The co-construction of Problem Based Learning: using video data to explore the facilitation process.

Jackie Goode, Institute for Research into Learning and Teaching in Higher Education (IRLTHE), University of Nottingham.

Paper presented at the British Educational Research Association Annual Conference, University of Warwick, 6-9 September 2006

Abstract

This paper reports on research into a new Graduate Entry Medicine (GEM) course which uses Problem-based learning (PBL) as a central element of the curriculum for the first eighteen months of the programme. Although PBL is increasingly used in a range of disciplines, such as medicine, law, engineering, social work etc., it is characterised by flexibility and diversity, in that it can be implemented in a variety of ways in and across different subjects and disciplines in diverse contexts. It can therefore look very different to different people at different times depending on the staff and students involved in the programmes utilizing it. Whilst there are those who rush to conclusions about whether PBL ‘works’ or not, or is better or worse than ‘traditional’ curricula, the fact that PBL has attracted little in the way of observational research means that we don’t have a very clear idea of what constitutes PBL in different contexts. Our research is a contribution to rectifying this.

We used a variety of qualitative methods, including in-depth interviews with staff and students; non-participant observation of staff training sessions, staff briefing meetings, and PBL groups; and video recording of PBL groups in action. Research shows that people are often unable to describe in detail many of the practices they use and rely upon in accomplishing both individualistic and collaborative tasks. In normal circumstances, these practices are tacit, taken-for-granted, seen-but-unnoticed, and are rarely discussed or, in some cases, even thought about. Despite the fact that the GEM staff and students are encouraged to be highly reflective about their own learning, therefore, we were keen to supplement the more usual qualitative interviewing with observation, but more especially with video-recording. We see video as an ideal way of collecting interactional data on people’s real practices. This paper focuses on the process of PBL group facilitating.

Using video in research

Slide 1: Title page

A new four-volume set of books on visual research methods came out this year(‘Visual Research Methods’ (Ed) Peter Hamilton. The Open University, Sage Benchmarks in Social Research Methods). The publishers observe that the use of visual evidence in social and cultural research is an exciting and stimulating area of growing interest, bridging the social sciences and humanities. At the same time, they suggest, these visual technologies themselves raise all sorts of methodological questions. We certainly found some of the stimulation, and raised some of the questions, in our research into the use of Problem-based learning on a new graduate entry medicine course, and I’d like to touch on both here by showing some visual data.

Slide 2: Introduction

  • Training Tomorrow’s Doctors
  • Researching GEM
  • PBL structure and organisation

To begin with, I need to tell you, very briefly, something about the rationale for adopting PBL in the training of doctors; something about the research project we undertook; and something about the structure and organization of the PBL component of the course we studied, before sharing a video extract with you.

Recent reforms in Medical Education have been driven by a GMC document ‘Tomorrow’s Doctors’ which outlines the new kinds of knowledge and skills needed by doctors to practice effectively in the modern health service. High on the list is the fact that medicine is multi-disciplinary and practised in teams, requiring good communication and team-working skills; and also the notion that since medical knowledge is constantly changing, doctors, like other professionals, need to become life-long learners. They will need to be learning from – and teaching – others, throughout their careers. Problem-based Learning is seen to be a good vehicle for all of these requirements.

The ‘problems’ in question are cases or patient scenarios which unfold across a series of PBL meetings. The situated learning, based around the case, models the way the students will engage in things like history-taking, clinical reasoning, and diagnosis, in their professional practice when qualified. Learning in small groups, usually of around 6 to 8, recognizes the knowledge and expertise contained within the group as the jumping off point for further research and learning; the communication and team-building skills are developed asgroup members’ joint resources are brought to bear, and students are expected to learn from, and teach each other. Within this first cohort of graduate students, the science/non-science ratiowas 48:41, 9 students had PhDs, and the vast majority had worked before coming in the course, with most being in their 30s, so there is a fair bit of expertise of all sorts within the groups. Of course, learning in this way involves a different model of teaching by course staff than traditional didactic models – and this is something I’ll come on to shortly.

There is an ongoing debate about PBL - whether it ‘works’ as well as traditional pedagogic methods, what the cost implication are of the kinds of resources it relies upon, what ‘value added’ it brings- and what constitutes evidence of these things. What characterizes the literature, however, is a series of claims and counter-claims about a huge variety of practices going under the name of PBL – leading to a plea for a whole collection of studies examining what constitutes different PBL programmes –our research is a contribution to answering that plea. And the project aims and objectives were:

Slide 3: Research Aims and Objectives

And we used a variety of qualitative methods, including in-depth interviews, observation, and videoing:

Slide 4: Methods

Other information you need to make sense of the video we’ll see is the ‘shape’ of the PBL component of the course

Slide 5: PBL Structure and Organisation

One of the themes that emerged early on, not surprisingly, was facilitation – perceptions of what it involved, the kinds of practices used, and the ways it was experienced by both staff and students. And that’s what I’m focusing on in this paper. And to do that, you need to know who the facilitators were.

Slide 6: Facilitators

As might be imagined, it was possible, in terms of their prior experience and natural inclination, to position staff – and they positioned themselves – at different points on a spectrumof orientations to learning and teaching, with ‘didactic methods’ at one end, and facilitative approaches at the other. Facilitator training heavily promoted the line that facilitators were not there to teach. The trainer modeled turning back questions onto the students, if students asked them direct questions as ‘the expert’. Students were allowed to access staff expertise formally in lectures, and informally outside of PBL sessions, but adopting an active teaching role in PBL was seen to subvert the process of enquiry-based learning the students were engaged in.

Nevertheless, a discourse quickly grew up amongst staff and students on the course around how ‘directive’ or ‘non-directive’ different facilitators were. And this discourse played itself out on an occasion when we showed video extracts of their PBL group to some of its student members. I want to show you a short section of what we showed them, and then share some of their observations on it, before finishing with some observations of my own about the use of video data in research.

Slide 7: Video extract

  • Week 7, Block 2, Musculo-skeletal: ‘An embarrassing fall’
  • Session 2 of 3: the giving of ‘patient information’ (test results etc)
  • First 20 minutes: team building/bonding

The students in the extract are in week 7 of the course, in the second ‘block’, which is Musculo-skeletal, dealing with a case entitled ‘An Embarrassing Fall’, featuring an elderly Asian woman who has presented with injuries sustained in a fall. In this extract, the group has had its first PBL session of the case. The business of this meeting is to review some of the issues they identified and the questions they generated at that first meeting – which they wrote up on a white board that appears in the right of the picture – and to deal with some new patient information or data which the facilitator has for them – and generate more learning points and questions from this, which get written up on a white board on the left of the picture. The first 20 minutes of the one and half hour session has been taken up with going round the group sharing what’s been happening to each of them since they met last time – an informal ‘team-building’ activity. After this time, the facilitator is seen to pick up his papers and begin to order and examine them in a way which signals that he at least is ready to get down to business, and as soon as the last student has ‘reported’, the group turns to the patient information.

This giving of patient information is a discrete and regular element of each PBL case, and there are different ways of ‘doing’ it. Some facilitators may simply hand over the written information to the group, for example, whilst some groups like to use role play, with the facilitator taking the patient role and them questioning him or her as the doctor. It is an interesting feature to use to look at issues of directiveness or otherwise, because the facilitator is clearly being asked questions, and giving answers in response – but what it is ‘legitimate’ to give out is the information he holds about the patient, as opposed to anything else.

You won’t be able to make out exactly what the students are saying, but this is less important for current purposes than attending to the direction of the interactions.

The information-giving interaction started off as a role play, but by this point, it seems to morph from time to time into traditional ‘teaching’ of the science involved. In the group is a very knowledgeable ‘expert’ student, and at one point it seems that she and the facilitator are competing with each other.

The extract begins with the facilitator saying “She has marked thorasic hyphosia…” The expert student then begins to explain what this means…immediately, as has beencharacteristicof this group, where there is plenty of student-student interaction, the students begin to discuss this between themselves. The expert then gets up to the board to explain further…initially they all look and listen to her, but as she pauses, and a question is asked, the facilitator answers authoritatively with ‘It’s always a curve…’ – and this is where the 2 begin to compete a bit – with the student to her left continuing to interact with her, whilst the student to her right – in the centre back of the picture, starting to address his questions to the facilitator…she reclaims the floor briefly, but soon sits back down, and the facilitator initiates the giving of more patient information, which the woman on the left writes up, checking at one point that she has heard correctly something he said…

..Alex DOES continue to focus his attention AWAY from the facilitator, posing his question ‘What’s a murmur?’ to his fellow students….and for a while student-student interaction is restored…..but only until the facilitator intervenes again to answer Alex’s question with ‘It’s just a noisy function of the valve’. This has the effect that the next two questions, from the student on his left, and from the student centre back, are clearly directed at him. By the end of the extract, all the attention is focused on the facilitator, as his talk and his hand gestures put him securely in ‘teaching’ as opposed to ‘facilitating’ mode.

When we showed this extract to members of the group, comments included: ‘This facilitatorreleases information in a controlling way – he decides what information to give out and in what order’. There was also an assertion that ‘most of the interactions flow through him’and an observation thatthis facilitator seemed to ‘enjoy teaching and explaining medical knowledge to us’. The view was expressed that there is ‘a fine line to be drawn between launching into teaching when the group does not want it and standing back and letting the students work things out for themselves’. So this facilitator was being positioned towards the more ‘didactic’ end of the spectrum, and the one extract we saw might seem to support that. However, even within that extract, which I purposely ended at a point when the group had fallen silent and the direction of the students’ gaze was uniformly towards him, there were examples to show that some students responded to the facilitators’ uninvited interventions by directing further questions to him. A more extended viewing of the tape reveals that he certainly does have difficulty from time to time resisting ‘joining in’ the students’ discussions between themselves, for example, to ‘tell’ someone that what they’ve just said is right and then to go on to elaborate upon it for them – but it also shows that he is also asked questions from time to time as the expert.

Being either a directive or a non-directive facilitator is shown to be too simplistic a conceptualization of the process. It is much more accurate to conceptualise the version of PBL revealed by our video data as a ‘co-construction’ between facilitator and students.

What is the value of using video in this research?

Slide 8: Value

  • Empirical evidence on PBL
  • Reinforces a conceptualization of knowledge/learning as socially constructed
  • Offers opportunities for participant validation of data analysis
  • Provides stimulus material to support reflective practice (staff and students)

Finally, I’d like to conclude with some caveats:

Slide 9: Caveats

  • Issues of informed consent
  • Time and technical constraints (who produces the data? Time implications for its analysis, technical issues around usable formats, storage, retrieval etc)
  • Importance of contextualizing extracts