Problem-based Learning Tutorial Groups Research Articles

Influence of tutor interventions and group process on medical students' engagement in problem-based learning.

Student engagement is influenced by several variables, among which are the teaching styles employed by faculty. In problem-based learning (PBL), the role of faculty is to facilitate the learning of the tutorial group as they work through clinical problems. However, the influence of tutor intervention styles and group process on engagement of students in PBL tutorials is unclear. The study was conducted with year 2 and 3 medical students (n= 176) in PBL tutorial groups at the end of an integrated PBL course. Students evaluated their behavioural, cognitive and emotional engagement in PBL tutorials using a pre-validated 11-item questionnaire. Students also filled in a modified version of a previously published tutor intervention profile (TIP) questionnaire. The modified TIP questionnaire represents three constructs (1) steering the learning process (6 items), (2) stimulating student autonomy (4 items) and (3) establishing relatedness with students (3 items). In addition, PBL group process was evaluated using a 5-item nominal scale: (1) tutorial atmosphere, (2) listening and information sharing, (3) group performance, (4) decision making and (5) reaction to leadership. Establishing sense of relatedness in the group by PBL tutors was the most important predictor of emotional engagement (F= 41.213, ΔR2=0.191, β=0.438, P= 0.000). On the other hand, steering the learning process was a significant predictor of behavioural engagement (F= 19.0, ΔR2=0.098, β=0.314, P= 0.000). However, stimulating student autonomy was not a significant predictor of student engagement in PBL tutorials. On the other hand, enhancing the group process in PBL tutorials significantly predicts student engagement with strong impact on emotional and cognitive engagement of students. Establishing the sense of relatedness in the group and steering the learning process by PBL tutors as well as improving PBL group process are significant predictors of student engagement in PBL tutorials with emotional and cognitive engagement being the most sensitive variables affected.

Integrated and Contextual Basic Science Instruction in Preclinical Education: Problem-Based Learning Experience Enriched With Brain/Mind Learning Principles

The revisiting of learning approaches and models developed on the basis of constructivist theories and the integration of these with the new evidence obtained from neuroscience studies provide a new interdisciplinary perspective and create an infrastructure for education. With the impact of the constructivist approach, learning characteristics and individual differences, real-life coherence, complexity, and contextuality/situativity with contextualized/situated cognition and learning have become more important. Consequently, the focus of learning activities has shifted to integrating related basic, clinical, and sociobehavioral knowledge and cognitive and metacognitive strategies with process-oriented learning and teaching; decision making/problem solving; reflective practice and thinking; and positive motivational, emotional, and sociocultural climate. All these support deeper knowledge and enrich learning experiences (Caine & Caine, 2010, p. 11-32; Caine, Caine, McClintic, & Klimek, 2005, p. 1-14; Durning & Artino, 2011; Fischer, 2009; Mennin, 2007, 2010; Wilkerson, Stevens, & Krasne, 2009; Vermunt & Verloop, 1999).During the last three decades, the major viewpoint in medical education was to bring clinical context to earlier years and increase the integration among the basic, clinical, and social sciences (Norman, 2009; Wilkerson et al., 2009). Accordingly, during the preclinical period, problem-based learning (PBL) and scenario-based learning are widely used, whereas during the clinical training period, task-based learning and work-based learning are preferred. Evaluations of PBL, in general, have provided evidence that this model is effective, but some common problems have also emerged during its application. For example, a meta-analysis conducted with 43 selected articles indicated that students in PBL conditions are better at both remembering the acquired knowledge and applying it (Dochy, Segers, Van den Bossche, & Gijbels, 2003). Nevertheless, research focusing on PBL-related learning processes such as deep and meaningful learning, student motivation and participation, and group dynamics has revealed some problems. The major problems experienced are as follows: converting the method into routine and mechanical steps, inadequate integration or deep processing of knowledge, insufficient individual preparation, and poor group dynamics with unsatisfactory student participation (Antepohl, Domeij, Forsberg, & Ludvigsson, 2003; de Grave, Dolmans, & van der Vleuten, 2001, 2002; Khoo, 2003; Moust, Roebertsen, Savelberg, & de Rijk, 2002). Regarding the PBL tutorial group learning process, one of these studies conducted with 200 first- to third-year medical students investigated students' perceptions of the occurrence of critical incidents and their inhibitory effects on group functioning (de Grave et al., 2002). Among six critical incidents (i.e., lack of elaboration, lack of interaction, unequal participation, lack of cohesion, difficult personalities, and lack of motivation), unequal participation, lack of interaction, and lack of elaboration were the most frequent success inhibitors. According to students' perception, lack of motivation and lack of elaboration were the two prominent inhibitors of learning in the tutorial groups, highlighting the strong impact of motivational influences on tutorial group functioning.The abovementioned problems that emerged during the PBL tutorial group emphasize that studies focusing more on learning process as a whole along with its different components should be conducted. According to complex theory and contextualized cognition and learning theory, a holistic approach is needed for small-group interactive learning processes such as PBL. Therefore, in such studies, not only cognitive and metacognitive but also motivational and sociocultural components should be considered. In this context, the evaluation of PBL learning should include both decision making/problem solving with cognitive and metacognitive components and the learning experience as a socialization process with affective, motivational, and sociocultural components (Ntyonga-Pono, 2006; Vermunt & Vermetten, 2004). …

Student peer assessment in evidence-based medicine (EBM) searching skills training: an experiment

Student peer assessment (SPA) has been used intermittently in medical education for more than four decades, particularly in connection with skills training. SPA generally has not been rigorously tested, so medical educators have limited evidence about SPA effectiveness. Seventy-one first-year medical students were stratified by previous test scores into problem-based learning tutorial groups, and then these assigned groups were randomized further into intervention and control groups. All students received evidence-based medicine (EBM) training. Only the intervention group members received SPA training, practice with assessment rubrics, and then application of anonymous SPA to assignments submitted by other members of the intervention group. Students in the intervention group had higher mean scores on the formative test with a potential maximum score of 49 points than did students in the control group, 45.7 and 43.5, respectively (P = 0.06). SPA training and the application of these skills by the intervention group resulted in higher scores on formative tests compared to those in the control group, a difference approaching statistical significance. The extra effort expended by librarians, other personnel, and medical students must be factored into the decision to use SPA in any specific educational context. SPA has not been rigorously tested, particularly in medical education. Future, similarly rigorous studies could further validate use of SPA so that librarians can optimally make use of limited contact time for information skills training in medical school curricula.

Learning in the tutorial group: A balance between individual freedom and institutional control

The study investigates factors in problem-based learning tutorial groups which promote or inhibit learning. The informants were tutors and students from speech–language pathology and physiotherapy programmes. Semi-structured focus-group interviews and individual interviews were used. Results revealed three themes: Responsibility. Time and Support. Under responsibility, the delicate balance between individual and institutional responsibility and control was shown. Time included short and long-term perspectives on learning. Under support, supporting documents, activities and personnel resources were mentioned. In summary, an increased control by the program and tutors decreases student’s motivation to assume responsibility for learning. Support in tutorial groups needs to adapt to student progression and to be well aligned to tutorial work to have the intended effect. A lifelong learning perspective may help students develop a meta-awareness regarding learning that could make tutorial work more meaningful.

Students’ approaches to learning in problem-based learning: Taking into account professional behavior in the tutorial groups, self-study time, and different assessment aspects

Problem-based learning (PBL) represents a major development in higher educational practice and is believed to promote deep learning in students. However, empirical findings on the promotion of deep learning in PBL remain unclear. The aim of the present study is to investigate the relationships between students’ approaches to learning (SAL) and academic achievement in a PBL environment, taking into account the role of self-study time and students’ professional behavior in the PBL tutorial groups. In addition, different knowledge categories that determine achievement (i.e., understanding of concepts, understanding of the principles that link concepts, and the linking of concepts and principles to conditions and procedures for application) were taken into account. A hypothesized structural equation model including these variables was tested. Results showed that the PBL students in this study reported more use of a surface compared to a deep approach to learning. The hypothesized model demonstrated an excellent fit of the model with the data. The relationship between SAL and academic achievement was mediated by self-study time and professional behavior. These findings imply that self-study time and professional behavior are crucial variables to take into account when studying SAL.

The relationship between students’ small group activities, time spent on self-study, and achievement

The purpose of this study was to investigate the relationship between the contributions students make to the problem-based tutorial group process as observed by their peers, self-study time and achievement. To that end, the Maastricht Peer Activity Rating Scale was administered to students participating in Problem-Based Learning tutorial groups. With this rating scale students had to rate the constructive, collaborative and motivational activities of their peers within the tutorial group. In addition, time spent on self-study was measured with a self-estimation method and achievement was measured with a unit test and a group assignment. A causal model of these variables was developed, in which the three types of activities were assumed to affect time spent on self-study, which would in turn affect unit test scores and group assignment scores. A structural equation modeling analysis indicated acceptable model fit. Especially apparent was the evidence for the causal relations between a student’s constructive activities and his/her unit test score and between a student’s collaborative activities and the group assignment score. On the other hand, time spent on self-study was not affected by the students’ contributions, nor did it have an effect on the unit test score. These results suggest that there are indeed causal relations between a student’s contributions to the tutorial group process and achievement.

Six Ways Problem-Based Learning Cases Can Sabotage Patient-Centered Medical Education

Problem-based learning (PBL) cases tell a story of a medical encounter; however, the version of the story is typically very biomedical in focus. The patient and her or his experience of the situation are rarely the focus of the case despite a prevalent discourse of patient-centeredness in contemporary medical education. This report describes a qualitative study that explored the question, "How does PBL teach medical students about what matters in medicine?" The qualitative study, culminating in 2008, involved three data collection strategies: (1) a discourse analysis of a set of PBL cases from 2005 to 2006, (2) observation of a PBL tutorial group, and (3) semistructured, in-depth, open-ended interviews with medical educators and medical students. In this report, using data gathered from 67 PBL cases, 26 hours of observation, and 14 interviews, the author describes six specific ways in which PBL cases-if not thoughtfully conceptualized and authored-can serve to overlook social considerations, thereby undermining a patient-centered approach. These comprise the detective case, the shape-shifting patient, the voiceless PBL person, the joke name, the disembodied PBL person, and the stereotypical PBL person. PBL cases constitute an important component of undergraduate medical education. Thoughtful authoring of PBL cases has the potential to reinforce, rather than undermine, principles of patient-centeredness.

The Correlation between the Dimention of Trust among the Member of the Group and the Effectiveness of PBL Tutorial Group

Background: The tutorial plays a central role in problem-based learning (PBL). The effective implementation of small group tutorials is one of the key contributors to the students success in examinations. This study aimed to identify factors perceived as the predictors for effectiveness of PBL group tutorial.Design and method: The subjects of the study were all of the students (year of 2008) of the Medical College of Sultan Agung Islamic University taking the Tropical Disease Module. The adapted version of the scales adopted in this study included the scale developed by Van den Bossche et al for assessing team (group) effectiveness, trust dimension and learning behavior, a scale developed by Dolmans & Ginns (2005) for assessing tutor’s performance, a 5 points likert scale was used to asses the student opinions. Quantitative approach with correlation and multiple regression analysis was applied.Result: Of 238 students included in the study 84 (37.3%) were male and 139 (62.3%) were female. There was a significantly positive correlation between the trust dimension related to the interpersonal relationship among the members of tutorial group with the effectiveness of tutorial group ( r = 0.631, p< 0.01). There was a medium correlation among cohesion, group potency and psychological (r= 0,700, p < 0.05 there was correlation among the variables of (r = 0,557, p < 0,001), group potency (r = 0,517, p < 0,001), and psychological assurance (r = 0,437, p < 0.001). These three variables contributed to the group effectiveness as much as 48.4% with a F value of 87.857. The component of independence was not found to be the predictive factors for group effectiveness. The correlations among the variables of cohesion, group potency and psychological assurance resulted in contingency coeficien of 0.700 with p<0.05.Conclusion: The higher trust related to the interpersonal relationship among the member of groups, the more effective the group will be. Cohesion, group potency and psychological assurance were found to be the predictive factors for group effectiveness (Sains Medika, 3(1):16-23).

The Correlation between the Dimention of Trust among the Member of the Group and the Effectiveness of PBL Tutorial Group

Background: The tutorial plays a central role in problem-based learning (PBL). The effective implementation of small group tutorials is one of the key contributors to the students success in examinations. This study aimed to identify factors perceived as the predictors for effectiveness of PBL group tutorial.Design and method: The subjects of the study were all of the students (year of 2008) of the Medical College of Sultan Agung Islamic University taking the Tropical Disease Module. The adapted version of the scales adopted in this study included the scale developed by Van den Bossche et al for assessing team (group) effectiveness, trust dimension and learning behavior, a scale developed by Dolmans & Ginns (2005) for assessing tutor’s performance, a 5 points likert scale was used to asses the student opinions. Quantitative approach with correlation and multiple regression analysis was applied.Result: Of 238 students included in the study 84 (37.3%) were male and 139 (62.3%) were female. There was a significantly positive correlation between the trust dimension related to the interpersonal relationship among the members of tutorial group with the effectiveness of tutorial group ( r = 0.631, p< 0.01). There was a medium correlation among cohesion, group potency and psychological (r= 0,700, p < 0.05 there was correlation among the variables of (r = 0,557, p < 0,001), group potency (r = 0,517, p < 0,001), and psychological assurance (r = 0,437, p < 0.001). These three variables contributed to the group effectiveness as much as 48.4% with a F value of 87.857. The component of independence was not found to be the predictive factors for group effectiveness. The correlations among the variables of cohesion, group potency and psychological assurance resulted in contingency coeficien of 0.700 with p<0.05.Conclusion: The higher trust related to the interpersonal relationship among the member of groups, the more effective the group will be. Cohesion, group potency and psychological assurance were found to be the predictive factors for group effectiveness (Sains Medika, 3(1):16-23).

Peer Assessment in Problem-Based Learning: A Qualitative Study

Peer assessment provides a powerful avenue for students to receive feedback on their learning. Although student perceptions of peer assessment have been studied extensively in higher education, little qualitative research has been undertaken with medical students in problem-based learning (PBL) curricula. A qualitative study of students' attitudes to, and perceptions of, peer assessment was undertaken within the framework of a larger study of metacognition with first-year medical students at the University of Queensland. A highly structured format for provision of feedback was utilised in the study design. Many recommendations from the higher education literature on optimal implementation of peer-assessment procedures were put into practice. Results indicated the existence of six main themes: (1) increased responsibility for others, (2) improved learning, (3) lack of relevancy, (4) challenges, (5) discomfort, and (6) effects on the PBL process. Five of these themes have previously been described in the literature. However, the final theme represents a unique, although not unexpected, finding. Students expressed serious concerns about the negative impact of peer assessment on the cooperative, non-judgmental atmosphere of PBL tutorial groups. The practical implications of these findings are considered.

Analysis of verbal interactions in tutorial groups: a process study

Collaborative learning, including problem-based learning (PBL), is a powerful learning method. Group interaction plays a crucial role in stimulating student learning. However, few studies on learning processes in medical education have examined group interactions. Most studies on collaboration within PBL used self-reported data rather than observational data. We investigated the following types of interactions in PBL tutorial groups: learning-oriented interactions (exploratory questioning, cumulative reasoning and handling conflicts about knowledge); procedural interactions, and irrelevant/off-task interactions. The central question concerned how much time is spent on the different types of interaction during group sessions and how the types of interaction are distributed over the meeting. Four tutorial group sessions in Year 2 of the PBL undergraduate curriculum of Maastricht Medical School were videotaped and analysed. The sessions concerned the reporting phase of the PBL process. We analysed the interactions using a coding scheme distinguishing several verbal interaction types, such as questions, arguments and evaluations. Learning-orientated interactions accounted for 80% of the interactions, with cumulative reasoning, exploratory questioning and handling conflicts about knowledge accounting for about 63%, 10% and 7% of the interactions, respectively. Exploratory questioning often preceded cumulative reasoning. Both types occurred throughout the meeting. Handling conflicts mainly occurred after the first 20 minutes. Task involvement in the tutorial groups was high. All types of learning-orientated interactions were observed. Relatively little time was spent on exploratory questions and handling conflicts about knowledge. Problem-based learning training should pay special attention to stimulating discussion about contradictory information.

PERSPECTIVES: Exploratory Thoughts Concerning Educational ReformWith Problem-Based Learning In China

The author, a novice problem-based learning (PBL) advocate in China and a young faculty member of the School of Stomatology at Wuhan University, joined a PBL tutorial group as an observer during his two-month visit at McMaster University. He describes his observations and thoughts as they relate to the current reform of health sciences education in China.

Medical Student Perceptions of Factors Affecting Productivity of Problem-Based Learning Tutorial Groups: Does Culture Influence the Outcome?

Background: The popularization of problem-based learning (PBL) has drawn attention to the motivational and cognitive skills necessary for medical students in group learning. This study identifies the effect of motivational and cognitive factors on group productivity of PBL tutorial groups. Description: A self-administered questionnaire was completed by 115 students at the end of PBL tutorials for 4 themes. The questionnaire explored student perceptions about effect of motivation, cohesion, sponging, withdrawal, interaction, and elaboration on group productivity. We further analyzed (a) differences in perceptions between male and female students, (b) effect of "problems," and (c) effect of student progress over time on group productivity. Evaluation: There were linear relations between a tutorial group's success and the factors studied. Significant differences were noted between male and female student groups. Conclusions: Students and tutors need to recognize symptoms of ineffective PBL groups. Our study emphasizes the need to take into account cultural issues in setting ground rules for PBL tutorials.

Solving problems with group work in problem-based learning: hold on to the philosophy.

Problem-based learning (PBL) has gained a foothold within many schools in higher education as a response to the problems faced within traditional education. Working with PBL tutorial groups is assumed to have positive effects on student learning. Several studies provide empirical evidence that PBL stimulates cognitive effects and leads to restructuring of knowledge and enhanced intrinsic interest in the subject matter. However, staff members do not always experience the positive effects of group work which they had hoped for. When confronted with problems in group work, such as students who only maintain an appearance of being actively involved and students who let others do the work, teachers all too often implement solutions which can be characterized as teacher- directed rather than student-directed. Teachers tend to choose solutions which are familiar from their own experience during professional training, i.e. using the teacher-directed model. These solutions are not effective in improving group work and the negative experiences persist. It is argued that teachers should hold on to the underlying educational philosophy when solving problems arising from group work in PBL, by choosing actions which are consistent with the student-directed view of education in PBL.

The problem-based learning tutor: Teacher? Facilitator? Evaluator?

Despite the structural heterogeneity of problem-based learning (PBL) curricula, most PBL schools have embraced self-directed learning, emphasizing the use of small-group discussion and integration of the basic medical sciences with clinical problems. Self-directed learning is but one of the many terms such as discovery method or study-centred education adopted by authors since Dewey to describe an educational approach that places the learner in control of his or her learning (Knowles, 1975). The putative bene® ts of self-directed learning include enhanced opportunities to elaborate one’s knowledge through active involvement and verbalization, enhanced motivation through an increase in relevance and personal control, and the practice of skills needed in lifelong learning (Schmidt, 1983). In this educational milieu, the role of the `teacher’ requires revision; new skills are required of the teaching faculty so that they are willing and competent to allow students to take an active role in guiding their own learning and in teaching one another (Barrows & Tamblyn, 1980). This review explores the literature that has developed around the de® nition of the teacher or tutor role in `facilitating’ the learning of students in a PBL setting. Several controversies have arisen over the optimal role of the faculty person in facilitating a PBL tutorial group, including level of participation, content knowledge and involvement in student evaluation. While it appears that there is probably no completely satisfactory resolution of these controversies, from a review of the frequently con icting pieces of evidence, an attempt will be made to synthesize from the literature a coherent picture of an effective tutor in the PBL setting.