Problem–based learning in midwifery Cathy Rowan, Senior Lecturer & Dr. Chris McCourt, Head of Graduate School Sarah Beake, Research Midwife Centre for.

Problem–based learning in midwifery

Cathy Rowan, Senior Lecturer& Dr. Chris McCourt, Head of Graduate SchoolSarah Beake, Research MidwifeCentre for Research in Midwifery & Childbirth Thames Valley University

Aim of study

To investigate the key questions raised in the existing work on problem based learning

To explore the teachers’ perspective

The current students’ perspective The perspective of graduates in

practice

Design and methods

Implementation study 1998-2000 Quasi experimental (pre and post-pbl cohorts) Mentor rating survey, grades, academic staff

interviews and focus groups with graduates Follow up study 2004-6

Grounded theory, perceptions of PBL Interviews with staff, focus group of students in

1st & final semester, survey after graduation Long-term follow-up interviews with graduates

from original study

Literature: students’ views

4 reviews in medical education and more limited research in other professions

Students generally evaluate PBL positively Learn independent learning, problem solving,

using and conveying information & may increase motivation

Concerns include reliance on others in the group, initial anxiety and uncertainty particularly relating to lack of structure (Moore et al 1994 Das 200 Sadlo 1997)

No clear evidence that PBL was superior but comparisons in different contexts are difficult to make

Literature: teachers’ views

McCourt and Thomas (2001) explored students, mentors and teachers perceptions

Initial difficulty in letting go of module/lecture approach and feeling ‘unable to teach’’

Challenges for teachers of balancing student driven approaches with requirements of professional practice

Managing group dynamicsAlso idenfied by Haith Cooper 2003, Savin Baden 2003

Literature: outcomes

Some reviews in medical education suggest that students achieve slightly lower scores in factual & higher in clinical assessments, overall little difference in formal outcomes

There may be longer term benefits, but no convincing evidence that PBL is superior to traditional methods,

Difficulties in comparing contexts

Students’ & staff perceptions

Students: key categoriesAnxieties about

learning Concepts of learningThe process Group issues Perceptions of the

teachers’ role Relationship to

practice

Teachers:Getting the balance -

process /contentAdapting to facilitative

styleManaging group

dynamicsEncouraging

participation and discussion

Interface with practice

Anxieties about learning

Anxiety and uncertainty re level of knowledge, obtaining information, gaps, ‘basic facts’, A&P

List of what should be covered, quizzes and consolidation by the teacher were valued

Wanted more guidance about requirements & more feedback especially re assessment

I’m not convinced I’m getting the information I should be getting

You don’t know how much you are meant to bring in in terms of information or the depth..

Concepts of learning

Many students held didactic concepts & saw it as ‘teach yourself’ or teaching each other midwifery

But some found it a good way to learn Students tended to interpret PBL as about

finding out how to get information Tended to focus on their topic &

presentations -others contributions were not always valued

Understood value of discussion but found this difficult - felt lacked knowledge to do so

The process Time constraints - a common issue but

particular challenge with trigger process & some felt it was a waste of time

Assessment driven. Students could not always relate this to trigger work

Anxieties re learning (content and process) led to demands for more structure & input

Perceived as tedious or dull if focused on individual presentations which limited discussion

Felt discussion would be better if everyone knew about the topic

Focus on presentation

Its really nerve racking talking in front of your peers now we are getting a bit more confident but it’s still quite scary, you are concentrating so much on getting your information out that whatever has gone before you in a blur…

this presentation thing doesn’t work

Challenge of discussion

When we question we are questioning someone who doesn’t know

How can you question something when you have never experienced it?

you don’t get anything from it no-one else is supporting you and you are left feeling am I too hard on my colleagues so that at the end of the day you just think ‘oh well let it go’

teachers

Teachers attempted to discourage presentations as performance

Promoting discussion was difficult Felt the students needed greater

preparation Some teachers felt a combined

approach might work better They varied in approach to the

sessions

Group issues

The group is a stimulus to learning The size of the group made a difference,

ideally about 8-12 Resentments of poor contributions among

students Importance of group dynamics and

participation-Students were reluctant to give honest feedback, challenge or question each other

Diversity - difficulties for quieter students and those where English was not first language

Perceptions of the teachers’ role

She makes a lot of difference Steering, guiding, sometimes identifying

questions, resource, keeping on track, helping students clarify, fill in the gaps/ensure understanding

Aiding reflection, helping the group make operational decisions

“Big brother” Some lack of clarity of role & variation in style and

approach Valued qualities: enthusiasm, encouragement,

knowledge, being in touch with practice, summarising content and teasing knowledge out

The teachers’ perspective

The role changed - letting go Importance of group and facilitation skill Group dynamics are key The difficulty of knowing when to input

and when to stand back Challenge of modelling and drawing out

good discussion and meaning of ‘critique’ The difficulties of facilitating a mixed

ability group

Relationship to practice

The skills learnt through PBL related to practice e.g. communication, questioning, finding info

Theory and practice related well (year one)

Though some felt poorly prepared for practice, lack of mentor support (resistance to questions)

Students at the end of 18 months wanted more practical sessions in the programme (but all do)

Relationship to practice

We came back and it just felt that every thing we had done had all come together for us then when you put it with the practical side … it all comes together

we’re going to the second module and we are expected to function when you get into these placement areas and you still haven't grasped the theory in practice

Teachers’ perspective

They are studying very hard in relation to the issues that we present them yet the transference from that to other aspects doesn’t seem to be taking place.. It may be that they don’t have time to apply the skills

Suggestions from students

An introductory session by the teacher Given the topic area before the trigger It can work better if all the group

resource the topic it would work better if everyone knew

about the subject and it’s a discussion not you presenting standing there and everyone expected to learn from it

Overall views

Promotes good learning, understanding & memory

Information retrieval/ critiquing research Working with others some not convinced they were learning

much/ concerned about gaps in knowledge Would be more able to question with a good

knowledge base It’s good in moderation Some differences between shortened and

three year. 3 year generally more positive

Themes from 1st-final semester

Repeated themes: did not feel able to

challenge each other

teaching yourself/ one another

time constraints Anxieties re

learning

New themes: Valued

consolidation by the teacher

it is better if you all have some knowledge

teacher variation too much emphasis

on research

Long term views

Long-term views highly consistent with initial ones & were very mixed

Anxiety about learning (content) endured but seemed confident about learning process

They highlight the importance of early stages - guidance, direction, feedback

Recommend more initial preparation & input

Group issues central (value & challenge)

Longer-term views contd.

Student motivation and practice experience crucial

Less concerned about theory/practice gap than pre-pbl students

Value tended to emerge during later study - study & enquiry skills, link to practice seeing the whole person knowing how to think your way around a problem

I think I knew more that I thought I knew I think I’m a good midwife