Dr. Robert M.K.W. Lee,
Department of Anaesthesia,
McMaster University,
Hamilton, Ontario,
  The Use of Problem-based Learning (PBL) in Nursing Education
1. History of McMaster Medical School
(1) Planning started in 1966, first class of 30 students enrolled in 1969
(2) 3-year program, inter-disciplinary without discipline-oriented subjects, emphasis on problem-solving, integrated approach to human biology
(3) Major revision in 1983, 2000.
(4) Current class = 138, more female than male students
2. Why use PBL?
(1) This is how we as adults learn
(2) It is the most practical and efficient way of learning
(3) We do this in our daily professional and personal lives
(4) Learning is not static, but a dynamic process
(5) Develop a life-long learning attitude
(6) Develop group and interpersonal skills
3. Advantages of PBL
(1) Motivation to learn is self-imposed
(2) Building of new knowledge on existing one (depth)
(3) Integration and application of knowledge(problem-solving)
(4) Wider coverage of the topic (big picture)
(5) Development of other skills (e.g. inquiry, critical appraisal, communication, group)
(6) Life-long learner
4. Disadvantages of PBL
(1) Lack of traditional structure and progression
(2) Perceived lack of depth in the knowledge acquired
(3) Too much time is spent in a tutorial “talking”
(4) It is hard to fail a student
(5) You need more teachers
Monitoring the Outcome of Problem-Based Learning in Medical Education
1. History of PBL in Nursing
(1) First introduced at the McMaster University School of Nursing in 1976 using a hybrid model, offering several PBL courses along with other courses in more traditional way
(2) Currently, 3 types of courses: Nursing courses (60%) using PBL, Health Sciences courses which are lecture based, and elective courses.
(3) This model is now used by several nursing schools in Australia and UK, and in some selected Nursing courses in South Africa, China, Japan and Thailand.
2. Why PBL in Nursing?
Changing health care delivery process, with emphasis on:
(1) Ensuring client access, providing quality care, and reducing costs
(2) Demand for evidence-based practice
(3) Data-driven outcome
(American Association of Colleges of Nursing 1999 Position Statement on nursing education)
3. PBL in other schools and disciplines
(1) Health Sciences: Dentistry, occupational therapy, pharmacy, physical therapy, public health, and veterinary medicine.
(2) Architecture, business, education engineering, forestry, police science, and social work
4. Expectations of Nursing Graduates
(1) Autonomous
(2) Independent decision-making
(3) Self-directed professional
(4) Ability to:
Explore options
Ask questions and provide explanations
Develop appropriate nursing care plan
Life-long learner
5. Common theme on nurses in the 21st century
Ability to adjust to changes in
(1) Knowledge
(2) Technology
(3) Health care approach and delivery
(4) Expectations from the patients
Information relevant to nursing profession doubles every five years!
6. How PBL can help to achieve these goals?
(1) Fostering of clinical reasoning skills
(2) Learn to work in an interdisciplinary professional practice
(3) Learn to work in a managed-care environment
(4) Develop information search and management strategies
7. Outcome study on PBL in Nursing
(1) Most are case studies except some recent ones
(2) “Transforming Nursing Education Through Problem-Based Learning”,
Editor: Elizabeth Rideout, 2001, Jones and Barlett Publishers, Inc. Mississauga, Canada; London, UK
8. Outcome study on PBL in Nursing (Lewis & Tamblyn, 1987, Nursing Papers 19: 17-26)
(1) Compared PBL graduates with graduates from traditional school, testing knowledge using MCQ and problem-solving by observers while on clinical placements.
(2) Traditional group performed better than PBL group in all areas except teaching skills
(Based on one course, details on how PBL was done, and whether the test method was appropriate, are questions to be raised)
9. Outcome study on PBL in Nursing (Ryan & Hodson, 1992, J.Nurs.Edu. 31: 198-202)
(1) Surveyed employers of BScN 5 years after their graduation
(2) Employers reported graduates functioning above expected levels in leadership skills, nursing skills, communication skills and professionalism
(3) Graduates reported they were
  well-equipped to cope with change
  comfortable with taking responsibility for learning
  Sought additional knowledge daily
  Showed initiative and used self-directed, PBL approach
10. Outcome study on PBL in Nursing (Andrews & Jones, 1996, J.Adv.Nurs. 23: 357-365)
(1) Observed 11 4th year students in a 6 3-hour PBL sessions, focusing on problem-solving process in their analysis
(2) Students missed some key references and not knowing the depth of knowledge they need to achieve
11. Outcome study on PBL in Nursing (Biley and Smith, 1998, J.Adv.Nurs. 27:1021-1029)
Interviewed 12/45 nurses from a PBL program in UK
(1) Experienced same transition trauma from a student to a nurse as traditional group
(2) More open-minded, research aware and innovative than traditional group
(3) High autonomy; reflexive and independent professionals
(4) Better sense of responsibility to do self-directed learning, and serve as a catalyst for change
12. Outcome study on PBL in Nursing (Amos & White, 1998, Nurse Educator 23:11-14)
  Pilot study with 24 RN students returning for BScN, using PBL for 2 semesters, 9 students in each group with a facilitator
(1) Positives are: critical thinking, learn how to learn, creativity in learning, ability to link to the community, team work, research skills, personal growth
(2) Concerns by students: variation and quality of work presented by students; a lot of work but learned a lot; enjoyed PBL experience; difficulty in confronting peers (e.g. detrimental behaviour).
13. Outcome study on PBL in Nursing (Happell, 1998, Nurse Educ. Today 18: 362-367)
  A survey of students in a psychiatry nursing course using PBL in a 3-year program where 1st year was traditional teaching, and the rest PBL
(1) Foster the interest of students in the skills and knowledge of psychiatric nursing
(2) Stimulated a strong interest in pursuing this as a career in the students
14. Outcome study on PBL in Nursing (Rideout, 2001 in Transforming Nursing Educ…..)
  Used the Course Experience Questionnaire to survey McMaster BScN students
(1) High levels of satisfaction in independence, tutors, expectations, asessment, workload, and outcomes
(2) Overall satisfaction with the program
15. Outcome study on PBL in Nursing (Rideout et al. 2002, Adv.Health Sci.Edu. 7:3-17)
  Compared graduating BScN students in a PBL curriculum (McMaster) with those in a traditional nursing program (Ottawa) in relation to their perceived preparation in:
(1) Clinical practice
(2) Clinical functioning
(3) Knowledge
(4) Satisfaction with their education
(1) Cross-sectional survey
(2) Self-report questionnaires
(3) 45 minutes to complete
(4) April, 1999 graduates
(5) 2 weeks before program completion
17. Outcome study on PBL in Nursing (Rideout et al. 2002, Adv.Health Sci.Edu. 7:3-17)
  Clinical practice
(1) No difference in their perceived ability to make
  Clinical Decision
  Collaborative relationships
(2) PBL better than Conventional in
  Self-directed learning
18. Outcome study on PBL in Nursing (Rideout et al. 2002, Adv.Health Sci.Edu. 7:3-17)
  No Perceived Difference in Preparation for Clinical Practice in :
(1) Adult Medicine
(2) Adult Surgery
(3) Pediatrics
(4) Geriatrics
(5) Mental Health
(6) Community Health
(7) Maternal Child
19. Outcome study on PBL in Nursing (Rideout et al. 2002, Adv.Health Sci.Edu. 7:3-17)
(1) PBL scored higher than Conventional in
  Nursing knowledge
  Health care system
  No difference in the theoretical and professional knowledge
Satisfaction with their education
(2) PBL scored higher than conventional in
  Role of tutors
  Outcome of program
  Student assessment
  Level of independence
  Overall satisfaction
  No difference in their perception on the clarity of expectation and workload in program
20. Future Study
(1) critical thinking in practice
(2) longitudinal study of clinical functioning and practice
(3) long term effects on career patterns
21. Conclusions
  PBL has been shown to be an effective method in the training nursing professionals, which promotes their life-long learning attitude
  For a successful implementation of PBL
  Having experienced tutors is essential
  Clear course content and learning process need to be clearly defined
  It is more effective to provide PBL course in a PBL curriculum
  If a PBL course is offered within a traditional curriculum, two semesters for a course will allow sufficient time for the students to learn to adjust.
  (Edwards et al., 1998, J. Nursing Edu. 37:139-141)