Advances in Health Sciences Education (2005) 10:231–252 DOI 10.1007/s10459-005-6705-3
Springer 2005
Problem-Based Learning Online: Perceptions of Health Science Students RUTA K. VALAITIS1,*, WENDY A. SWORD1, BOB JONES2, and ANDREA HODGES1 1
School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada and Public Health and Community Services Department, City of Hamilton, Ontario, Canada; 2 Visualization Design Institute, Sheridan Institute of Technology and Advanced Learning, Oakville, Ontario, Canada (*author for correspondence, Phone: 905-5259140, ext 22298; Fax: 905-5218834; E-mail:
[email protected]) Received 26 October 2004; accepted 29 April 2005
Abstract. This qualitative study explored health sciences students’ perceptions of their experiences in online problem based learning (PBL) and focused on their views about learning and group process in the online environment. Participants were novices to online learning and highly experienced in PBL, therefore, they could reflect on past face-to-face PBL experiences. Three groups of learners were involved, including undergraduate nursing and midwifery students and graduate students in a neonatal nurse practitioner program. Findings are presented using the six steps of the PBL process (Rideout & Carpio, 2001). Results indicated that it is feasible to conduct PBL online. Students felt that it increased their flexibility for learning, enhanced their ability to deeply process content, and provided access to valuable learning resources. Students experienced a period of adaptation to the online environment, perceived a heavy workload, and had difficulties making group decisions online. In addition to using asynchronous communication, chats (synchronous communication) were valued to support group decision-making online. Students appreciated validation of their online contributions from their peers and wanted clear expectations of what constituted successful tutorial participation from their tutors. Although online PBL can work effectively, tutors and students need to develop online literacy skills to smooth their transition to an online PBL environment. Key words: computer-mediated communication, graduate education, midwifery, nursing, online learning, problem-based learning, undergraduate education
Background and Literature Review Today’s students have numerous new challenges. Many of them are studying, working, as well as nurturing families and are often required to travel for learning opportunities. With the growing international adoption of problembased learning (PBL) in health sciences education, Camp (1996) predicted that PBL would evolve to apply computer technologies to overcome these
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barriers. Educators are thus exploring the use of technology to support PBL. The purpose of this study was to explore health sciences students’ perceptions of their experiences in online PBL. It focuses on their views about learning and group process. What makes this study unique is that participants were highly experienced in PBL and as a result could reflect on their online versus past face-to-face PBL experiences. Few peer-reviewed studies of online PBL were found and most involved participants with no previous PBL experience. Researchers generally reported that students do as well or better in online PBL compared to faceto-face PBL. Carr-Chellman et al.’s (2000) matched-case study investigated the feasibility of utilizing problem-based collaboration in an instructional design course at a distance compared to a traditional delivery mode. Both groups met the course objectives with equal success. Pankratz (1998) reported that Canadian business students in a hybrid (face-to-face and online) PBL course did better in written test scores than they did in a previous course without online support. In contrast, Chan et al. (1999) conducted a randomized controlled trial of the feasibility and effectiveness of a PBL intervention with physicians offered through email compared to Internetbased education without group discussion. Pre- and post-intervention results showed no statistically significant differences in knowledge test scores between groups. Dennis (2003) also found no significant differences in learning outcomes of physiotherapy students when comparing online to face-to-face PBL. A few studies examined the use of various technology features to support online PBL. An international group of dentistry students highly rated multimedia resources, such as video clips and images (Matheos et al., 2001). Kamin et al. (1999) conducted a formative evaluation of PBL case videos by medical students. They concluded that video cases in conjunction with PBL and collaborative conferencing provide a rich environment for active learning. The use of labels (words attached to notes describing how a message added to the discussion, such as, ‘fact,’ ‘recommendation’ and ‘reference’) has also been studied as a support to online discussions. Orrill (2001) explored the frequency of the use of labels in two online graduate-level classes and examined how they improved the understanding of the flow of discussion. She found that students used evidence minimally to support their conjectures. Sloffer et al. (1999) also studied labels to support inquiry (also referred to as PBL) and online collaborative learning. Context labels were not seen to get in the way of thinking, were useful to help structure arguments, and provided a reference point for the instructor. Finally, Ryan et al. (2004) described an online tool to support clinical reasoning as an adjunct to face-to-face PBL with promising results. Researchers investigating online PBL have examined learning outcomes as well as the use of technological features to support PBL. None, however,
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have explored the process of online PBL itself. This paper addresses McMaster health sciences students’ experiences with online PBL and explores their perceptions about learning and group process. Methods The problem-based learning process McMaster health sciences education curricula are grounded in PBL. The six steps of the PBL process (Rideout and Carpio, 2001) describe the process used by nursing and midwifery programs at McMaster University. This PBL process was applied in this online study. In step one, the problem is presented to the group, terms are reviewed, and hypotheses generated. Students review the scenario that is the stimulus for PBL and identify terms and concepts that are unfamiliar. Sharing of information begins. Terms and concepts that are poorly understood by students are noted as learning issues. Students’ initial work involves generating hypotheses to explain the client situation. In step two, learning issues and information sources are identified. Following preliminary exploration of the scenario, PBL requires that students identify knowledge gaps and learning issues for study. Given the multitude of learning issues that often are identified and the collaborative nature of PBL, groups must make decisions about their learning focus and choice of learning resources. In the third step, students move to information gathering where independent study occurs. In step four, knowledge acquired is discussed and debated critically. In addition, students begin to apply information to the case, gather further details about the case, review and summarize data, and identify further knowledge gaps. Step five involves application of new knowledge to the problem in a practical way. This stage is not to ‘‘simply accumulate relevant information, for the process now requires students to apply what they have learned to the problem in a practical way’’ (Rideout and Carpio, 2001, p. 31). For example, students might create a teaching plan for a family or a long-term plan of care. Reflection on the content and process of learning occurs. This final step of PBL involves the examination of the quantity and the quality of learning and function of both individual members and the group as a whole. Students review what they learned and its relevance to practice. They review their group processes, identifying what worked well and what they want to change. This reflection on the content and process of learning takes place when students have completed a scenario; it is also encouraged weekly to maximize learning and group functioning. Participants On-campus students from midwifery, nursing, and the graduate neonatal nurse practitioner programs were recruited to take part in the study. Twenty-one
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female and one male student agreed to participate. In addition, three tutors participated who were highly experienced in PBL but novices in online tutoring. Ethical approval was obtained from the University. Students were given the option to withdraw from the research at any time without any negative consequences. A group of undergraduate fourth year midwifery students and a group of neonatal nurse practitioner students in their final semester were given the option to either work collaboratively on an online PBL case or individually write a paper. All but one student chose to work online. They concurrently met in a regular face-to-face PBL class and knew each other well. A third group of third year undergraduate nursing students who volunteered for the study, met face-to-face for PBL in the first term and then reverted to an exclusively online mode in the second term. The student groups and their online activity are described in Table I. Computer-mediated communication software, digital case and resources The course management software used for this study was FirstClass. Conferences were divided into two general sections – PBL Groups and the PBL Case and Resources (Figure 1). Students could access their group’s private PBL conferences on the left of the screen. Each PBL group’s conference space was designed to support certain processes of the PBL process: ‘‘Generating Issues and Learning Gaps,’’ ‘‘Constructing Knowledge’’ and ‘‘Evaluation of PBL’’ (Figure 2). A synchronous chat room and a conference for general housekeeping issues also was provided and new conferences were created as needed. The right side of the space provided all participants access to the digital case and other resources (Figure 1). A PBL case related to Fetal Alcohol Spectrum Disorder (FASD) was developed for the study. Data from three short scenarios were presented using short paragraphs of text, digital videos of simulated patient interviews, and electronic patient records. Digital Table I. Description of participant groups Group
Number of Year in students
Previous years
program of face-to-face
Number
Number Number
of weeks of notes of chats
PBL experience online
posted
Undergraduate midwifery 10
4th
3.5
6
300
3
Undergraduate nursing
7
3rd
2.5
4
444
2
Graduate neonatal
5
2nd
1.5
6
107
4
nurse specialists
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Figure 1. Main conference space.
resources were provided including web sites, a digital video about FASD, and two animations of embryological facial development and differentiation of facial deformities in FASD. Students could asynchronously access FASD experts in the ‘‘Interdisciplinary’’ conference, including a public health nurse, a health promotion specialist, a neonatologist, a nurse practitioner, a social worker, and a legal guardian of two children with FASD (Figure 3). Conferences were set up for participants to practice posting notes, get help and ask questions about the study. A tutor conference was available for faculty to communicate privately. Students and tutors were given a CD-ROM, which contained all the resources needed to install the FirstClass software, as well as digital case videos. All participants had 1 1/2 hours of hands-on training in FirstClass and handouts about how to use the software were distributed. Guidelines regarding expectations and requirements for successful tutorial performance were provided (Table II). In addition, tutors received readings related to online teaching and learning.
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Figure 2. Midwifery group’s private conference space.
Research Methods Qualitative data were collected from students using individual reflections and focus group interviews. Students were asked to write weekly reflections throughout the experience using questions adapted from Stephen Brookfield’s (1995) work on reflective learning (Table III). Sixty-one reflections were received (midwifery students n = 29; neonatal nurse practitioner students n = 18; and nursing students n = 14). Focus group interviews were conducted with each student group 1–2 weeks following their online experience. The semi-structured interview included broad questions about group process and learning in an online PBL environment. For example, students were asked, ‘‘In what way was your online PBL experience different from your past face-to-face PBL experiences?’’ and ‘‘Can you comment on the nature (depth and breadth) of the discussion in your online PBL experience compared to your past face-to-face PBL experiences?’’ The focus groups were audio taped, transcribed, and modified after checking for transcription errors.
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Figure 3. Interdisciplinary conference.
QSR’s NVivo software was used for data analysis. The members of the research team independently and inductively coded one focus group transcript and discussed coding similarities and differences. Through consensus, a master code list was developed and applied to the remaining data. All the data were chunked into meaningful segments and first level codes were assigned. The codes were then arranged into pattern codes, which held commonalities and formed sub-themes. Pattern codes were decided upon by consensus. Most codes were assigned descriptors to enhance consistency in coding. At least two researchers coded each of the remaining documents; each pair of researchers met to review coding similarities and differences. New codes were discussed with all researchers and a final master list was developed. A number of techniques were used to increase the trustworthiness of the findings. Constant comparison (Lincoln and Guba, 1985) was used to verify the main themes. Within-method triangulation, using data from individual reflections and focus group interviews, strengthened the credibility of the research and helped gain a deeper understanding of the phenomenon. Sim and Sharp (1998) describe within-method triangulation as using more than one strategy for data collection within a methodological approach. The participants and learning context were described in depth to support transferability to other settings.
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Table II. Guidelines for successful tutorial participation Successful tutorial participation forums and chat sessions will be measured by the following: • Meets attendance requirements online (logs in at least three times per week to ensure that discussion is effective in an asynchronous forum) • Contributes two to three quality messages in FirstClass per week • Provides evidence of critical thinking • Finds and shares new information and resources with peers • Assists peers in learning on an ongoing basis • Adheres to professional, ethical, and legal guidelines in computer mediated communications (Netiquette, copyright, confidentiality) • Supports other learners • Offers constructive feedback to peers • Actively participates by taking on the task of summarizing the salient points from the week’s discussion • Helps facilitate the group each week– a group facilitator can be chosen each week
Table III. Reflection questions 1. At what moment in the online class this week did you feel most engaged with what was happening? 2. At what moment in the online class this week did you feel most distanced from what was happening? 3. What action that any one (tutor or student) took in the online class this week did you find most affirming and harmful? 4. What action that anyone (tutor or student) took in the online class this week did you find most puzzling and confusing? 5. What about the online class this week surprised you the most? (This could be something about your own reactions to what went on, or something that someone else did, or anything else that occurs to you.) 6. Is there anything else that you think we should know about your experience in the online class this week? 7. Have you talked about the project with your group outside of the on-line sessions? If so, how was the PBL process influenced by these communications?
Findings Findings are presented based on the steps of the PBL process as described by Rideout and Carpio (2001).
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Step one: review of terms and generation of hypotheses In step one of the PBL process, students did not mention difficulties related to the identification of terms, concepts or hypotheses related to the scenario. However, their comments about initial problems navigating the web site suggest that this step of the learning process was hindered in the online environment. Some students were confused about the purpose of each conference and expressed uncertainty about where to post notes. As one student said, ‘‘Like it was crazy trying to figure out what was the difference between ‘Gaps’ and ‘Constructing.’ [conferences], because all of it was really meshed together…’’ Another student remarked ‘‘…what am I doing there? Is that where we’re supposed to start things?’’ Students identified that the synchronous chats were helpful for hypothesis generation. For example, ‘‘I really think the use of the online chat is very useful to brainstorm ideas regarding the case and to clarify issues immediately.’’ Another student talked about brainstorming in a chat compared to that which occurs face-to-face: ‘‘It was great to be able to brainstorm…the free flow of thought was stimulating and very realistic to an in-person class’’ Step two: identification of learning issues and resources In step two, group decision-making was difficult and contributed to a lack of clarity regarding learning objectives and frustration. A participant commented: We had a lot of trouble trying to decide where to go with the case problem. I had no idea what to research and post this week, so I ended up just posting something that I didn’t think really related to the case. Decision-making online took more time than face-to-face. In spite of this, groups were generally committed to decision-making by consensus. ‘‘I think it was good because we decided as a group. Somebody raised the issue and then we sort of came to a consensus…’’ Students found that ‘‘online chats were the most effective method of decision making’’ and it was easier than posting notes in the asynchronous conference. Students were able to establish objectives in synchronous chats. One participant noted, ‘‘[The chat] was the only time when the group would make group decisions, and you wouldn’t take a week after to decide where are we going now.’’ Although some students found chats fun and engaging, most found them overwhelming and frustrating. A variety of factors contributed to students’ frustration: everyone ‘talking’ at once, slow typing skills, multiple conversations, lack of peer response, the fast pace of the conversation, and feeling unheard. As one participant said:
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The chat for me was frustrating because I would type something in and three people have already said it. Or I’d erase it and then I’d start over, and then somebody else would say something and then somebody would say, where is [the student]? Well, I’ve been trying to put something on here for the last 5 minutes! You’re trying to be fast so you just blurt out a little phrase and then there it lands in the middle of some other line of conversation that’s taking place, and it was like, oh man. Despite the early frustrations, most students felt they gained chat skills with experience. Some groups created separate conferences for each learning objective. This helped to provide clarity about the learning focus and to organize numerous student contributions. One student noted: I am finding the separate [conferences] for each objective very helpful in organizing the information. It does not seem as overwhelming when presented this way… I like the fact that I can go into a specific folder and focus on one objective and then go to another folder and give my input there. Separate conferences also made it easier to follow and later retrieve information: Many of us have felt that it is hard to follow the threads and actually absorb any of the info posted because it feels like you are jumping all over the place… But [now] instead of one [conference], have four [one for each objective]. This is an excellent suggestion for keeping this organized and making it easier to go back and find info that you want to comment on later. Step three: information gathering and independent study Participants perceived that they had more learning flexibility with online PBL in the third step of the PBL process, because they were able to learn at their own pace and could go online anytime and anywhere. Some students felt that online PBL supported their individual learning style. As one student explained: I know everyone learns in a different way. Like for me I used, I think, the video and the transcripts. I don’t know if I used the computer documents …for my data gathering. Just I’d like to read it and pick up points from there. A number of students remarked on the accessibility of FirstClass and how online PBL would benefit students working at a distance. As one participant stated:
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Now when I was living… in my little room by myself, away from my family, it would have just been a lifesaver for me. It would have been because I didn’t know anybody… you really are isolated. So [online learning] would have been a godsend. There were more resources to support the case than would normally be supplied to students (e.g. electronic patient records and online experts). Many students seemed to appreciate these additional resources. A student observed, ‘‘well before when we’ve done PBL, it’s just been like one paragraph kind of scenario, and then it’s self-directed learning and you go off and do your own [work]. There’s definitely more provided on the computer.’’ Despite the availability of many online resources, some students forgot about them and used traditional resources. Possible reasons included having to learn many new things and forgetting where resources were located. One student explained: I recall… about the additional resources around the journals and the Websites, but I got onto my own track of searching and just kept on going with it. When in fact it might have already been right there waiting for me, but I did my typical lit search and textbook reviews… Several students found themselves making more use of Internet resources than usual. One participant said,… I sort of took advantage of the opportunity, I decided it was an online case and we were using computer technology, so I’ve used a lot more Internet resources than normally I do in my PBL…’’ Generally, the videos of the scenarios were well received by students. One student felt ‘‘the interviews were a little bit more helpful to me than actually reading through some of the forms, just because it seemed like you were there and doing that observation …’’ Some students remarked that their slow Internet connections and speed of downloading videos discouraged their viewing. Several students found that the video transcripts were sufficient to meet their needs. Others valued the opportunity to observe simulated interviews. A nursing student remarked, ‘‘Usually, we’re the one participating in the interview, so it was neat to kind of be an outsider. You gain more information that way I think.’’ Students’ comments about the electronic documentation of patient data were generally positive. However, they indicated that they were not extensively used. ‘‘I found them useful, although I didn’t use them a lot. Initially it was good to scan them just to get additional information that wasn’t provided in the scenario.’’ Students had access to six FASD experts by means of the interdisciplinary folder. Anna Guardian (fictitious name), the legal guardian of the two FASD children, particularly impressed the students. One student said,
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‘‘So having a real person with real experience, that was really good.’’ and noted that Anna Guardian was more genuine than the characters in the PBL case videos. Students also expressed satisfaction with the other experts. For instance, a student noted that having access to a Children’s Aid Society worker: …filled a huge learning gap and again somebody talking about their reality, their experience. So you’re not reading a journal that talks about child welfare in the US in different states and that sort of thing. It was a true picture of what is the reality here, and that as a care provider is what you need to know. Another student liked the idea of contacting experts by e-mail, noting: That public health nurse posted a huge response… very, very detailed. And it was really good to have those resources. I thought that was a really neat feature because we don’t normally have that for PBL. We have people contacts but we rarely use them. Just because we can post an e-mail to them it was much easier to access those resources. The questions and responses generated in the interdisciplinary folder were available to all three groups of students. Access to other students’ work was met with mixed feelings. One neonatal student found it confusing and: …a waste of time, because I didn’t think that it applied to the questions we were interested in answering necessarily. Now maybe it spurred me on into different thoughts. But when I was going through it, I was just like, oh, this is dragging on. I was more interested in reading what’s specific to our group. Another student in the same group had a different reaction: Once I early on figured out that all of the groups that were participating in this pilot study were working from the same problem, I actually found the other interdisciplinary notes interesting…. I like the different perspectives that other people were bringing out…in some ways it did make me think in different ways or ask different questions.
Step four: critical discussion and debate In the fourth step, many students felt that they had to work hard at processing the information in an online environment. However, the process of writing online supported students’ synthesis of information. ‘‘We are forced to not only read but also integrate and organize the information in order to write up a posting.’’ The time spent in online PBL also helped students process information:
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I like the autonomy and the sort of ability to process the information over time that the online learning gave us. Compared to what we do when we come to class … you cram a lot in for that sort of one session and then we all sort of go bananas … I’m a slower processor, I reflect, I go back and think, and then that makes me go down another path. Students also generally thought that they responded to others’ contributions in a more focused way compared to face-to-face discussions, which added depth to the discussion. Something I really actually liked about [online learning] was the depth of the information that got posted. If you’ve ever sat in one of our PBL classes on Friday, we get like next to nothing accomplished, I mean in terms of the actual academics, because we spend so much time talking about our personal clinical experiences and births…. Although many students were positive about the depth of their learning, some felt that analysis of information was lacking online. One student remarked: I thought we had done some excellent work. But where I felt that we were missing out was on the overall synthesis of the material that we would ordinarily get out of our verbal conversation. I think for me solidifying it through that synthesis was missing. A number of factors hindered online PBL discussions including work overload, ‘‘dumping’’ of information, unclear tutor expectations, posting of repetitive information, difficulty following discussion threads, and the potential for misinterpretation of notes. Overall, students perceived that the workload involved in posting and reading notes was overwhelming, particularly in light of their busy schedules and lack of study time. One student compared online to face-to-face PBL as follows: [I] found the volume of the workload was far in excess of what we normally do for class. Somebody said signing on every day… you don’t do PBL preparation for [face-to-face] PBL every day! ‘‘Dumping’’ of information was problematic, particularly at the start of the online experience. A student vividly described the problem as follows: It was just like everybody was like barfing out their information on the screen. I mean everybody, myself included. We were just like, oh found this, found this, and there was no integration. Like there was nobody commenting on other people’s [notes]… You were really dying from frustration because you put up a question and absolutely everybody ignored it because they were so busy putting out [their] own stuff.
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Some students thought that they needed to contribute ‘‘mini essays’’ to demonstrate their understanding of the material: ‘‘You wouldn’t come to class to [write mini essays] but you felt you had to, you know, say well, I know this, this, and this.’’ The tendency to ‘‘dump’’ information appeared to be related to the students’ lack of experience in participating in online discussions, unclear tutor expectations, and grading of participation. There was a need for ongoing tutor feedback to clarify expectations of online participation. Students clearly wanted and valued tutor feedback. Today when I received [my tutor’s] e-mail I felt TOTALLY affirmed. Not only did [the tutor] agree with some of the points I had raised, but [the tutor] also gave us guidance, suggestions and affirmation that we were ALL doing a great job…. We needed this! In particular, they wanted guidance about the quantity and quality of notes. ‘‘I need [an instruction about] what to expect… an example of this is how much you should be contributing and showing what the critical analysis process would be.’’ Students found it frustrating when repetitive information was posted. A student remarked: [I found it] frustrating when people post information that has already been touched upon or presented… it’s almost like people think they just need to get something down so that they can be graded… but it just makes it redundant and boring. The discussion threads confused many students. ‘‘It is confusing when one person replies to someone else’s comments and then you go back and read the comments you don’t know what they are replying to!’’ The length of threads and time lag in response were also problematic. A student commented, ‘‘It took a lot of concentration to keep track of what people were saying, who was saying what. It would be like everyone saying something different at the same time.’’ Many participants were concerned about misinterpreting online notes. Although a misinterpretation occurred on only one occasion, a student explained: It has been a challenge to phrase and write things so as not to accidentally offend anyone. I do get the feeling that we have to tip toe around each other a little more than we used to. Doing PBL online has produced a bit of a communication challenge. What do they say… ‘‘the pen is mightier than the sword?’’ I guess that means the pen has to be handled with more care. Lack of non-verbal communication was viewed as a potential cause of miscommunication:
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…when you’re face-to-face and you see the facial expressions and you hear the intonation in the voice. And I think that that just brings forward a different dimension of how [strongly] people feel about an issue or how…they don’t seem interested in it at all. Despite a number of difficulties in maintaining online discussion, there were a number of factors that supported it. These factors included peer validation, the formation of discussion threads, formatting of notes to ease online reading, the permanency of notes, and user-friendly software. Many students reiterated the importance of peer validation. ‘‘It helps when you go back and see that someone has responded to what you have said, then you feel more like, ok, this is a group thing. It’s kind of like being around a table and having a discussion.’’ Although many students felt that the discussion threads were confusing at first, a number of participants later found they helped the flow of discussion. One student explained, ‘‘[It] was nice to…go back to [the] previous thread, next thread. I mean once you got going it was actually, ok yeah, this is what it’s about.’’ The permanency of notes also was valued. As reported by one student. ‘‘I like the fact that [the notes are] still there. Whereas, in class you talk about something and boom, it’s gone.’’ Reading notes was easier when participants improved the format of their notes. Finally, most students viewed the computer-mediated communication (CMC) technology to be user-friendly. ‘‘I really enjoyed using the PBL online this week, I feel like I’m really getting the hang of it and it’s so easy to use.’’ Online discussions improved over time. One student remarked, ‘‘[At first,] it’s like anything that anybody came across that had to do with FASD was on there and it’s like, ok, that’s enough already. And the second time it was much more like [a] response.’’ There was a period of adaptation before students engaged in meaningful online PBL discussions. Step five: practical application of knowledge to the problem None of the online student groups fully completed this stage of PBL. The inattention to step five could have been due to a number of factors including the short length of time they spent online, the period of adaptation to online learning, and/or difficulties of condensing the large volume of information generated online. A few students applied their newly acquired knowledge to the problem in a practical way through online interactions with the legal guardian. These authentic interactions often provided new insights: ‘‘The legal guardian’s notes were enlightening of the day-to-day struggles that the parents and grandparents have to go through.’’ Another student explained how she offered the guardian help. ‘‘That process to me felt like you were actually doing something with that information aside from putting it down and trying to
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study it.’’ None of the groups devised a care plan. As one neonatal student remarked, I think one of the differences from our online versus our in class was that either as individuals or as a group we would get to the point where we would develop a plan of care for our babies in our classroom, like in class. We would say, so ok, what are you going to do about this problem or this presentation, what are you going to order, what are you going to talk to the family about? And we never got there [online]’’ Step six: reflection on the content and process of learning With respect to the last step in the PBL process, students who participated in online PBL reported that group evaluation was seldom done and the evaluation conferences had minimal use. ‘‘I think we missed [weekly evaluation] because it brings closure for sure.’’ Students also noted that attention to assessment of group functioning could have led to earlier resolution of a problem within their group. ‘‘I agree had we done weekly evaluations maybe we would have caught [student’s name] frustrations, mine, everyone’s frustrations. It would have not been so massive… it would have been resolved sooner. But we didn’t.’’ Formal evaluation was perceived to add to the overwhelming workload. Some participants thought it would have been helpful to have someone prompt group evaluation, ‘‘Saying, ok post your thoughts of the week’’ and ‘‘maybe [the tutor] just saying let’s have a review of what you thought the strengths and weaknesses of the week.’’ There was a sense among some students that group evaluation occurred informally. One student reflected, ‘‘So it sort of naturally happened even though it wasn’t formalized.’’ In addition, students sometimes provided what was perceived to be informal feedback to individual group members about the quality of the information posted. As one participant said, ‘‘I think [evaluation] came out in a very informal way. I think that just about everyone of us probably complimented [student’s name] on the value of [the student’s] summaries.’’ Feedback often was in the form of endorsement of individual contributions, which fostered group cohesion. ‘‘This has been a good week, because people really seem to be commenting on others’ work. That is definitely what makes me engaged.’’
Discussion Online learning provides increased flexibility for students (Andrusyszyn et al., 1999; Choi, 2003; Poole, 2000). Our findings clearly showed that students appreciated the opportunity to learn at their own pace and in a manner that matched their individual learning style. They also valued the flexibility in
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time and location of learning. Adult learners with children, or those who juggle work with studies, are likely to benefit the most from this added flexibility. Research with graduate students indicates that flexibility is an important benefit of online learning (Andrusyszyn, et al., 2000; Burge, 1994). Students generally felt that online PBL provided them with more time to process material more deeply. Ronteltap and Eurelings (2001) conducted a content analysis of graduate students’ online PBL messages. They argued that writing in asynchronous communication might lead students to a deeper level of processing. Similarly, in the study by Andrusyzyn et al. (1999), graduate level nursing students felt online learning supported more opportunities for reflection and discussions were in more depth. In an editorial, Moore (2002) argued that the computer-mediated learning environment could support certain types of learners, particularly those who need and want more time to prepare their contributions. The online environment supports ‘‘continual sustainable communication’’ and provides ‘‘the amount of time needed for reflective thinking’’ (p. 62). He argued that having ample time to reflect and think deeply might contribute to high-level (deep) thinking. The unique resources available to students in the online environment were highly valued. Students appreciated the ease of access to the FASD experts who were recruited to communicate with the students online. A study of medical students participating for 12 weeks in online PBL found that their volume of online discussions with experts increased significantly over time (Stromso et al., 2004). The use of experts in our study also enhanced the authenticity of learning. Through online dialogue with a ‘‘real’’ client (Anna Guardian), students gained new perspectives about the day-to-day struggles of parents of a child with FASD. Chur-Hansen and Koopowitz (2004) supported the use of ‘‘patient’s voices’’ in PBL and identify patients as an under-utilized learning resource. Students also felt that they gained different perspectives from their interdisciplinary peers by reading past online contributions directed to the experts. Although there was no direct interaction between the three student groups in this study, online PBL offers tremendous opportunities for interdisciplinary learning and deserves attention in future research (Camp, 1996). The videos, electronic documentation forms, and animations also were appreciated. The auditory and visual resources were felt to support individual learning styles and provided details about the case that could not have been delivered through a text-based format. Kamin et al. (2000) argued that the use of video cases in their virtual PBL medical education program encouraged visual recognition skills, modeled professional behavior, and provided authentic scenarios for students. However, further research is needed to examine what effect online media rich cases have on PBL learning. Given that some students in our study forgot about these digital resources, the
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importance of conference design to improve awareness of readily available resources is underscored. Although students identified a number of positive aspects of online PBL, it was not without its challenges. Students felt that the conferencing system was easy to use, but they experienced a period of adaptation moving to the online environment. Similarly, Ronteltap and Eurelings (2001) found that law and medical students needed time to get used to online PBL. In a study by CarrChellman et al. (2000), graduate computer sciences students who participated in online PBL experienced frustrations with overload, time stresses, time zones, and technical difficulties. These findings led the authors to conclude that it is important to have experience with collaborative learning at a distance before moving online. Mattheos et al. (2001) studied online PBL with international dentistry students and found that students struggled with technical issues, overestimated their competence with computers, and misunderstood the PBL process. The authors recommended that students have more intensive training sessions and knowledge of PBL methods before moving online. Therefore, based on our findings and past research, there is evidence that students who are new to online PBL need to develop online literacy. Training in online PBL might be most effective if provided over time. The first training session could address basic technical skills, such as installing conferencing software, creating and replying to notes, and basic site navigation. Expectations of successful tutorial performance, including clear and realistic expectations, should also be reviewed at this time. A second training session could focus on strategies to support PBL group processes, critical thinking, and decision-making in an online environment, as well as the effective use of asynchronous tools and online resources. Students initially had difficulty setting learning objectives. This aspect of PBL was frustrating due to time lags in asynchronous discussion, which also made group decision-making difficult. Once learning objectives were established, students found it useful to have a new conference set up for each objective. Another difficulty was how to have in-depth critical online discussions. Initially, students tended to dump information and posted repetitive information, which frustrated and overwhelmed participants. Cartwright (2000) similarly found that students were confused about how to have meaningful discussion online. Preliminary communications were monologues rather than discussions, because students were reluctant to reply critically to their peers’ messages. These findings highlight the need for training and guidance in how to have effective discussions online. Duffy et al. (1998) highlight that the design of conferencing systems plays a vital role in supporting discussions. As others have found (Orrill, 2001; Winiecki & Chyung, 1998), students initially perceived that the discussion threads were confusing. Winiecki and
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Chyung described how online threads become difficult to follow. Online asynchronous communication is discursive (many conversations at once), compared to the serial nature of face-to-face discussions where speakers take turns in discussion. The time lag between messages, as well as the loss of conversational practices (such as head nodding, turn-taking, and references to previous statements), creates challenges for online discussion. One technique to overcome these challenges suggested by Winiecki and Chyung is to place strategic ‘‘snips’’ or quotes from previous messages into new messages to repair a lost idea in a thread. The ‘‘reply with quote’’ feature in FirstClass allows such ‘‘snips’’ to be incorporated as highlighted text in a message, thus helping to preserve the context of a previous message. Students were shown this feature during their training and used it more often as they gained online experience. Most students felt that synchronous chats were invaluable to support online PBL, particularly group decision-making and objective setting. Research examining the use of synchronous discussions in collaborative learning supports this finding. Mercer (2002, Unpublished Doctoral Dissertation) reported that chats provided students with immediacy of responses, and enabled collaboration and negotiation for decision-making within a short time frame. In the study by Mattheos et al. (2001), students felt that synchronous communication was far superior to asynchronous communication for problem discussion and hypothesis generation. McConnell (2001) found that chats led to agreements in decision-making and supported convening of groups, which ultimately led to more online asynchronous discussion. Findings from our study, as well as from other research (Cameron et al., 1999; Herring, 1999), indicated that students valued having a permanent record of chats for later reference. In light of these findings, educators must carefully select conferencing software for online PBL that supports both synchronous and asynchronous communication. Despite the value of chats, students often felt frustrated by them. Some students struggled with typing skills, which has been noted as a barrier by others (Mercer, 2002, Unpublished Doctoral Dissertation). Others found the chats hard to follow due to their fast pace and the fact that multiple conversations were happening at once. Mercer similarly found that students had difficulty following the rapid progression of chat messages. Herring (1999) attempted to explain this phenomenon as ‘‘interactional incoherence.’’ Turntaking typically occurs in spoken conversation where the transition from one speaker to the next ideally occurs with little or no gap, and there is no overlap between speakers. This type of interaction does not naturally occur online. Herring recommended strict turn taking to help improve online synchronous communication. The findings support the usefulness of having a chat moderator, as well as training in synchronous communication. The importance of the role of the tutor in online PBL cannot be ignored. Students clearly valued tutor guidance and wanted more direction with
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respect to expectations of the quality and quantity of notes. To reduce student anxiety, tutors need to set clear and realistic expectations for the frequency of online participation, as well as provide guidelines for what constitutes a quality online contribution. These issues become even more important in situations where tutorial participation is graded. Moore (2002) supports that students have high levels of online participation when expectations related to online discussion are specific and participation is graded. Choi’s study (2003) found that when the online tutor acted as a facilitator versus an observer, students had higher levels of satisfaction and motivation to learn and more clarity of learning objectives. In contrast, Stromsmo et al. (2004) found that students expected less of their tutor, possibly because they did not have competence to facilitate online. VandeVusse and Hanson (2000) identified a variety of faculty roles by analysing tutor input in a graduate nursing course using online PBL. Faculty assisted with navigation, explained expectations to students for successful participation, clarified faculty role, stimulated critical thinking, shared professional expertise, and provided encouragement. Many of these roles are congruent with those of a tutor in face-to-face PBL (Wolf and Rideout, 2001). Tutors also could prompt ongoing group evaluation. Although students gave informal feedback to one another during chats and sometimes in asynchronous messages, more formal group process evaluation was not carried out. Little is known about how group process evaluations occur in online PBL. Clearly more research is warranted to further our understanding of online PBL. How would students have perceived online PBL if they had been online beyond 4–6 weeks? Would tutors with more online experience have averted some of the online PBL struggles? How does the design space impact learning and use of resources? Research also is needed to examine the impact of hybrid approaches (face-to-face PBL mixed with online PBL) when distance is not an issue. Can the use of rich digital PBL cases and resources promote learning or reduce self directed learning? One of the major barriers in interdisciplinary learning is the problem of students’ conflicting schedules. Can interdisciplinary learning be effectively supported in online PBL? Since students in this study were not true distance learners, it is unknown how geographically isolated students would have perceived the PBL online experience. Conclusions This study has shown that PBL can be successfully implemented in an online format. It affords increased flexibility for students and is felt to enhance depth of learning by stimulating greater analysis and synthesis of information. The online environment provides opportunity for the case, which is the stimulus for learning, to be presented in a media rich format. It also allows for
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access to a broad selection of learning resources, including unique audiovisual resources and experts in topics relevant to the case. Both asynchronous and synchronous communications are software features necessary to support online PBL. Although there is a period of adaptation to online PBL, carefully planned training sessions can assist students to adjust to online PBL. Tutor training that addresses not only the technology aspects of online PBL but also the importance of clearly defined expectations and the provision of ongoing feedback is essential. Development of online literacy in students and tutors will smooth their progression to online PBL, and facilitate meaningful discussion and effective decision-making in both asynchronous and synchronous modes. In spite of its challenges, online PBL has the potential to support the acquisition and application of new knowledge in a variety of contexts, and creates the possibility for interdisciplinary learning.
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