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Research ArticleObservational Application Comparing
Problem-BasedLearning with the Conventional Teaching Method for
ClinicalAcupuncture Education
Yun Jin Kim
School of Traditional Chinese Medicine, Xiamen University
Malaysia, Jalan Sunsuria, Bandar Sunsuria, Sepang,Selangor 43900,
Malaysia
Correspondence should be addressed to Yun Jin Kim;
[email protected]
Received 12 December 2018; Revised 12 February 2019; Accepted 11
March 2019; Published 18 March 2019
Academic Editor: Jenny M. Wilkinson
Copyright © 2019 Yun Jin Kim.This is an open access article
distributed under the Creative Commons Attribution License,
whichpermits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Aim. Although the problem-based learning (PBL) teaching method
was introduced in 1969, its rapid and widespread applicationin
Malaysia started in 1979. This study aimed to evaluate satisfaction
with PBL compared to that of conventional learning,
usingsatisfaction surveys and the Rosenberg Self-Esteem scores, of
students learning clinical acupuncture at the School of
TraditionalChinese Medicine (TCM), Xiamen University Malaysia.
Method. The participants of this study (N=36) were registered for
abachelor’s degree program in TCM in 2016 and enrolled in the
Science of Acupuncture and Moxibustion course beginning inSeptember
2018. The students were randomly allocated into two groups: PBL
group and conventional group. A self-administeredlearning
satisfaction survey and the Rosenberg Self-Esteem scores were used
for data collection. An independent sample t-test wasused to
compare the results between the two groups. A p-value
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2 Evidence-Based Complementary and Alternative Medicine
Another field of medicine that has adopted PBL is
clinicalacupuncture education. Acupuncture is a simple and
effectiveprocedure, used worldwide, that has less adverse effects
thanother forms of treatment, such as herbal medicine [6]. PBLis an
appropriate tool for teaching the subspecializations ofclinical
acupuncture, since most of the PBL scenarios arebased on the
systematic teaching method. Also, in contrastto conventional
clinical acupuncture education and clinicalskills training methods,
PBL is a student-centred teach-ing approach, in which students
develop clinical reasoningskills, identify their learning needs in
an interactive groupdiscussion, apply newly gained knowledge to
problems,and summarize what they learn with the group. There
aremany advantages to the integration of PBL using clinicalcase
scenarios in acupuncture education and clinical skillstraining. In
this way, students learn the topic by experiencinga clinical case
and discussing it in a tutor-guided smallgroup. This method also
helps students with the use of self-evaluations. Additionally, PBL
allows students to acquirebasic knowledge of acupuncture and the
Meridian Theoryand to learn clinical skills. PBL is helpful for
cultivatingclinical thinking skills and enhancing continued
medicalprofessional learning programmes.
Therefore, the aim of this study was to evaluate learn-ing
satisfaction from the students’ points of view, using asatisfaction
survey and the Rosenberg Self-Esteem Score, ofPBL compared with
that of conventional learning for clinicalacupuncture.
2. Materials and Methods
2.1. Study Design. The participants of this study (N=36)
wereenrolled in a bachelor’s degree program in Traditional Chi-nese
Medicine (TCM) in 2016, and the study was conductedin the Science
of Acupuncture and Moxibustion course(Course Code: TCM303)
beginning in September 2018 at theSchool of TCM, Xiamen University
Malaysia.
According to the local and national ethical instructionsfor
research (National Committee for Clinical
Research:http://www.nccr.gov.my/index.cfm) guidelines, this
studydid not require ethical approval. The human biologicaltissues,
good clinical practice (GCP), and clinical trialresearch subjects
were respected. All students were ade-quately informed about the
purpose and granted anonymityand confidentiality regarding their
data. We obtained writteninformed consent from all students prior
to study participa-tion.
We randomly allocated the participants into two groups,the PBL
group and the conventional group, each containing18 students. The
PBL group was further subdivided intothree groups, with six
students in each group. The PBLcourse included Phase A modules that
were designed tomeasure the student’s clinical knowledge of
acupuncturetreatment strategies, using case reports, and Phase
Bmodulesthat were designed to discuss decision-making
regardingmedical ethics and cultural dimensions of traditional
andcomplementary medical care in Malaysia, China, and
othercountries. Both phases aimed to teach students the ability
to
integrate their knowledge of acupuncture in learning
clinicalpractice skills and discussing medical ethics. Each group
ofsix students worked together to collect information,
discusspossible mechanisms and causes, develop hypotheses
andstrategies to test the hypotheses, andprepare for
presentationsand discussions in class.
The conventional group was taught with teacher-centredlearning,
involving lecturers and short discussions.While theproblem-solving
element was presented by and/or discussedwith the lecturer in
class, the teaching plan and materialswere determined by the
lecturer and conveyed to the studentsduring lecture.
2.2. Study Procedure. The PBL and conventional teachingplans
were created by the School of TCM, Xiamen UniversityMalaysia’s
expert panel, consisting of an external examinerand an industrial
advisor. Each teaching plan included learn-ing outcomes, clinical
case reports exhibiting medical ethicaldilemmas, and guidelines for
lecturers, and expert externalpanels. The assessments used by both
groups consisted ofthe following: (a) the learning satisfaction
survey and (b)the Rosenberg Self-Esteem Scale. At the end of six
sessions,the lecturer was instructed to leave the lecture hall,
andall students completed the learning satisfaction survey
andRosenberg Self-Esteem Scale. The forms were then collectedin a
ballot box.
The research process consisted of three steps as follows:
Step 1(1) Setting up the curriculum for peer lecturers for
the PBL and conventional teaching methods. Theteaching
components of the curriculum includedacupuncture basic theories and
clinical case studies,the acupuncturist-patient relationship, and
rights andresponsibilities of patients and acupuncturists.
Eachteaching plan was designed with learning objectives,learning
outcomes, clinical case studies, and courseguidelines for the
lecturer. For the PBL method, thecourse guidelines included details
of the PBL stepsand potential ethical problems for the clinical
casestudies.
(2) Setting up the learning satisfaction questions. Exter-nal
panels for content validity provided 10 questions,which were
measured on a 5-point scale. Learningsatisfaction was measured by
the students’ subjectivefeelings. Students’ satisfaction/feelings
were coded ona 4-point scale, ranging from 1 (strongly disagree)
to4 (strongly agree).
(3) Adopting the Rosenberg Self-Esteem Scale. TheRosenberg
Self-Esteem Scale assesses a student’s over-all evaluation of
personal worthiness as a humanbeing.The scale consisted of 10
Likert-type scale itemsdesigned to assess positive and negative
evaluationsof self. Students’ responses were coded on a
4-pointscale, ranging from 1 (strongly disagree) to 4
(stronglyagree). Thus, a possible total score ranged from 10to 40,
with higher scores reflecting more positiveevaluations of
self-esteem [7].
http://www.nccr.gov.my/index.cfm
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Evidence-Based Complementary and Alternative Medicine 3
Assessed for eligibility (N=36)
Excluded (N=0)
Completed the study (N=18)Lost to follow-up (N=0)
Allocated to PBL (N=18) Allocated to Conventional (N=18)
Randomized (N=36)
Data analysed (N=18)Exclusion analysis (N=0)
Completed the study (N=18)Lost to follow-up (N=0)
Data analysed (N=18)Exclusion analysis (N=0)
Figure 1: The flow of the research design.
Step 2(1) Pretest using the Rosenberg Self-Esteem Scale. All
students were tested and scored on this scale beforeclasses
began.
(2) Conducting the education. Each group was assigneda separate
classroom. The courses were taught orsupervised by the same
lecturer for six sessions.The teaching in the conventional group
was teacher-centred, although there was some discussion after
thelecture. Both groups received an introduction to thecourse in
the first session.
Step 3(1) Posttest using the Rosenberg Self-Esteem Scale.
All
students were tested and scored on this scale after thecourse
ended.
(2) Learning satisfaction survey. All students answeredthe
learning satisfaction questions after the courseended, and the
answers were scored.
2.3. Statistical Analysis. Data collection and statistical
analy-sis were performed using SPSS software (version 16.0;
IBM,USA) for data analysis. All data are shown as mean ±standard
deviation (SD). An independent sample t-test wasused to compare
results between the PBL and the conven-tional groups. A p-value
of
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4 Evidence-Based Complementary and Alternative Medicine
Table 1: Sociodemographic comparison between participants in
thePBL and conventional groups.
Index PBL Conventional p-valueGendern (%)
Male 10 (55.5%) 9 (50%) 0.328Female 8 (44.5%) 9 (50%)
Nationalityn (%)
Malaysia 12 (66.7%) 13 (72.2%)0.167China 6 (33.3%) 5 (27.8%)
Others 0 (0%) 0 (0%)
Previous degreen (%)
STPM 6 (33.3%) 9 (50%)
0.381UEC 9 (50%) 7 (39%)A Level 1 (5.7%) 0 (0%)
Foundation 2 (11%) 2 (11%)Scholarshipn (%)
Y 6 (33.3%) 7 (39%) 0.513N 12 (66.7%) 11 (61%)
Financial stressn (%)
Y 2 (11%) 1 (5.7%) 0.512N 16 (89%) 17 (94.3%)
Physical problemn (%)
Y 2 (11%) 1 (5.7%) 0.316N 16 (89%) 17 (94.3%)
Mental healthn (%)
Y 0 (0%) 0 (0%) 0.258N 18 (100%) 18 (100%)
First languagen (%)
Chinese 17 (94.3%) 16 (89%)0.552English 1 (5.7%) 2 (11%)
Bahasa Malay 0 (0%) 0 (0%)
on item 1 (p=0.025), item 3 (p=0.017), and item 7 (p=0.023),as
shown in Table 3.
4. Discussion
Currently, the implementation of PBL in Malaysian medicalschools
has been extensive. The major objectives of PBLevaluated in this
study were the acquisition of relevant med-ical knowledge, clinical
skills, medical interviewing skills,and medical ethics in a
clinical acupuncture context, whichallows students to obtain
information from a wide range ofviewpoints [8]. PBLmotivates
students to think critically andgenerate ideas and to acquire the
basic medical and clinicalknowledge, clinical skills, and behaviour
required to becomecompetent clinical physicians [9]. Another study
showed thatfor the PBL sessions were observed regarding the
availabilityof enough learning resource [10].
PBL uses a “focus on the problem” approach.The startingpoint is
realistic and helps students learn to contextualizeproblems within
a scenario. PBL is a student-centred, smallgroup-based, learning
approach and presents challengingproblems based upon realistic
situations. Based on con-structivist epistemology, PBL begins with
an unstructuredproblem that hasmultiple possible solutions [11].The
studentsparticipate in self-directed learning and apply their
newknowledge to the problem.They then reflect on their learningand
the effectiveness of their chosen solution. PBL is a
usefuleducational methodology for TCM students in that studentsare
expected to understand basic medical concepts in the
Table 2: Results from the learning satisfaction surveys of
studentsin the PBL and conventional groups.
Questions PBL Conventional p-value(1) Satisfaction of
basicacupuncture knowledge 3.44±0.83 3.38±0.13 0.216
(2) Satisfaction of clinicalacupuncture knowledge 3.23±0.57
∗ 2.13±0.08 0.021
(3) Satisfaction ofpre-clinical to clinicalknowledge
3.89±0.35 3.78±0.12 0.191
(4) Satisfaction ofimprovement of hands-onskills
3.57±0.34 3.14±0.32 0.258
(5) Satisfaction ofimprovement of medicalinterviewing skills
3.98±0.13∗ 1.76±0.11 0.035
(6) Satisfaction of interestin the topic and enjoymentof
learning
3.46±0.59∗ 1.03±0.45 0.017
(7) Satisfaction ofself-directed learning of thesubject
matter
3.22±0.75∗ 1.32±0.50 0.019
(8) Satisfaction ofcollaboration in smallgroups
3.48±0.27∗ 1.64±0.36 0.015
(9) Satisfaction of learningoutcome 3.92±0.15
∗ 2.78±0.59 0.018
(10) Satisfaction ofunderstanding of patientevaluation
andmanagement
3.23±0.21∗ 1.89±0.64 0.039
Values represent mean ± SD.A higher score indicates a better
outcome.∗Indicates a statistical difference from the conventional
group (p
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Evidence-Based Complementary and Alternative Medicine 5
Table 3: Results of the pre- and posteducation Rosenberg
Self-Esteem Scale in the PBL and conventional groups.
Items PBL ConventionalPre- Post- p- value Pre- Post- p-
value
(1) On the whole, I amsatisfied with myself 1.12±0.12
2.97±0.13
∗† 0.021 1.13±0.11 2.02±0.13† 0.025
(2) At times, I think I amno good at all 3.54±0.23 2.78±0.17
0.066 2.87±0.15 2.77±0.17 0.083
(3) I feel that I have anumber of good qualities 1.31±0.33
2.78±0.18
∗† 0.012 1.34±0.09 1.88±0.32† 0.017
(4) I am able to do things aswell as most other people 1.43±0.22
2.68±0.14
∗† 0.038 1.38±0.11 1.78±0.22 0.071
(5) I feel I do not havemuch to be proud of 2.57±0.37
1.67±0.15
∗† 0.036 2.52±0.12 2.43±0.13 0.088
(6) I certainly feel useless attimes 2.45±0.18 1.91±0.23 0.071
2.43±0.14 2.28±0.17 0.055
(7) I feel that I’m a personof worth, at least on anequal plane
with others
1.54±0.05 3.01±0.18∗† 0.024 1.53±0.10 2.11±0.07† 0.023
(8) I wish I could havemore respect for myself 2.41±0.21
1.56±0.11
∗† 0.015 2.39±0.13 2.17±0.03 0.096
(9) All in all, I am inclinedto feel that I am a failure
2.73±0.20 1.31±0.12
∗† 0.025 2.70±0.12 2.48±0.04 0.082
(10) I take a positiveattitude toward myself 1.87±0.22
3.02±0.15
∗† 0.019 1.83±0.11 2.09±0.11 0.091
Values represent mean ± SD.Items 1, 3, 4, 7, and 10: A higher
score indicates a better outcome; items 2, 5, 6, 8, and 9: A lower
score indicates a better outcome.∗Indicates a significant
difference from the conventional group (p
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6 Evidence-Based Complementary and Alternative Medicine
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