructed to implement these teaching skills for the creation and delivery of weekly learning issue (LI) presentations within a problem-based learning (PBL) course. PBL facilitators assessed students by using the rubric to assign a score of 0–2 corresponding to the level of skill performance.ImpactScores in every dimension of our LI assessment rubric showed significant improvement above week 1 at the end of the initial 4 weeks of practice and assessment. Follow-up assessment showed durable performance and significant improvement for 3 out of 5 at weeks 8 and 12.Lessons LearnedOur novel framework was effective in fostering the adoption and implementation of five teaching skills among first-year medical students over a 4-week period, with most skills remaining durable over 12 weeks. Furthermore, end-of-course surveys showed that students found feedback received using the framework helpful in improving their LIs, and faculty reported that student LI presentation quality improved overall.

Does problem-based learning facilitate enactment of learner agency in undergraduate dental curricula? A Q study.

Addressing a literature gap on leaner agency in health profession education, this study explores students' perceptions on which aspects of a problem-based learning (PBL) environment cradle their leaner agency enactment. Thirty-eight students from a newly established undergraduate dental medicine programme in Qatar participated in the study. Q methodology was adopted to collect and analyse data both qualitatively and quantitatively. A 40-statement Q-set was established based on a proposed conceptual framework of learner agency in PBL, including three dimensions-intrapersonal, behavioural and environmental. Q methodological factor analysis identified four significantly different student viewpoints, which underscored participants' enactment of learner agency addressing the intrapersonal, behavioural and environmental dimensions of the conceptual framework. Despite differences in opinion regarding sources of learner agency, the four student viewpoints unanimously underscore the importance of PBL facilitators' expertise to nurture and develop agency amongst undergraduate students. Post-sorting qualitative data further confirmed the quantitative analysis. Time constraints and workload were identified as the main challenges by the participants. This study explored enactment of learner agency as perceived by undergraduate dental students in a PBL curriculum. The findings of this study provide new insights into participants' subjective understanding of learner agency in a PBL curriculum in dentistry. Structured support is needed for students having no prior PBL experiences to develop their learner agency at both intrapersonal and behavioural (self-regulated learning) dimensions, and to ensure they interact with their learning environment proactively.

Development of professional identity among dental students - A qualitative study.

The study explored dental students' perception of their professional identity (PI) development at a newly established dental college with a problem-based learning (PBL) curriculum. Qualitative methods based on focus groups were used for data collection. The conceptual framework of the study was informed by a subject-centered sociocultural approach to PI development. Purposive sampling was used to collect data from five focus groups of undergraduate dental students to gain a deeper understanding of their PI development in a PBL environment. Out of a total of 38 dental students in years 2 and 3, 34 students (89.47%) participated in the focus groups. A theory-driven thematic analysis was used to dissect the views and experiences of the participants to explore factors contributing to PI development in the early years of the program. At an individual level, PBL was seen to be appropriate for PI development. However, some participants placed more emphasis on practical training in operative dental skills. Relational sources especially role modeling by the PBL facilitators and faculty staff were identified as a key factor to nurture PI development. Mixed views were observed on the value of PBL to enhance team-working skills. The participants also identified challenges of PBL and provided recommendations on further improvements to enhance the learning experiences of the students. This study provided useful insights into a PBL curriculum at a newly established dental institution. The findings underscore the value of PBL in developing PI and also highlight the challenges of implementing PBL in a socio-cultural context and pedagogical implications for further program improvement.

Temporary Transitions to Online Problem-based Learning: Advice for Tutors and Learners

We provide a narrative review of the crucial elements for online Problem Based Learning (PBL) and a reflective overview of factors to consider when temporarily moving to online tutorials, forming a practical guide for educators in the health professions and beyond. We give general set-up advice based on the literature and our own recent experience (tutor and learner observational feedback, departmental meeting notes, newly-developed written resources and performance reports) of transitioning between temporary online PBL and face-to-face PBL but note that the majority of this advice translates easily to many types of virtual, interactive tutorial. We also include contextual evidence and theories from existing literature, with a focus on online PBL facilitation, learning and quality assurance. Despite widespread implementation of online teaching, there remain unanswered questions about whether deep learning occurs. The focus of this reflective paper is to better align online PBL practice with the principles of contextual, active, collaborative and self-directed learning and learning issues to be pursued.

Health educators' professional agency in negotiating their problem-based learning (PBL) facilitator roles: Q study.

University educators are expected to cope with emerging situations and complex issues in teaching and learning, and this requires them to be agentic and proactive. While professional agency of health educators has not been investigated adequately, this study explores health educators' perception of their enactment of professional agency in the PBL facilitation process in a postpandemic context. Forty PBL facilitators from medical and dental programs in Qatar University participated in the study during the fall semester of 2021, after resuming in-person PBL sessions. To collect and analyse data both qualitatively and quantitatively, Q methodology was employed. A 33-statement Q-set was established based on a proposed theoretical framework of professional agency in PBL facilitation, which included three dimensions-intrapersonal, action, and environment. Q factor analysis identified five significantly different viewpoints regarding how PBL facilitators perceive their professional agency sources, namely, (1) institutional resources, (2) policy guideline, (3) making efforts to improve support for students, (4) beliefs on PBL effectiveness, and (5) agentic actions. While four of the viewpoints were positive, participants with the second viewpoint reported negative perceptions and described lack of interest in facilitation work. All three dimensions of the framework were addressed and indicated complexity and interrelatedness of agency enactment. Consensus was observed regarding the need for more professional learning activities for faculty involved in PBL facilitation as source of professional agency. The results revealed a high variation of participants' perceptions of professional agency enactment throughout the three dimensions, indicating the need for establishing a common understanding of PBL facilitation work in a given context. For practical implications, further institutional efforts are required to support professional learning for PBL facilitation in a postpandemic context. Alternate approaches highlighting enforcement of agentic actions in all dimensions of intrapersonal values, stance and action taking, and active interactions with students, colleagues, and institutional environments are crucial. Q methodology provides new conceptual and empirical insights to explore the subjectivity of actors in health education.

Using Teacher Dashboards to Assess Group Collaboration in Problem-based Learning

Assessing group collaboration is a critical element in Problem-based Learning (PBL). In asynchronous online PBL settings, facilitators encounter challenges to assess group collaboration because of delayed responses, lack of social cues, and the orchestration load. Teacher dashboards have the potential to support facilitators to assess collaboration by providing synthesized and visualized information about student learning. Previous studies have explored facilitators’ user experience of teacher dashboards. However, little is known about how facilitators with different levels of PBL expertise interpret dashboard information differently. In this study, we analyzed ten PBL facilitators’ utterance moves while interacting with an online teacher dashboard to examine the difference between expert and novice facilitators as they used each visualization. This study can inform the design of teacher dashboards on collaboration assessment.

"Cognitive Peer Coaching"- A workplace-based faculty development approach for problem- based learning facilitators: A qualitative study.

To explore the factors affecting the learning process of novice problem-based learning facilitators trained through Cognitive Peer Coaching. The qualitative study with phenomenological design was conducted at the Islamic International Medical College, Riphah International University, Islamabad, Pakistan, from March to August 2018, and comprised problem-based learning facilitators, experts and novices who were given orientation about cognitive peer coaching through workshops. Novice facilitators were trained by experts through cognitive peer coaching cycle comprising pre-observation, observation and post-observation phases following socio-cognitive apprenticeship theory based on modelling, coaching, scaffolding, articulation, reflection and exploration. Data was collected through an observation checklist and semi-structured interviews which were audio-recorded, transcribed and subjected to thematic analysis manually. Of the 15 subjects, 10(66.6%) were novice facilitators and 5(33.3%) were experts. Six themes generated and they were mental growth spurred from within, conscientisation, experiential learning, intrinsic motivation, effective body language, and impediment to success. Learning by observation, learning by doing, increased motivation, autonomy, constructive feedback and reflection augmented the facilitation skills, while unawareness about reflective practices and peer coaching were identified as major obstacles in personal and professional growth of faculty. Cognitive peer coaching was found to be a dynamic, innovative and feasible faculty development approach that contributed to the learning of facilitation skills from psychological, emotional and social perspective.

McGovern Medical School at The University of Texas Health Science Center at Houston.

McGovern Medical School at The University of Texas Health Science Center at Houston.

Problem Based Learning: Learning from the Experiences of Medical Students

Introduction: Problem based learning (PBL) is student centered learning approach that has been implemented in many medical colleges. Since the literature has controversial takes on the utility of PBL, exploring student perspectives might share insights on the contextual merits and demerits of PBL approach. Aims & Objectives: To evaluate experience of medical students regarding PBL in hybrid integrated curriculum. Place and duration of study: May to June 2018 at two medical colleges of Lahore (Shalamar Medical College & University College of Medicine and Dentistry. Material & Methods: Descriptive cross sectional study conducted in May to June 2018 at two medical colleges. Sample size was 188 students of 1st and 2nd year MBBS of Institute 1 and 110 students of 1st and 2nd year MBBS of Institute 2. Pre validated questionnaire was distributed and students were asked to record their experience about PBL using a 5-point’s Likert scale. Data was analyzed by using non-parametric statistics. Results: Institute 1 (188 participants), Institute 2 (110 participants), females being 205 (68.79%). Mean score <3 indicates bad experience while >3 indicates good experience about PBL. Results showed that students of both institutes found several key benefits of PBL acquiring critical thinking, problem solving, communication skills and team work. PBL was perceived as better learning approach than lectures. Moreover students of Institute 1 mean score <3.0 showed dissatisfaction regarding tutor performance in PBL facilitation which was statistically significant (0.048). Conclusion: It is recommended that tutor and student training should be mandatory before introducing PBL. PBL session marks can be included in internal assessment. Only senior faculty and volunteering to facilitate should conduct PBL sessions.

Faculty Members versus Teaching Assistants as Problem-Based Learning (PBL) Facilitators: Medical Students’ Perception

Problem-Based Learning (PBL) is a student-centered pedagogy that depends on the principle of using real life problems as a trigger for the acquisition and integration of new knowledge through the problem-solving skills and experiences. The PBL allows medical students to develop important skills and attributes. Among the pillars of successful PBL implementation is the ‘class tutor’. The PBL tutor is known as the guide or mentor for the students. Tutors prompt students with metacognitive questions and provide direction without directly telling the student what to look for and where to go for information. The aim of the study was to compare the performance of faculty members and teaching assistants in facilitating PBL sessions from the students' points of view. A comparative, cross-sectional study was conducted on ISNC medical students who attended PBL sessions with both faculty members and teaching assistants in various integrated modules. A questionnaire designed by the researchers and transformed into an online survey (through Google Forms) has been used for data collection. The descriptive statistics have been used and a p-value < 0.05 was considered as statistically significant. A total of 348 medical students responded to the questionnaire. The data collection tool was based on a questionnaire that was analyzed for its validity and reliability and showed a high validity reflected by KMO and Barlett‘s test of Sphericity with a value of 0.908 (p < 0.000) and high reliability reflected by Cronbach‘s alpha with a value of 0.928. The study participants reported that 63.5% and 79.6% of faculty members and teaching assistants, respectively, had sufficient to high performance, while 36.5% and 20.4% of faculty members and teaching assistants, respectively, had a poor or insufficient performance. No association was found between students’ perception of the facilitation performance of faculty members &teaching assistants and their demographic data. The perception of the medical students of the PBL facilitation skills of teaching assistants was more positive than the skills of faculty members. Teaching assistants are suitable PBL facilitators probably because they have a better understanding of students’ needs than faculty members, being closer to them in age or their recent experience as undergraduate medical students.

The Benefits and Drawbacks of Problem-Based Learning: The View of Pre-Housemen and Clinical Year Students

Problem-based learning (PBL) extensively practiced learning approaches in medicine and various higher education settings. Success or failure of PBL depends on student's perception and attitude as well as the facilitators. Understanding student's perception and attitude toward PBL and also the facilitator would work as feedback to upgrade PBL. The purpose of this is study was to determine the students of clinical years and pre-houseman perceptions and attitudes towards the PBL and its facilitators. A questionnaire-based cross-sectional study conducted in a private institution in Malaysia; the questionnaire was prepared using Google docs and distributed to pre-housemen and clinical year students. The results showed 86.2% of participant's positive perception that voiced as the Problem Based Learning encourages them for learning cognitive and soft skills. More than half of the students have consented; that students with dominant leadership benefit more with PBL, and others remain disadvantages in PBL is one of the drawbacks. The majority of the students expressed a positive attitude towards the facilitators; that the guidance and encouragement extended during the PBL session. They also expressed their opinion that the facilitator should debrief at the end of the PBL session. The study concludes that PBL is an appropriate tool to nurture students and enrich them with their soft skills and making better use of cognitive ability. Furthermore, the study conceptualizes that besides some drawbacks in PBL facilitation, it is one of the best methods pave up to the achievements of university objectives. This study results would be beneficial in the facilitation of future PBL sessions not only in Lincoln University College but also in other global universities.

A Problem-Based Learning Session on Pregnancy Options, Counseling, and Abortion Care.

Before their clinical rotations, medical students have limited exposure to women's health issues, particularly abortion. We piloted a problem-based learning (PBL) module to introduce second-year medical students at the University of Louisville School of Medicine to counseling patients about pregnancy options. Students were divided into groups of 10 and met for two 2-hour sessions. In the first session, learners were presented with a case about a woman diagnosed with Zika virus who was considering pregnancy termination. Students discussed the case and developed learning objectives to research. One week later, students reconvened and shared what they had learned individually. Students were asked to complete pre- and post-PBL surveys. PBL facilitators also completed a survey evaluating the module. Fifty-eight percent of students felt informed or very informed about abortion after the PBL, compared to 30% before (p < .001). Students' mean quiz score increased from 29% on the pretest to 40% on the posttest (p < .001). Ninety-three percent of facilitators believed this PBL provided students with tools to better counsel about abortion, but only 56% of faculty felt adequately trained to facilitate this discussion. Students appreciated this PBL as an opportunity to discuss pregnancy options counseling and to clarify their own values surrounding abortion provision. Despite their positive response to the module, students identified barriers that would prevent them from implementing knowledge learned from this module in practice.

Enhancing Cognitive Engagement of Pre-clinical Undergraduate Medical Students via Video Cases and Interactive Quizzes in Problem-based Learning.

BackgroundProblem-based learning (PBL) is one of the main pedagogical approaches utilized in the undergraduate medical education (UGME) program at a private medical college in Karachi, Pakistan. Video-enhanced cases and formative assessments were introduced at the end of PBL sessions to evaluate their effectiveness in enhancing student engagement.MethodsA mixed methods study was conducted with Year 2 medical students (n=102; divided into 11 groups) and faculty (n=11) facilitating the PBL process. Of the 10 PBL cases, five were converted to video-enhanced cases and five were kept as paper-based, “traditional” cases. “Micro” videos were used to introduce clinical scenarios, augmented by a set of guided questions related to the scenario. In addition, a formative quiz was conducted to assess concepts at the end of video-enhanced PBL sessions. At the end of a module, students and facilitators completed an online survey regarding this modified learning experience, and this was followed by a focus group discussion with the PBL facilitators.ResultsMore than two-thirds (71%) of the students and all facilitators preferred video-enhanced over paper-based cases. Seventy-nine percent of the students agreed that this method increased peer-peer and peer-facilitator engagement, while 66% (n=68) of the students and 81% (n=9) of the faculty agreed that the end of PBL formative assessment activity would support the "Universal Design for Learning" framework.ConclusionVideo-enhanced PBL used during the introduction of the case and formative assessment activities at the end of the PBL sessions improved student engagement and contributed positively to the discussions and their understanding.

Conceptions on PBL Facilitator’s Role: A Perspective of Chinese Teacher

Teachers’ conceptions on their role produce significant influences upon their performance in the class and students’ learning outcome. This study aims to investigate Chinese teachers’ conceptions on their role as PBL (problem based learning) facilitators. A total of 32 semi-structured interviews are conducted, complementing by observations as cross-validating data source. Data analysis is carried out in a qualitative manner. The findings are: 1 The majority of the PBL teachers consider their role as either dominator or directors for students and tend to maintain strong dominance over students’ learning process, 2 a few teachers take an “outsider” view by granting student high autonomy and keeping a minimum interference with student’ learning process. The polarized conceptions on PBL teachers’ role can be accounted partly by Chinese particular educational tradition and a lack in the knowledge regarding PBL. Therefore, to facilitate PBL implementation in China, a conceptual change to Chinese teachers regarding learning and good teacher, and more institutional support equipping teachers with PBL related knowledge and facilitating skills are needed.

Do Problem-Based Learning approaches provide effective educational interventions for music therapy training courses? Experiences from an action research project at the University of South Wales

A Problem-Based Learning (PBL) approach was piloted across the Master’s in Music Therapy programme at the University of South Wales. The main aim of the project was to explore whether the development of music therapy students’ practical and clinical reasoning skills could be enhanced by using a PBL approach during training. Case scenarios integrating many aspects of required learning covering key curriculum areas were developed and used in PBL sessions with each year group. The sessions were facilitated by a trained PBL facilitator and observed by the course leader. Students completed a pre- and post-PBL survey, giving information about their confidence in several areas of clinical reasoning. Feedback was also gathered on their views on the PBL approach and effects on their learning experience. Results show that engaging with the PBL process had a positive effect on students’ clinical reasoning confidence, and that students valued the experience.

Innovative Design Ability Development of Postgraduates by PBL Pedagogy

Problem-based learning (PBL) pedagogy was implemented into the mechanical engineering postgraduate curriculum to train their self-directed learning and innovation designing ability. Then a new PBL pedagogy process was built up for mechanical engineering postgraduate that used in the School of Mechanical Science and Engineering, Northeast Petroleum University. The faculty and PBL teams cooperated with the oil company's engineers to resolve the problem low yield well for improving the pump efficiency and running time. At last, the oil company adopted one of the PBL teams' new small displacement reciprocating pump to use in the Daqing oil field and achieved a very well results. In the PBL pedagogy process, the faculty and facilitators resolved three contradictory questions that improves the PBL application area and builds up a set of teaching curriculum for postgraduate. Meanwhile, the mechanical engineering postgraduate students improved their self-directed learning ability, critical thinking ability, cooperative learning ability and innovation design ability.

Forming One’s Educator Identity: Exploring Experiences of Senior Medical Students Who Facilitate Problem-Based Learning Groups

Although the facilitation of problem-based learning by upper class medical students (also known as “near-peers”) is widely employed in medical schools, there is a paucity of research highlighting the experiences of these facilitators. We therefore conducted a study to explore the lived experiences of near-peer problem-based learning facilitators. Thirty reflective papers, written by near-peer facilitators who participated in an elective course, were analyzed by the four authors using a constant comparative method. While near-peers described themselves as “teachers,” they struggled with their role identity, acutely remembering their own student experiences. They felt challenged to know when to intervene and how to stay true to principles of constructivism, and felt rewarded by the opportunity to reflect on their own education and to see their own growth. This research highlights important steps in fostering students’ formation as educators: introduction of educational theory, opportunities for applying theory in practice, and opportunities to reflect on experiences. We suggest that these steps may provide a model for others who are implementing near-peer facilitator development.

Self-Observation and Peer Feedback as a Faculty Development Approach for Problem-Based Learning Tutors: A Program Evaluation

ABSTRACTProblem: Good teaching requires spontaneous, immediate, and appropriate action in response to various situations. It is even more crucial in problem-based learning (PBL) tutorials, as the tutors, while directing students toward the identification and attainment of learning objectives, must stimulate them to contribute to the process and provide them with constructive feedback. PBL tutors in medicine lack opportunities to receive feedback from their peers on their teaching strategies. Moreover, as tutorials provide little or no time to stop and think, more could be learned by reflecting on the experience than from the experience itself. We designed and evaluated a faculty development approach to developing PBL tutors that combined self-reflection and peer feedback processes, both powerful techniques for improving performance in education. Intervention: We developed an observation instrument for PBL facilitation to be used both by tutors to self-observe and reflect on own teaching strategies and by peers to observe and provide feedback to tutors. Twenty PBL sessions were video-recorded. Tutors completed the instrument immediately after their PBL session and again while watching their video-recorded session (self-observation). A group of three observers completed the instrument while watching each recorded session and provided feedback to each tutor (peer observation and feedback). We investigated tutors' perceptions of the feasibility and acceptability of the approach and gathered data on its effectiveness in enhancing tutors' facilitation skills. Context: The preclinical medical curriculum at the University of Geneva is essentially taught by PBL. A new program of faculty development based on self-observation and peer feedback was offered to voluntary tutors and evaluated. Outcome: Our results suggest that self-observation and peer feedback, supported by an instrument, can be effective in enhancing tutors' facilitation skills. Reflection on self-observation raised teachers' awareness of the effectiveness of the strategies they used to foster student learning. This motivated a need to change their teaching practice. However, for the changes to become operative, peer feedback was required, providing the cues and strategies needed to improve the facilitation skills. Lessons Learned: Peer coaching was considered feasible and useful to improve tutors' facilitation skills. Evaluating the program made it possible to assess tutors' needs and the reasons underlying their difficulties, and this in turn provided the basis for advanced workshops. Nonetheless, aspects related to logistics and the time constraints of such an individualized approach, as well as the cultural appropriation of peer coaching, might be obstacles that need to be addressed.

Design and Facilitation of Problem-Based Learning in Graduate Teacher Education: An MA TESOL Case

This exploratory, evaluative case study introduces a new context for problem-based learning (PBL) involving an iterative, modular approach to curriculum-wide delivery of PBL in an MA TESOL program. The introduction to the curriculum context provides an overview of the design and delivery features particular to the situation. The delivery approach has established multiple roles that contribute to the design and facilitation of the learning environment: lead instructors, collaborating instructors, and students as peer teachers. These roles also identify milestones on a collaborative instructional skills trajectory for professional development. In this mixed methods study, qualitative data were collected from collaborating instructors (the majority of whom were alumni) in order to illuminate the nature of successful PBL cycles and quality peer teaching, as experienced in the program. Their perspectives were also elicited on their position in the trajectory, highlighting current professional development benefits and future needs. Quantitative data on student demographics and mean GPA for coursework triangulate the qualitative results. Implications and recommendations for further research are explained.