FACILITATION SKILLS IN PROBLEM-BASED LEARNING
Kay Wilkie, PBL Co-ordinator
School of Nursing and Midwifery
University of Dundee
Paper presented at the Qualitative Evidence-based Practice Conference, Coventry University, May 15-17 2000
The paper presents the findings from the first cycle of an qualitative, evaluative study into the relationship between skills used by facilitators of problem-based learning in a pre-registration nursing diploma programme and the success (or otherwise) of the problem-based sessions.
Background
Problem-based learning (PBL) has been viewed as an appropriate learning / teaching strategy for professional education since its inception at McMaster University in the early 1960s. PBL differs from other forms of small group work in that students are presented with a issue about which they have identify their own learning needs, rather than having the learning predetermined for them. Although PBL is used in a wide range of courses including engineering, architecture and law, the majority of existing problem-based courses prepare health care professionals.
The School of Nursing and Midwifery at the University of Dundee implemented problem-based learning as the main learning / teaching strategy for its pre-registration nursing and midwifery programmes in 1997. PBL was seen as an appropriate strategy for nurse education because of its potential for theory to be learned in a context in which it would be used in practice; its ability to integrate content from supporting subjects such as life and social sciences with nursing; the opportunities it offered to develop critical thinking in students and its student-centred approach. The ‘value added’ elements of PBL such as team working skills, communication skills and negotiating abilities were attractive to educators accused of failing to produce the ‘knowledgeable doers’ demanded from the nursing diploma programmes introduced in 1992 (Runciman et al 1998, May et al 1997). This confidence in PBL was reflected three years later in “ Fitness for Practice” the UKCC’s report on nursing preparation which advocated PBL as a method of integrating nursing theory with practice . (UKCC 1999).
The approach to PBL adopted by the School of Nursing and Midwifery could be classed as mixed or ‘hybrid’ as other teaching / learning strategies such as lecture, workbooks and laboratory sessions were used in addition to PBL. None of the School’s teaching staff was familiar with PBL so an external consultant was contracted to provide 3 days facilitator training for each member of teaching staff who had expressed an interest in PBL - around 60% of the School staff undertook the training programme, although not all of those trained subsequently elected to facilitate PBL teams.
Not all of the teaching staff were convinced that PBL was, in fact, a suitable strategy, claiming that it made heavy demands on teaching time and learning resources which could be better utilised by other strategies. These attitudes and unfamiliarity with the strategy created a need for research to be undertaken into the functioning of PBL. Evaluation of the strategy was undertaken through the School’s formal modular evaluation programme which provided quantitative data on 6 aspects of PBL. PBL was rated highly by students in these evaluations. Norris (1990) points out that when a session has gone especially well, rather than feeling smug, professional growth makes it imperative to extract the features which made it so successful. Felletti (1997) agrees, stating that “what works and what doesn’t” in PBL needs to be clearly determined. A research project was set up to examine “What’s going on in the lived curriculum of PBL ?”
Research Design
The literature revealed a lack of closely observed studies into the conduct of PBL sessions. Little had been added to the material on facilitating groups since the work of Heron in 1989. While existing material presented an idealisation of the PBL tutorial process (Barrows & Tamblyn 1980 Barrows 1988), there was little which offered ‘reality as it is, not as it ought to be’ (Byron, Don Juan). In order to get as close as possible to the reality of PBL, a qualitative research design, Situational Responsiveness (Patton 1990), was chosen. The ‘responsiveness’ element of the design allowed the researcher to use whatever research method was appropriate to study situations as they arose, rather than being constrained by predetermined methodologies. Patton claims that too much research is based on habit rather than on situational responsiveness and attention to methodological appropriateness and that this can lead to bias and a tendency to pre-meditated decisions. Situational responsiveness acknowledges that as the situation being observed is not in the control of the researcher, it is incumbent on the researcher to be meticulous and accurate in the collection and recording of data by whatever method. With situational responsiveness there is no constraint on the research setting and no constraints on outcomes. Situational responsiveness uses the researcher as the instrument of the research. Patton claims that, provided the views of the researcher are clearly identified as such, any loss in rigour is offset by the flexibility, insight and tacit knowledge brought to the situation. He points out that distance from the situation is no guarantee of objectivity.
The research design permitted triangulation of both method and data sources improving the credibility of the data (Denzin 1989) and allowing progressive build up of a variety of perspectives, including in this case, quantitative data obtained from the formal School evaluations. The design also permitted collaborative working with the feeding back of results to the facilitators involved in the project. This was an important feature as the strategy was new to everyone involved. Changes to PBL could be implemented quickly rather than waiting for the full project report - again responding to the situation. The study aimed to understand or at least document day-to-day reality, including differences in individual experiences and to capture and monitor unforeseen consequences as well as anticipated outcomes.
The research was designed in three cycles:-
First Cycle - a study of four facilitators and their PBL teams undertaken during the second term of the three year nursing diploma programme. The facilitators were selected from the second cohort of teachers to undertake PBL preparation. Students were in the second intake of the problem-based programme. .
Second Cycle - the research subjects to be studied were selected from the first cohort of teachers to be prepared for PBL. The students were in the Branch (second 18 months) of the pre-registration programme - the data collection for this cycle is now almost complete and analysis is in progress.
Third Cycle - 8 facilitators from the Second Cycle plus three teachers with particularly distinctive styles identified in the First Cycle were selected for study. The data collection for this cycle is currently in progress.
The findings from the first cycle are presented below.
Research Methods
Information was collected by a variety of methods: audio-taping of PBL sessions, diaries kept by facilitators, open interviews with individual facilitators and groups of students, field notes kept by the researcher and the results from School evaluations.
The primary data source was the transcripts of taped PBL sessions. Each ‘PBL’ consisted of three sessions each lasting from 1 - 3 hours. In the introductory session students were presented with the PBL trigger, existing knowledge was reviewed and new learning needs identified. The new learning required allocated by the student team. The second session reviewed progress made and offered an opportunity for students to clarify their learning needs, exchange material such as journal articles and identify any problems with accessing material. In the feedback session students presented and integrated their new learning to create at least one possible way of dealing with the situation presented in the original trigger. There were three sets of three PBL in the term being studied. Each of the nine sessions was taped and the tapes transcribed by the researcher. Open interviews with each of the facilitators and a group interview with the students took place after the completion of the audio-taping.
The purpose of the research and its collaborative nature was raised with facilitators at a facilitator development day. Information about the research design was circulated and comments sought. All facilitators agreed in principal to be involved. Selection of participants for the research was purposive as the researcher wanted to select subjects who were typical facilitators and, in the context of the situation, ‘expert’, as far as any of the School staff could be classed as PBL experts. Purposive sampling selection is held to be one of the weaker methods of selection (Parahoo 1997, Polit & Hunglar 1995) however, it was integral to the research design as it permitted key people who emerged as the situation developed to be included in the study. When permission was obtained from facilitators, their PBL student teams were approached. The teams had had one term of PBL prior to the start of the study so had had some opportunity to form relationships within the team.
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For the first cycle, four facilitators were selected from a population of 14 who would be involved with the student intake. Two facilitators were chosen from each of the School of Nursing and Midwifery’s campuses. Facilitators came from a range of professional backgrounds representing three of the 4 branches of nursing and having either hospital and community nursing backgrounds. The two main methods of nurse teacher preparation in Scotland (full-time certificate and part-time diploma) were also represented. Two facilitators were male and two female. The facilitators selected were given more detailed information about the study. Written consent was obtained. All students in the cohort were given information about the project by the PBL co-ordinator (the researcher). Students in the teams of the four selected facilitators were given more detailed information about the study and asked to participate. All four teams agreed and individual written consents were obtained.
Concerns have been raised about the accuracy of information obtained by audio-tape. (Polit and Hunglar 1995) People may feel inhibited by the recording or there may be a form of Hawthorne effect which causes atypical behaviours. Students were offered the chance to take control of the tape recording - an option selected by two teams. The facilitators indicated that they felt inhibited by the tape at the start of each session but most felt that the feeling wore off as the session progressed. Students generally felt the same way.
“As long as I don’t have to listen to myself on the tape afterwards its OK” - Gina
“We don’t really know you, so it didn’t matter. I wouldn’t have liked it if it had been James (their facilitator) that was listening to it” Joanne
“I’ve been asked to do much worse things since I started the course !” Craig
One facilitator (Gordon) indicated that he felt that the team had been inhibited by the presence of the tape recorder. At a later interview he withdrew the statement saying the team seemed just as inhibited in the next term when they were not being taped. Some of the language used on the tapes and the ideas expressed seem to indicate that after the first few minutes of the session, most students forgot about the recording.
Interviews with facilitators and students were held in the term following the taped sessions. Facilitators were interviewed individually and invited to comment on the running of the PBL session, their role as facilitator and, from a facilitator’s point of view, what constituted a successful PBL session.
Students were invited to attend a group interview, 50% accepted. This also followed an open structure, with the students being invited to comment on their perception of the PBL sessions, how successful they were and, from a students’ point of view, what constituted success.
Analysis
It had been intended to use a thematic approach to the analysis of the transcribed tapes. It quickly became apparent that this approach did not yield the required information as the themes which emerged reflected the content and outcomes of the PBL sessions. Although this information did not add to the knowledge of facilitation skills, it provided valuable confirmation that the PBL triggers were stimulating the intended learning and that the programme outcomes were being met.
The transcripts were reviewed to identify skills which facilitators used during the sessions. A template of a successful PBL session was devised from students comments and facilitators’ diaries and comments. The template was assessed for validity by facilitators within the School and by colleagues from other institutions who were also involved in developing PBL. The transcripts of each session were then mapped using the template to identify when particular techniques were used and the effect of the technique on the progress of the PBL session. Interview transcripts and diary comments were used to inform the analysis. Results were presented for discussion and validation at facilitators’ meetings.
Findings
The Pattern of PBL
Introductory PBL Sessions
The introductory sessions of each PBL scenario appeared to develop in a dialogic pattern analogous to a orchestra tuning up and then playing a concerto. The various movements or sections lasted for varying lengths of time and were influenced by the action of the facilitator (the conductor).
Template for a Successful Introductory Session
Tuning Up
This phase followed the issuing of the trigger. In this phase students began to develop a common understanding of the trigger / situation (the score), check meanings (pitch) and to relate the scenario to prior knowledge . Students talked to each other, usually in twos or threes, often at first in subdued voices, often several at one time, becoming louder as confidence grew.
Prelude
The discussion spread to the wider team and fragments of issues which would be developed later were voiced. Most students contributed at this point. The development of shared understanding continued and opportunities for individual team members to pick up themes were created. This appears to match with the work of Shotter (1993) and Niemi and Kemmis (1999) who talk about the need for ‘communicative spaces’ to be opened up in order for the group to reach a shared understanding. This phase appeared vital to the success of the session. If a consensus was not reached by the PBL team for whatever reason, the discussion did not progress and, in the worst cases, dialogue ceased.
Main
Individual issues were clarified and more in-depth discussion took place Movements around each one. At this point the themes or issues were often put forward first by one student with others then joining in support.
Finale
The issues were summarised and the associated work allocated.
Review Session
The pattern of the review sessions was much less clear cut. The process sometimes was a re-run of the introductory session, especially if the original session had not been particularly successful, or a rehearsal for the feedback session. One facilitator suggested that a successful review session lasted only a few minutes because everyone knew what they were doing and had found sufficient resources to do it. Several students echoed this sentiment saying that a successful review session was one which was cancelled.
Template for a Successful Review Session
Checking
Students verified with each other that they were studying the agreed topic and that Clarificationthere was no overlap. Issues were redefined if there was confusion.
Resourcing
Useful resources were shared. Facilitators often asked for help e.g. resources, data base terms, approachable experts
Rehearsing
Mock presentation e.g. checking clarity of audio-visual material or role play.
Unlike the introductory session where one phase flowed into the next, the review sessions tended to be more disjointed with movement back and forth across the three phases.
Feedback Session
The feedback session was the most straightforward of the sessions. On listening to the tape these sessions resemble more established methods of teaching, being a cross between seminar and group presentation.
The dialogic pattern in the feedback sessions resembled a series of solos / duets rather than an orchestra. When asked at interview what constituted a successful PBL feedback session all facilitators emphasised the product or outcomes.
“ When they [the students] have all done some work and have all got something to feedback”
(Angela)
“ It’s good when they have nicely prepared materials like overheads and posters and not just wee bits of paper” (Jean)
“ I like it when they do something different - like role play” (Gordon)
Students, on the other hand, were less certain.
“I don’t like the feedback as much as the introductory sessions” (Lesley)