How to be an effective PBL tutor guide

Step 5 Define learning objectives Process The group agrees a core set of learning objectives often in the form of questions which form the basis of students’ private study.. Step 6 Priva

HOW TO BE AN EFFECTIVE PBL TUTOR

Table of Contents

A1 Problem - Based Learning: an Introduction 1

A1.1 What is PBL? 1

A1.2 How effective is PBL? 1

A1.3 What is the purpose of this Tutor Manual? 2

A2 Tutorial Times 2

A3 The ‘7-Step’ Approach to PBL: Defined and Explained 2

A4 The Role of the Tutor 3

A4.1 Before the tutorial: 3

A4.2 During the first tutorial: 4

A4.3 During the second tutorial (Step 7): 4

A4.4 After the tutorial: 4

A4.5 Throughout the entire module: 4

A5 The Goals of the Group 5

A5.1 Intermediate: 5

A5.2 Long-term: 5

A6 Group Formation 5

A7 Guidance in Group Facilitation 6

A8 Using Questions in PBL 7

A9 Understanding Student Learning 7

A10 Tutors’ Likes and Difficulties with PBL 9

A11 Students’ Likes and Dislikes with PBL 9

A12 Further reading 10

A1 Problem - Based Learning: an Introduction

A1.1 What is PBL?

In problem-based learning a group of 7-9 students work through a problem and generate learning objectives that they need to research in order to be able to be able to address the problem The group is facilitated by a PBL Tutor PBL was introduced to Barts and the London in 1999 The duration of the activity of groups is variable but is not less than three weeks and may extend for up to twelve weeks - as is the case with FunMed

As a method of teaching, PBL was first introduced at McMaster University in the late 1960s It has since spread throughout other parts of the world, including the UK, and is now commonly used in medical education Broadly speaking, PBL in medical curricula is characterised by the use of problem scenarios based around patients, which provide a context for students to learn problem-solving skills and in doing so acquire knowledge about the basic and clinical sciences The actual process involved in PBL tutoring that we are using in our curriculum is based upon ‘7 steps’, which are specified in Section A3

A1.2 How effective is PBL?

The use of PBL as a method of teaching has been the subject of much research (those interested should consult the Further Reading A10) In general, research indicates that students and tutors alike find PBL a far more enjoyable learning experience than that encountered using a conventional lecture-based curriculum, whilst graduates have reported their training more positively in comparison with graduates from conventional curricula In addition to positive ratings concerning the learning experience, clinical supervisors' ratings of the competence of graduates and undergraduates are also generally supportive of the PBL curricula A number of studies have reported the

competence of PBL students either more positively or non-significantly different than students taught using a

conventional lecture-based However, reservations concerning PBL should not be overlooked, and will need to be examined very closely in the new curriculum Specifically, in some studies PBL students have been reported to perform worse on basic science examinations than conventional students, and questions have been raised concerning the practicality of using PBL in schools with intakes greater than 100 students

A1.3 What is the purpose of this Tutor Manual?

This Manual provides you with a comprehensive overview concerning your role as a PBL tutor Separate sections focus upon the individual components of the PBL process, and specific help, information and guidance are given throughout

A2 Tutorial Times

PBL groups will meet once or twice per week The format, for all except the first and last PBL sessions, is as follows:

Day Time (am /

pm) Aim of session

9-10 / 3-4 Presentation on previous PBL findings

10-11 / 4-5 Commence new PBL scenario

Rooms are booked in the Garrod Building, Whitechapel for all PBL sessions Tutors are expected to attend for all of the sessions, and if they are unable to attend for any sessions should contact their Institute teaching lead to arrange cover

A3 The ‘7-Step’ Approach to PBL: Defined and Explained

Step 1 Clarify terms

Process Individual students identify any words or concepts whose meaning they are unclear about Other

students may be able to provide definitions Students should feel safe to be very frank about what they do not understand

Reason Unfamiliar terms may act as an obstacle to understanding Clarification of even half-understood

terms may start the learning process

Written output Words on which the group cannot agree a meaning should be listed as learning questions

Step 2 Define the problem or issues

Process Students are encouraged to contribute their views concerning the nature of the problem and the

issues involved The tutor may need to encourage them all to contribute to a fast-moving, wide-ranging discussion Often the scenario can be broken into several sub-issues

Reason It is quite possible for every group member to have a different perspective on the problem

Comparing and pooling these views broadens intellectual horizons and helps define the task ahead Written output List of problems / issues

Step 3 Brainstorming

Process Students test out explanations for the issues The tutor may need to keep the discussion at a

hypothetical level and discourage students from going into too much detail too quickly

Reason This is a crucial step in which students retrieve information from memory This allows the group to

draw on each other’s understanding and to form links between items of incomplete knowledge When well handled by the tutor and the group, ‘understanding’ rather than ‘factual recall’ is promoted

Written outputList of possible explanations

Step 4 Organise explanations to form a tentative solution

Process The group scrutinises the problem in fine detail and compares it against their proposed explanations

to see how well they match and where further exploration is needed In so doing it develops higher level cognitive skills such as analysis, synthesis and evaluation This begins the process of defining the learning objectives, although it is inadvisable for them to be put down in writing too soon

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Reason This stage actively processes existing knowledge and identifies gaps It may reveal where existing

knowledge structures are inadequate, or may result in restructuring of existing knowledge if explanations can be offered Writing learning objectives too soon bypasses the intellectual process however, resulting in objectives which are too broad and superficial

Written output None (or some change in ordering of points, or links between them)

Step 5 Define learning objectives

Process The group agrees a core set of learning objectives often in the form of questions which form the

basis of students’ private study The tutor should encourage the group to make the learning objectives specific, not too superficial, and most importantly, achievable within the time available Some students may have objectives which are not shared by the whole group

Reason This process of consensus uses the expertise of the entire group (and tutor) to synthesise the

foregoing discussion into appropriate and attainable learning objectives This not only defines the learning task but also pulls together and concludes the discussion

Written output The written learning objectives are the main output of the group All students and the tutor must

make a copy

Step 6 Private study

Process Using the learning objectives decided upon, students individually seek out any available learning

resources to obtain the information they feel will contribute towards understanding, explaining and solving the problem scenario It should be emphasised that each student is responsible for all of their own learning, and must be prepared to contribute, in Step 7, towards each of the learning objectives, not merely work towards one particular learning objective

Reason The requirement for each student to work individually on all of the learning objectives helps the

student obtain experience of independent thinking and working

Written output Students’ individual notes

Step 7 Share results of private study

Process In the second tutorial the group returns to discuss the written learning objectives Students pool the

output of their study, share information about sources and help each other understand, and identify areas of continuing difficulty needing further study or expert help Each student should be prepared

to discuss all of the learning objectives when contributing towards the group's attempts to provide a complete explanation to the problem

Reason This forces students to test how far they have understood and can explain what they have

researched To do this successfully they will need to have expanded and changed their pre-existing knowledge Tutors need to point out wrong facts and interpretations if students cannot do so This ensures that by the end of the problem students have heard and contributed to a correct explanation This synthesises the work of the group, consolidates learning, and defines areas of uncertainty for future learning Inevitably, learning is incomplete, but this is quite deliberate because students should return to the topics when appropriate ‘triggers’ occur in the future In occasional instances students may be directed by tutors to undertake further work now

Written output Students’ individual notes

A4 The Role of the Tutor

The key role of a PBL tutor is to help with the tutorial group process and ensure that the PBL group goes through each problem in a rigorous and logical manner, using the ‘7-step’ approach detailed above Continuity of tutor is very important for PBL group working: as far as possible, the tutor should remain the same for the entire period

The role of a PBL tutor can be sub-divided into the following components:

A4.1 Before the tutorial:

1) Read the proposed learning objectives: These are the learning objectives that the course team would like the students to achieve after working on the problem The aim is that by seeking answers to their learning questions, students will achieve these goals

2) Read the problem: You must be familiar with the problem and how it is likely to stimulate discussion towards the proposed learning objectives

3) Be aware of the available resources: With some case there will be a set of learning resources (e.g library

resources, websites) that the students may want to use Students may require more specific information from you about these (e.g sources)

4) Check the room and time: Rooms have already been booked in the Garrod Building, Whitechapel

5) Make sure room has equipment needed: All PBL tutorials will need a whiteboard and markers It is unlikely that the room will have a flipchart, so all learning objectives will need to be written down by students and tutors

A4.2 During the first tutorial:

1) Choosing a chairperson: All members should take turns in each role within a group across the duration of the module Keep a record of the chairperson for each PBL

2) Choosing a scribe: The scribe uses the whiteboard to record the group’s deliberations and learning objectives Keep a record of the scribe for each PBL

3) Ensuring the group works through steps 1-5 of the ‘7-step’ process: At times you may have to remind groups of the steps to be gone through You may also wish to challenge them about their discussions A major task of the tutor is to help the chairperson of the group to stimulate discussion in both breadth (‘are there any other

explanations that we need to consider?’) and depth (‘does that comment sufficiently explain this part of the

problem?’), in addition to revisiting the learning objectives

4) Make sure that the learning objectives are recorded (and you have a copy): The learning objectives must form the basis of discussion in subsequent meetings

5) Record attendance at all tutorials: Attendance is compulsory

A4.3 During the second tutorial (Step 7):

1) The chairperson should be the same person as in the first tutorial

2) Make sure the group put up the learning objectives that they set: Learning how to use resources are important general aims of PBL learning

3) Make sure each student member discusses the information obtained during private study and clearly lists the sources: Make sure each member contributes to presenting information, and try to ensure everyone is drawn into discussion

A4.4 After the tutorial:

1) Make notes on the group process and contributions of individual members: Feedback on the functioning of the group and its members is one of the most important tasks for a tutor

2) Report any persistent or unexplained absence to the Student Office

A4.5 Throughout the entire module:

1) Think about how the PBL group is progressing: It is important that you are familiar with how your PBL group is functioning, particularly with regards to student attendance and contributions

2) Identification and initial management of academic difficulty amongst students: Where PBL tutors identify students with academic difficulties which cannot be solved simply, the module convenor and Head of Year should be informed without delay

3) Identification and initial management of non-academic problems amongst students, or where students request pastoral support: In such circumstances possible courses of action are:

a) provide initial support and guidance

b) recommend self-referral by the student to their personal mentor

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c) recommend self-referral to QMUL Counselling and Welfare

d) discuss referral or self-referral to the Dean for Students with the student

A5 The Goals of the Group

It is evident that PBL is not just a method of learning facts and expanding knowledge and understanding, but that it fosters skills that are essential in working life Group dynamics play a very important part in the PBL process The goals of the group can be broadly classified as intermediate and long-term, and could be a basis for tutor feedback

A5.1 Intermediate:

1) To get students to communicate: The communication skills of listening, questioning, explaining and responding, should be developed

2) To get students to think: Students will develop various intellectual and professional competencies associated with various types of thinking Thinking has been classified into many specific forms, which include:

Analysing, Creative speculation, Critical thinking, Designing, Evaluation, Logical reasoning, Problem-solving, Rational argument, Synthesising, Transferring knowledge across contexts

A5.2 Long-term:

Personal growth and competence of students and tutors: In addition to the goals of communication and thinking listed above, both students and tutors alike should show improvement in the following areas:

Management of own learning, Personal awareness, Self-confidence, Working with others

A6 Group Formation

As a group forms, it is common for it to go through a number of phases These phases need careful facilitation, requiring both tutors and students to be active Often the role that needs to be adopted in PBL facilitation will seem very unfamiliar to tutors with a conventional teaching background, who will have to give up their teaching autonomy

in two main ways: tutors will be unable to decide the material to discuss, and will be forced to use unfamiliar

teaching methods They must adapt to a role that they may perceive as being less attractive

A6.1 Four phases of group formation:

Groups have been described as undergoing a number of stages:

1) Forming: Group gets to know each other

2) Storming: Members of the group struggle to establish their roles

3) Norming: The group has arrived at an understanding of how to behave

4) Performing: Group works together to perform the task

Some groups never progress beyond stage 2 However the structure we are using for PBL and the designation of particular roles should help movement through the stages

A6.2 The role of the tutor during group formation:

1) Manage the learning

2) Manage the individuals

3) Manage the group process

A6.3 Issues to consider during group formation:

1) Expectations: Often students do not know what is expected of them Establishing an informal contract helps to clarify group goals and reduce student anxieties Additionally the feeling that it is acceptable and indeed expected to ask questions and try out ideas should be fostered Students will have had an introductory briefing about the PBL process, so may already have some questions about it

2) Safety: Sessions should not be plagued by fears, which can originate either from the students or the tutor Students may be frightened to contribute or made to look stupid, whilst the tutors fear that they may lose control or

be asked questions they are unable to answer There are several approaches which can be used to increase feelings

of safety:

a) Reward: Positively reinforcing helpful contributions encourages more like it

b) Risk reduction : There are a couple of ways by which the perception of risk within the group can be minimised First, make expectations clear, as much fear stems from feelings of uncertainty Second, never make students look foolish or allow other students to do so

c) Let students know the limits : If students do or say something unacceptable, the tutor must not only tell them so, but also tell them why

d) Overall control: The tutor should make it clear by their expectations and attitude that they do retain overall control

A tutor fulfilling their functions well should experience no difficulty in saying they do not know the answer to some things There are 31 other tutors who can be called on for help!

A7 Guidance in Group Facilitation

Groups of students function well when all members are actively participating in the learning process On occasions, learning can be impeded by certain interactions that may occur between different group members Tutors can improve the functioning of the group by identifying any such situations and intervening effectively to solve them In attempting to resolve these situations however, it is particularly important that the tutor neither humiliates the student nor shows them up in front of their peers Common situations that can arise in PBL groups, and ways of dealing with these situations, are detailed below It should be noted that subtle interventions often result in dramatic changes in group dynamics It is also worth remembering and using the power of other group members to influence individuals within it

1) Situation: The chairperson does not take control.

Solution: Remind the group of the need for learning objectives and the time that is left to achieve them Ask

the chairperson whether they wish to allocate tasks or set goals for the group

2) Situation: One member dominates the group.

Solution: Comment on the helpfulness of the dominant student but invite suggestions from others Suggest

that the chairperson may wish to allocate tasks to other group members, as the dominant person has already contributed a lot

3) Situation: A member of the group is silent or rarely participates

Solution: If this person rarely contributes, try to get the group to focus on what they say when they do

contribute This will encourage them to say more If this person never makes a contribution, gently encourage them to participate Do not ignore them however Try not to point out directly that the person has been very quiet, as this will make them even more anxious Be aware that they may be having difficulties, and if you are concerned, have a quiet word with them after the session If you are still concerned about the student, they may need further guidance (see Sections A4.5 and B4)

4) Situation: The group is working well, but only half the group is contributing.

Solution: Try to encourage other members to take part Ask the chairperson to take everyone’s view on what

has been discussed so far

5) Situation: The whole group is silent or hardly working.

Solution: Do not do the work for them! Ask if they are having difficulties Encourage them to pinpoint the

difficulty and work out solutions, for example, check on factual points

6) Situation: The group relies excessively on the tutor as a source of information or direction.

Solution: Reassure the group of their progress and of the validity of their previous learning objectives Discuss

with them the role of the PBL tutor (as facilitator, not as source of wisdom)

7) Situation: Two members of the group get into a heated discussion.

Solution: Attempt to calm the situation down Let each person have their say without interruptions, and take

each seriously

8) Situation: One or two members of the groups are disruptive

Solution: Gently comment on their behaviour (for example, ‘you seem bored’ or ‘you seem not to be listening’),

then ask them why this is the case Listen to what they say Remember that some people behave in this way when they feel they are struggling with the material Try to get them involved and thinking about the problem Do not ignore them and do not become angry with them

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9) Situation: One or two students are frequently late

Solution: Without accusation, ask them directly why they are late, and discuss ways of preventing this in the

future

10) Situation: A student is frequently absent.

Solution: Discuss this privately with the student If this does not lead to a solution, refer them to the Student

Office and Head of Year

A8 Using Questions in PBL

As with all activities in which communication forms a central component, the type of questions used when facilitating the PBL group is of vital importance Open, as opposed to closed, questions (closed questions invite Yes, No, or a single-fact answer) are often the most effective type of questions to stimulate and redirect student-centred

discussion

A8.1 Examples of open probing questions:

Can you give me an example?

Can you think of an alternative viewpoint?

Does that always apply?

How is that relevant?

How reliable is the evidence?

How accurate is your description?

In what situation would this rule break down?

What is the underlying principle?

What distinguishes the two cases?

You say it is x, which particular type of x?

8.2 Common errors in questioning:

Always asking the same type of questions

Asking too many questions at once

Asking a question and answering it yourself

Asking questions only of the brightest and most likeable student

Asking a difficult question too early

Asking irrelevant questions

Asking too many closed questions

Asking questions in a threatening way

Failing to face the implications of answers

Failing to build on answers

Ignoring answers

Not indicating a change in the type of question Not using probing questions

Not giving time to think

A9 Understanding Student Learning

An important aspect of the PBL learning experience is to understand how students learn new information Gaining a better understanding about student learning will help you identify some of the barriers that students may encounter, and provide you with solutions to help the student overcome such difficulties in PBL sessions

In the PBL setting, problem scenarios are used as a vehicle to make the students think about what they know, and more importantly, what they do not know This type of learning takes account of the fact that students initially attempt to solve problems using schemata Schemata are knowledge frameworks which we all possess and apply when trying to solve problems or make sense of the world When schemata are unable to provide a correct solution

to a problem, the student should recognise this and seek new information which will become assimilated into the schemata This will make the existing schemata more powerful when being applied to future problems The learning process can be characterised as follows:

1) New information required to solve the problem scenario is in conflict with or simply additional to existing

schemata

2) The student realises that their existing schemata are inadequate, incomplete or inconsistent with the new

information

3) Students assimilate new information into their existing schemata

4) Adapted, more powerful, schemata are formed which can be applied to help solve an increasing and diverse number of new problems

A9.1 Strategies that interfere with new learning:

Strategies that interfere with learning will be illustrated with reference to the following problem scenario:

Baby Sam

Sam’s mother had an awful pregnancy owing to diabetes mellitus Sam was born at 36 weeks by forceps delivery following failed ventouse He was a large baby and weighed 4kg Soon after birth he was jittery and had a tinge of jaundice

1) Over-reliance on the sufficiency of prior knowledge: Students read the problem scenario but fail to recognise that they need new knowledge to understand what is happening They report that they understand it or know the material contained in it

With regards to the above problem scenario, students report that the problem is about diabetic mothers When pressed they state that it is about the big babies associated with diabetic mothers Instead of using knowledge acquired from the text to answer questions, students simply associate the new material with their existing schemata

to report that the text of the problem scenario was simply repetitious Information in the problem is therefore not recognised as new or as requiring new explanations, i.e thinking everything can be understood from existing level of knowledge

Solution: The tutor has to make it clear that the material is, in fact, new

2) Over-reliance on unrelated facts whereby science is simply seen as the acquisition of facts: Science is viewed simply as an accumulation of facts, and science learning the recall of such facts Students therefore begin to recall isolated pieces of information which are not linked into meaningful schemata that support a better understanding and are capable of changing or elaborating the schemata

Solution: The tutor must present situations that require linking facts into the students’ schemata

3) Over-reliance on text vocabulary whereby science is simply seen as the acquisition of vocabulary: Students isolate new words or phrases, often out of context, and express feelings of understanding if they can state that the problem scenario is about a specific word Students report feeling confused about the problem, but feel that they simply need

to decode the new words For these students, answering questions about the text simply requires the recall of the new words or phrases Often words are not put into the context of the student’s own experience

With regards to the above problem scenario, students isolate ‘jittery’ as a new word, but then express feelings of understanding if they can state that the problem is about a ‘jittery’ baby It becomes a mindless exercise in

vocabulary acquisition This strategy pays off when the tutor asks questions requiring definitions or identification of new words

Solution: The tutor must present problem scenarios that require linking words into the students’ existing schemata This helps students better understand and explain the problem

4) Over-reliance on the adequacy of prior knowledge: New topics are understood simply in terms of existing

schemata Students do not try to assimilate new information into their existing schemata but become satisfied, simply confirming its correctness Often this results in students distorting or ignoring information inconsistent with their schemata Information is recognised as new, but students do not appear to understand that it challenges their existing schemata

With regards to the above problem scenario, the baby’s jaundice soon after birth is inconsistent with the students’ schemata that physiological jaundice occurs after the second day of birth The student recognises that the

information is new, but ignores that it is inconsistent They report that as the baby is born early, the baby’s jaundice has appeared early, therefore it is still physiological

Solution: The tutor must use probing questions (see Section A8.1) to challenge the complacency

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A10 Tutors’ Likes and Difficulties with PBL

Informal atmosphere

Being stimulated by students’ ideas

Hearing spontaneous insights of students

Seeing a student suddenly grasp an idea for the first

time

Seeing a student compile disjointed bits of information

Opportunity to provide personal feedback and praise

Keeping quiet whilst students progress with difficulty and make mistakes

Establishing a conducive atmosphere

Getting students to perceive their tutor as an equal, to talk to their tutor as a peer

Getting a discussion going

Directing discussion in fruitful directions

Shutting up vociferous students, whilst bringing in quiet ones

Being mentally alert and flexible all the time

Dealing with a poor or irrelevant answer

A11 Students’ Likes and Dislikes with PBL

Personally influence discussion

Understand what they are discussing

Encouraged to think

Discussing rather than being told

Being able to participate and find out other students’

ideas

Being able to have queries sorted out there and then

Having the opportunity to ask questions, no matter how

trivial

Try out ideas which may be wrong

Learning to converse in a literate manner

Develop power of analysing problems and arrive at

solutions

Flexible, less formal and intimidating

Individual attention, rather than a face in a large crowd

Members of the group who do not talk

Long silences

Groups being dominated by one person

Having to contribute when you do not wish to

Being asked vague questions

Being held up by problems or queries of other group members

Feeling of being constantly assessed by the tutor about knowledge and attitudes

Feeling the tutor as threatening

Having to complete a certain amount of work to understand what is going on

A tutor who interrupts too frequently or starts lecturing

A tutor who is not interested

A12 Further reading

 Albanese M (2000) Problem-based Learning: why curricula are likely to show little effect on knowledge and clinical skills Med Educ 34: 729-738

 Albanese M.A (2007) Problem-Based Learning Edinburgh: Association for the Study of Medical Education

 Albanese, M (2010) Problem-Based Learning In Swanwick T (ed) Understanding Medical Education Wiley-Blackwell, Edinburgh: Association for the Study of Medical Education

 Azer S.A (2005) Challenging facing PBL tutors:12 tips for successful group facilitation Medical Teacher 27, 676 – 681

 Bligh, J (2000) Problem-based learning: the story continues to unfold Medical Education 34, 688-689

 Colliver, J (2000) Effectiveness of problem-based learning curricula Academic Medicine 75, 259-266

 Davis M & Harden R (1999) Problem-based learning: a practical guide Medical Teacher 21 (2), p130-140 AMEE Guide 15

 Feather A & Fry H (2009) Key Aspects of Teaching and Learning in Medicine and Dentistry In: Fry, Ketteridge

& Marshall (eds) A Handbook for Teaching and Learning in Higher Education, 3rd edition, Chapter 26; Routledge

 Norman G.R & Schmidt H.G (2000) Effectiveness of PBL curricula: theory, practice and paper darts Med Educ 34: 721-728

 Wood D.F (2003) ABC of Teaching and Learning: Problem-Based Learning Br Med J 326: 328-330

learning Where are the leading exemplars? Higher Education Academy

We would like to acknowledge the University of Manchester Faculty of Medicine, Dentistry & Nursing for its

help with the guidance detailed in this guide

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