Effects of Contrasting Equivalent Teaching Approaches on Student Ratings

Journal of Allied Health, Spring 2004 by Bovee, Michael L, Gran, Donald F

One of the most active areas in educational research in recent years has centered on the method of problem-based learning (PBL). The advantages of PBL methods have prompted educators to investigate and implement PBL activities in the clinical science classroom. The purpose of this exploratory study was to note any difference in students' faculty ratings, when viewed as a whole, between one group of students taught with traditional didactic lectures as compared with a group of students taught using a PBL method in a clinical science course. There was no significant difference in aggregate survey outcomes between the two groups. When viewed individually, there was one question ("instructor shows a genuine interest in my performance or progress") that showed a significant difference (p

OVER THE YEARS, attempts have been made to develop and refine the educational process from a traditional didactic method. The use of various teaching approaches may help to address different styles of learning, because not all students are comfortable with independent learning,1 just as not all students do well in a didactic setting.

One of the most active areas in educational research in recent years has centered on the method of problem-based learning (PBL). PBL had its beginnings in medical education at case Western University in the United States and McMaster University in Canada.2 It grew as dissatisfaction with traditional curricula and teaching methods increased. The traditional methods were criticized for lack of relevance, poor development of inquiry skills, and problems related to applying theory to clinical practice. Many aspects of PBL methods have been studied, and its advantages have prompted chiropractic educators to investigate the value of these teaching methods.3-6 Recently, several chiropractic colleges' educational programs have been changed toward competency-based/problem-centered curricula and testing.7-9

Most chiropractic programs consist of 5 academic years, of which the first 2 are dedicated to the basic sciences, the second 2 to clinical sciences, and the final year to a clinical internship. The advantages of PBL methods have prompted educators to investigate and implement PBL activities in the clinical science classroom.7-11 These methods encourage self-directed learning, self-appraisal, development of clinical problem-solving skills, and teamwork.11,12 PBL educators use patient scenarios, ask questions, and require student groups to search for answers.13 Students individually search for answers, come to a group consensus, and then present their scenario to the facilitator. The facilitator asks probing questions and decides if the group can move on. This type of learning process can be thought of as reflective learning,11 where the student has a clearly defined question or problem to solve.

Benefits of this teaching style include flexible curriculum structure, reduced contact hours for students and faculty, better balance of theory with practice, and stronger objectives for classes.14 Faculty serve as mentors and facilitators in this process and should have specialized training.3,11,15

Whitman1 has cautioned that PBL is a different teaching approach and not all students are comfortable with independent learning. Frost11 noted that students initially tend to lack confidence in their ability and to question their depth of knowledge with the material. This tendency may be due to normal fears associated with methods that are different and the lack of faculty dominance in the teaching method. Introducing the PBL methods earlier in the curriculum may help to eliminate some confidence problems that Frost noted and accustom students with the process earlier when less clinical insight may be needed. Richards et al16 have suggested beginning PBL in the first or second year of training in order to see differences in the clinical years, which may add to the costs of education. However, the additional cost must be weighed against the needs of the developing student. Earlier introduction of PBL methods may add more value through familiarity to the entire curricular program.

Because the patient scenarios are complex rather than straightforward, more time may be needed to complete the learning synthesis process adequately.10 PBL methods require student discipline and the integration of information. Students are required to reflect on what they would expect to encounter during patient evaluations.17 The ability to teach peers is a skill required of most professionals,11 and teaching of peers is a desired component of the PBL experience.

Mennin et al18 have suggested that PBL, which does not stress the memorization of facts, may not prepare students as well as didactic learning for standardized examinations such as the national boards. It may be that students in a PBL method do not typically memorize facts, and often, national board questions have rote memory answers that would not favor PBL-taught students. Nevertheless, the authors in a previous study found no significant difference between students taught with PBL methods and those taught with traditional didactic methods on a standardized written examination.19 The questions in their study were similar to questions used on the national board examinations for chiropractic students. Also, in a major review of the literature, Vernon and Blake20 have suggested that students are unlikely to suffer detrimental consequences from exposure to PBL programs.