Creativity or Conformity?Building Cultures of Creativity in Higher Education
A conference organised by the University of Wales Institute, Cardiff in collaboration with the HigherEducationAcademy
CardiffJanuary 8-10 2007
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PBL: creative learning for imaginative care
Maria Kavanagh and Jane Nicol
University of Worcester
Institute of Health, Social Care and Psychology
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Abstract
This paper aims to demonstrate how the reality of practice has to be incorporated within education in order to promote the integration of theory and practice.
In order to address this, and the increasingly dynamic nature of both healthcare provision and professional education, Problem-Based Learning (PBL) has been introduced across two modules relating to ‘palliative care’ and ‘nursing in primary care and long term conditions’. PBL has been chosen, as a teaching and learning methodology, for its ability to empower students to take responsibility for their learning providing the opportunity for creativity. The use of PBL allows the student to explore a topic and go beyond the barriers that have traditionally existed within practice and education fostering heutagogy.
A‘hybrid’ approach to PBL was chosen incorporating facilitated sessions alongside lead lectures which explore aspects of the clinical situation in greater depth.
By reflecting on the challenges, pitfalls and positive outcomes of implementing this teaching and learning strategy, recommendations for future development will be presented.
Keywords: problem-based learning, key skills, professional education
PBL: creative learning for imaginative care
Only the curious will learn and only the resolute overcome the obstacles to learning. The quest quotient has always excited me more than the intelligence quotient
Eugene S Wilson (1900-1981)
Background information
Government policy increasingly emphasises the importance of primary care within health care provision (Department of Health 2006) whilst acknowledging the spiralling complexity of care within both health and social care (Department of Health 2005 (a)). Alongside this the NSF for Long Term Conditions (Department of Health 2005 (b)) explicitly includes palliative care as one of its quality requirements. This challenge requires greater flexibility of the workforce and increased cooperation between both statutory and non statutory bodies.
One approach within nurse education relates to the need for nurses to demonstrate ‘individual capability’ (Hase and Kenyon 2006). A ‘capable nurse’ is more likely to demonstrate the ability to utilise their problem solving skills both in familiar and unfamiliar environments. They will also be able to evidence skills of flexibility and adaptability in unexpected situations. A competent nurse is capable of delivering healthcare in a variety of settings and responding to the needs of a rapidly changing society ( To maximise this ‘capability’ it is essential that nurses are equipped with both subject knowledge and key skills to optimise patient care in a rapidly changing health economy. By bringing together constructivism and social learning theory (Child 1986: Smith 2003) learning can further be enhanced by the inclusion of problems that reflect real life situations.
Problem-Based Learning is a student centred teaching and learning strategy designed to encourage deep subject knowledge and develop key skills. Inthis semester authentic clinical situations are used as a stimulus for the student learning activity. This enables the student to deal with ‘real life’ situations in a safe environment developing the skills and knowledge that will support transition into the workplace (Biggs 2004). The student is required to collect, review and analyse new information in relation to the problem set. Students then apply both their existing knowledge and the new information gathered to the initial problem and review further areas for learning - and so the process starts again until the problem has been solved (Price 2003). Students work in groups to solve the problem and are active from an early stage interacting within the group and beyond (Biggs 2004). This sharing of previous and new knowledge generates larger information databases for group members.
By including the development of key skills (Biggs 2004) within the curriculum students will be enabled to keep professionally up to date. The Dearing Report (1997) ( in recommendation 21 highlighted the need for not only subject knowledge but also key skills:
- Key skills: communication, in numeracy, the use of information technology and learning how to learn
- Cognitive skills, such as an understanding of methodology or ability in critical analysis
PBL can be delivered in a pure form, where the students are encouraged to seek out their own learning resources and supported by a facilitator or in a ‘hybrid’ form where the PBL is supported by subject based lectures (Newman 2004) and facilitation. There is evidence within the PBL literature to support the use of lectures where the content is decided by the students (Fisher & Moore 2005), and there has been research into the value of lectures within PBL (Berkel & Schmidt 2005) that concluded lectures do not increase time spent or interest but do help students organise their time.
Facilitation, in PBL, is about assisting the student to find things for themselves, answers will not be given though questions will be posed to further develop student knowledge (Price 2003). Gilkison (2003) discusses whether it is important for the facilitators to have subject expertise or not. Her findings suggest that lecturers who are experts are more inclined to actually suggest topics for discussion rather than allowing the students to develop their own. This could be seen as blocking student discussion and preventing self-direction, but was seen by the students as being supportive in terms of raising awareness of aspects for discussion. However, by not having such direction from a non-expert facilitator, students felt ‘compelled’ to question each other so increasing their skills of critical thinking.
Application to practice
Within the modules relating to ‘palliative care’ and ‘nursing in primary care and long term conditions’ a ‘hybrid’ method of PBL is used (Newman 2004) as a teaching and learning strategy and is not summatively assessed. The ‘hybrid’ method has been utilised to support meaningful learning (Alavi 1995) and to allow for students to utilise different strategies to search for information and share knowledge, fostering collaborative learning and critical thinking. The process of the PBL allows the students to develop skills of group working, problem-solving and self directed learning giving equal value to the process as to that of the content (Alavi 1995). Meaningful learning enables the learner to understand wholes and not just compartments of knowledge and supports the notion of transferable skills – a key element within this curriculum and nurse education.
To promote constructive alignment (Biggs 2004) the subject of the PBL informs the modules summative assignments. The PBL process is supported by the use of lead lectures on relevant subjects. The lead lectures are delivered by the module leader and subject experts. The use of lead lectures, whilst not providing the answers to the PBL, helps those experiencing time management problem organise their study better (Berkel & Schmidt 2005). Fryenius et al (2005) inferred that lecturers can alter the student experience from being one of an extrinsic nature to one of an intrinsic experience of relevance where the content makes learning deep and meaningful as it is related to their own frameworks of knowledge and skill. Interestingly it was noted by Fryenius et al (2005) that the passion and enthusiasm of the lecturer can actually bring the content to life and so provide what is termed a “vicarious experience of relevance”. Both lecturers involved in the modules are passionate and dedicated both to the skill of educating and to their particular field of expertise. Students have noted this during evaluation of the module and have actually suggested that this impacts on their level of interest and motivation. During these modules students undertake clinical practice within the primary care setting, so facilitating engagement of theory and practice and enhancing the motivation of the students to learn.
Throughout the process groups are encouraged to refer to the 8 tasks of PBL (Wolff 2000 cited in Newman 2004) regularly building on knowledge gained and encouraging the development of key skills and reflection. To reduce time constraints on the students (Chung 2001) both independent study time and facilitated study time are built into the module timetable.
Levett-Jones (2005) notes that the use of self-directed learning can increase student anxiety if the concept of PBL is unfamiliar. Neild (2004) enforces the need for preparation of both the student and the facilitator. The PBL launch is at the commencement of the module, with the process being clearly outlined and evidenced with the information delivered in class being included in the student workbook. To ensure consistency of facilitation between the groups (Chung 2001) the role of the facilitator is clearly identified as being one of assisting the students to find the information themselves, questioning is used to gain an understanding of student knowledge and to provide further avenues of enquiry (Price 2003). The facilitator is on hand to help the group manage problems e.g. conflict (Wolff 2000 cited in Newman 2004). Both lecturers involved in this PBL exercise are experts in either the field of primary care or palliative care although in facilitating learning for both modules, they manage to combine both expert and non-expert knowledge.
Whilst PBL is used as a teaching and learning strategy students are required to feedback their learning to the other groups. By giving a presentation students further increase their key skills e.g. oral skills, presenting skills and teaching skills (University of Plymouth 2001 cited in Fisher & Moore 2005). Formative feedback is given to the groups, with the feedback based on the summative assessment used in semester 5. In sharing knowledge gained from a variety of personal and group constructs a broader body of knowledge will be available.
Future plans
At present the use of PBL is as a teaching and learning strategy however this lends itself to closer integration. Further assimilation of these modules,by the use of a combined PBL assessment strategy, will mirror recent health policy (Department of Health 2005 (1) (2); Department of Health 2006) promoting constructive alignment enhancing quality within the semester (Biggs 2004). This synthesised approach will provide the students with a meaningful real life experience of the complexities of nursing in the 21st century.
Further enquiry into the use of lead lectures within PBL will be made with the aim of introducing interactive lectures (Fyrenuis et al 2005), this approach will encourage assimilation of old and new knowledge as the first lecture will act like an advanced organiser as advocated by Ausubel’s assimilation theory (Keating 2006). Subsequent lecture content will be directed by the student increasing participation and motivation. This format will require a flexible and responsive teacher demonstrating solid subject knowledge which in turn will maintain quality (Biggs 2004).
References
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