RESNA 28th Annual Conference - Atlanta, Georgia
Aimee J. Luebben, EdD, OTR, FAOTA
Educators providing assistive technology (AT) instruction use a variety of methods, one of which is problem-based learning (PBL). To analyze and interpret student-perceived effects of PBL, this paper presents a two-part descriptive qualitative evaluation study investigating student feedback following the internship experiences. The study determined that student-perceived effects of PBL following the first clinical internship were positive about this pedagogical approach as evidenced by 95% of the respondents providing examples of improved clinical reasoning, self-directed/continued learning, and professional behaviors.
KEYWORDS: problem-based learning, assistive technology, education
Although most professional education is designed around a traditional instructor-centered approach (lectures with a focus on content), graduates sometimes have difficulty generalizing knowledge to real world contexts. Some professional programs have adopted PBL, an educational strategy that places emphasis on the learner, to develop entry-level practitioners with strong abilities in the areas of critical thinking, problem-solving, communication, teamwork, self-direction, and lifelong learning. In PBL the problem (which comes first) serves as the foundation for student construction of knowledge. While content is important, PBL also emphasizes the process: seeking information through researching a topic, applying information to a particular problem, and generalizing content and the process to similar situations and people.
Harden and Davis (1) proposed a learning continuum, beginning with traditional information-based, teacher-centered learning (no PBL) and progressing toward increasingly more student-centered, PBL tied to real situations. This continuum includes 11 learning approaches (examples are listed in parentheses): (a) theoretical (traditional lecture, textbook), (b) problem-oriented (lecture with protocols or guidelines), (c) problem-assisted (lecture followed by practical experience), (d) problem-solving (case discussions), (e) problem-focused (lecture with study guides), (f) problem-based: mixed (student opts either for information-based or PBL), (g) problem-initiated (problems used to interest students in a topic), (h) problem-centered (text provides series of problems followed with information to solve problems), (i) problem-centered discovery (principles derived by students from their work), (j) problem-based (information from one problem generalized to another), and (k) task-based (problems solved in real time in the clinical setting). Educators use a variety of methods for AT instruction, ranging from one end of the learning continuum to the other. Previous studies investigating modification of content once delivered in traditional ways indicate that AT instruction redesigned with PBL strategies moved 7-8 rankings toward PBL end of the learning continuum, but was unable to reach the eleventh and final step because the task-based learning approach involves solving problems in the clinical setting in real time (2, 3). Scaffa and Wooster (4), studying the effects on clinical reasoning, showed that a PBL course significantly facilitates student critical thinking skills. Stern (5), who investigated student perceptions of PBL, reported the following student improvements: clinical reasoning skills, professional behaviors, pursuit of self-directed and continued learning, self-confidence, and preparation for clinical internships. Clinical internships are times in which students in professional programs encounter task-based problems, the eleventh learning approach on the learning continuum, and are expected to solve problems at the level of beginning practitioners.
The purpose of this study was to determine student-perceived effects of PBL following the first clinical internship, considered a task-based learning approach, which is the eleventh and final step of the learning continuum.
A two-part descriptive qualitative evaluation approach was used to analyze and interpret student-perceived effects of PBL following the first clinical internship. After a summer completing 12-week (480 clock hours) internship experiences, students returned to a Midwestern university for a 16 credit hour semester in which one course featured Journal Club (JC). Once a traditional classroom discussion, the assignment converted to e-Journal Club (e-JC) in 2001 when the program started using Blackboard®, a virtual classroom application that includes electronic discussion capabilities, electronic testing, and storage for course materials. For e-JC, students are assigned to analyze a minimum of 20 (of 25 offered) research papers, interpret studies related to the profession, and apply research results to the clinical process. Students, for part of the assignment, respond to a discussion board forum prompt related to a particular paper. For an article investigating the effects of a PBL course on students’ clinical reasoning skills (4), the e-JC discussion board prompt was: “From your experience with PBL . . ., discuss how this pedagogical method was different from traditional teaching. As an example, explain how PBL either produced a change in your skills from beginning to end or prepared you for your clinical experience.”
The discussion board prompt was offered to a 28-student cohort (26 females and 2 males: a typical program and profession gender ratio) with an average age of 24.13 years (SD = 2.85 years). Student responses to the discussion board prompt were collected and stripped of student identifiers before analysis and interpretation. To analyze and interpret the discussion board responses, one part of the descriptive qualitative evaluation approach involved assigning to discussion board responses one of five criteria developed to grade reflective journals (6): a reflection level Likert scale that ranged from 1 (describes learning) to 5 (indicates future behavior). The second part of the analysis involved qualitative classification of student responses, using as a priori categories Stern’s (5) student improvement findings: clinical reasoning skills, professional behaviors, pursuit of self-directed and continued learning, self-confidence, and preparation for clinical internships.
Of the 28 students, 20 (71% response rate) chose to respond to the Blackboard discussion board forum on PBL. The respondents included 18 females and 2 males with an average age of 24.68 years (SD = 3.48 years). Because there were no significant differences in age [t(46)= -.476, p > .05, n. s.] and the composition was similar (90% female composition compared with 93% in the original student cohort), respondents were considered a representative sample of the student cohort.
Table 1 provides a stem and leaf display (by gender), showing number and percentage of students achieving each reflection level. Students achieved reflection levels ranging from 2 (analyzes learning) to 5 (indicates future behavior) with an interpolated median level of 4.13 ( gains a new understanding).
| Level of Reflection | Gender (F = female; M = male) | Number | % |
|---|---|---|---|
| 1. Describes learning | F F F F F F F F F F F F M F F F F F M F |
20 |
100 |
| 2. Analyzes learning | F F F F F F F F F F F F M F F F F F M F |
20 |
100 |
| 3. Verifies learning | F F F F F F F F F F F F M F F F F F M |
19 |
95 |
| 4. Gains a new understanding | F F F F F F F F F F F F M |
13 |
65 |
| 5. Indicates future behavior | F F F F F |
5 |
25 |
Table 2 shows the number and percentage of student responses corresponding with Stern’s (5) findings of student improvements in the areas of clinical reasoning (applying new information/generalizing to new situations), self-directed/continued learning, professional behaviors, preparation for clinical internships, and self-confidence.
| Stern’s Findings of Student Improvements | Number | % |
|---|---|---|
| Clinical reasoning (applying new information/generalizing to new situations) | 17 | 95 |
| Self-directed/continued learning | 17 | 95 |
| Professional behaviors | 17 | 95 |
| Preparation for clinical internships | 12 | 60 |
| Self-confidence | 3 | 15 |
In this study, the finding of a relatively high median response reflection level (gains a new understanding) was not surprising because students have had many opportunities to practice reflective writing through journaling or discussion board assignments. The finding that 60% of respondents discussed PBL in relationship to their internship experiences may have resulted from the either/or aspect of the discussion board prompt in which students selected the “how PBL produced a change in your skills from beginning to end” option rather than the “how PBL prepared you for your clinical experience” alternative. That few students reported improved self-confidence is not surprising because at the time of the study students were halfway through the professional program.
Previous studies (2, 3) demonstrated that AT instruction redesigned with PBL strategies moved 7-8 rankings toward the real world end of the learning continuum, but was unable to reach the task-based learning approach because the final step involved solving problems in the clinical setting in real time. After experiencing the task-based learning approach on their clinical internships, student feedback indicated that the PBL learning process resulted in enhanced clinical reasoning, self-directed/continued learning, and professional behaviors in all but 5% of respondents.
Aimee J. Luebben, EdD, OTR/L, FAOTA
Professor and Director
Occupational Therapy Program
University of Southern Indiana
8600 University Blvd.
Evansville, IN 47712-3534
812-465-1179
aluebben@usi.edu.