INTERNATIONAL NURSING STUDENTS’ EXPERIENCES OF PROBLEM-BASED LEARNING IN A UNIVERSITY OF APPLIED SCIENCES
Qin Xiao Yi Master Thesis Nursing Science
Nurse teacher education University of Eastern Finland Faculty of Health Sciences Department of Nursing Science November 2016
TABLE OF CONTENTS ABSTRACT
TIIVISTELMÄ
1 INTRODUCTION... 1
2 PROBLEM-BASED LEARNING IN THE CONTEXT OF NURSING EDUCATION 4 2.1 Searching process for literature review ... 4
2.2 General principles and concepts of PBL ... 5
2.2.1 Basic principles of PBL ... 5
2.2.2 Group dynamics in PBL ... 5
2.2.3 Phases of PBL ... 6
2.3 Learners’ experiences and perceptions on PBL ... 7
2.3.1 Positive experiences on PBL ... 8
2.3.2 Negative experiences on PBL ... 10
2.3.3 Perceptions on tutors’ roles in PBL ... 12
2.4 Summary for research perspectives ... 13
3 PURPOSE, AIMS AND RESEARCH QUESTIONS ... 16
4 RESEARCH DATA AND METHODS ... 17
4.1 Sampling ... 17
4.2 Data collection ... 17
4.3 Data analysis ... 18
5 RESULTS ... 20
5.1 Students’ background ... 20
5.2 Students’ experiences on PBL ... 20
5.2.1 Students’ experiences of knowledge and skills development ... 20
5.2.2 Students’ experiences of individual interaction ... 28
5.2.3 Students’ experiences in the mechanism of PBL ... 31
5.2.4 Summary of students’ experiences on PBL ... 36
5.3 Students’ perceptions of tutors’ roles ... 37
5.3.1 Tutors’ role of guiding ... 37
5.3.2 Tutors’ role of supporting ... 40
5.3.3 Summary of students’ perceptions of tutors’ roles ... 44
6 DISCUSSION ... 46
6.1 Ethical considerations ... 46
6.2 Research reliability ... 46
6.3 Main findings and literature comparison ... 48
6.4 Conclusion and recommendations for nursing education ... 56
6.5 Suggestions for future research ... 59
REFERENCES ... 60
APPENDICES
APPENDIX 1. Table of literature searching and selection.
APPENDIX 2. Table of literature review.
APPENDIX 3. Questionnaire.
APPENDIX 4. Information letter for the students.
APPENDIX 5. Table of content analysis.
UNIVERSITY OF EASTERN FINLAND ABSTRACT Faculty of Health Sciences
Department of Nursing Science Nursing Science
Nurse Teacher Education
Qin, Xiao Yi: International Nursing Students’ Experiences of Problem-Based Learning in a University of Applied Sciences
Master thesis, 62 pages, 5 appendices (20 pages) Supervisors: Postdoctoral researcher Marjorita Sormunen, PhD
University lecturer Terhi Saaranen, PhD, Docent November 2016
With the rapid increase of biomedical information and knowledge, it has been more and more necessary to utilize problem-based learning (PBL) approach in the health and social care education. PBL is beneficial for learners to gain the necessary knowledge and form the key skills to professional practice. Nowadays, PBL has been actively encouraged to be implemented into the nursing education in different countries. However, there are only few studies related to the experiences and conceptions from the international nursing students’
viewpoints on the PBL in Finland.
The purpose of this study was to describe the experiences and perceptions of international nursing students regarding PBL as learning method and to explore better application of PBL for the international nursing students in a university of applied sciences in Finland. The aim of this study was to increase the understanding of students’ experiences and students’
perceptions related to the roles of tutors and to use the results to further development of PBL in the international nursing education in Finland.
The study was conducted using qualitative research method. The qualitative questionnaire contained both close-ended and open-ended questions. The sample group of study (n=18) were the 2nd year international nursing students. The content analysis was used to analyze data.
International nursing students had good impression on PBL as learning method applied into the nursing courses. The students reported the content of PBL case were suitable for students’
understanding. The students admitted that PBL enhances the ability for cooperating and critical thinking. Further, the guidance and support gained from tutors were considered as important. The tutors with abundance of professional experiences were more popular for these PBL nursing students.
This study provided the nursing educators with the students’ experiences of PBL learning methods and perspectives of tutor roles for the development of application of PBL in the nursing education in Finland. PBL could be utilized as learning method for nursing students to explore more knowledge independently and promote other learning skills. The nursing students should find their own roles and responsibilities in the group work and independent work. A more complete mechanism of PBL should make students receive more learning benefits from this learning method. Tutors’ guidance and supports were important for nursing students’ learning process in the PBL.
Key words: nursing education, problem-based learning, nursing students’ attitudes, perspectives, advantage, benefit, disadvantage, difficulty
ITÄ-SUOMEN YLIOPISTO TIIVISTELMÄ Terveystieteiden tiedekunta
Hoitotieteen laitos Hoitotiede
Terveystieteiden opettajankoulutus
Qin, Xiao Yi: Kansainvälisten hoitotyön opiskelijoiden kokemuksia ongelmaperustaisesta oppimisesta ammattikorkeakoulussa
Pro gradu -tutkielma, 62 sivua, 5 liitettä (20 sivua)
Ohjaajat: Tutkijatohtori, TtT Majorita Sormunen
Yliopistonlehtori, TtT Terhi Saaranen Marraskuu 2016
Biolääketieteellisen tiedon ja osaamisen nopea kasvu on lisännyt tarvetta hyödyntää ongelmaperustaisen oppimisen (Problem-based Learning, PBL) menetelmää sosiaali- ja terveysalan koulutuksessa. PBL on vaikuttava menetelmä, jonka avulla opiskelija voi kasvattaa ammatissa toimimisessa tarvittavaa osaamista ja avaintaitoja. Nykyisin monessa eri maassa kannustetaan ottamaan PBL käyttöön hoitotyön opetuksessa. Kuitenkin vain muutamassa tutkimuksessa on selvitetty kokemuksia ja käsityksiä PBL-menetelmästä Suomessa opiskelevien kansainvälisten hoitotyön opiskelijoiden näkökulmasta.
Tämän tutkimuksen tarkoituksena oli kuvata, millaisia kokemuksia ja käsityksiä kansainvälisillä hoitotyön opiskelijoilla on PBL:stä oppimismenetelmänä sekä selvittää, miten PBL-menetelmää voidaan parhaiten soveltaa suomalaisten ammattikorkeakoulujen kansainvälisissä hoitotyön opinnoissa. Tutkimuksen tavoitteena oli lisätä ymmärrystä opiskelijoiden kokemuksista ja käsityksistä tutoreiden rooleista. Tutkimustuloksia voidaan hyödyntää kehitettäessä PBL:n soveltamista kansainvälisessä hoitotyön koulutuksessa Suomessa.
Tutkimus oli laadullinen. Laadullisen kyselyn avulla kerätiin tietoja suljetuilla ja avoimilla kysymyksillä. Tutkittavat (n=18) olivat toisen vuoden kansainvälisen hoitotyön opiskelijoita.
Aineisto analysoitiin sisällönanalyysilla.
Kansainvälisillä hoitotyön opiskelijoilla oli hyvät kokemukset hoitotyön kurssilla käytetystä PBL-oppimisen menetelmästä. Opiskelijat raportoivat, että he ymmärsivät hyvin PBL:n casen sisällön. Opiskelijat olivat myös sitä mieltä, että PBL paransi kykyä yhteistyöhön ja kriittiseen ajatteluun. Lisäksi tutorilta saatua ohjausta ja tukea pidettiin tärkeänä. Tutorit, joilla oli runsaasti työkokemusta, olivat suosittuja PBL hoitotyön opiskelijoiden keskuudessa.
Tämä tutkimus tarjosi hoitotyön opettajille tietoa opiskelijoiden kokemuksista PBL:sta ja näkökulmia tutorin roolista. Tulosten avulla voidaan kehittää PBL:n soveltamista hoitotyön koulutuksessa Suomessa. PBL-menetelmää olisi mahdollista käyttää hoitotyön opiskelijoiden koulutuksessa, jotta he voisivat tutkia enemmän tietoa itsenäisesti ja siten edistää muita oppimisen taitoja. Hoitotyön opiskelijoiden pitäisi löytää omat roolit ja vastuut sekä ryhmätyössä että itsenäisessä työssä. Tutorin ohjaus ja tuki olivat tärkeitä opiskelijoiden oppimisprosessissa.
Asiasanat: nursing education, problem-based learning, nursing students’ attitudes, perspectives, advantage, benefit, disadvantage, difficulty
1 INTRODUCTION
The approach of problem-based learning (PBL) has been firstly implemented in medical education in 1960s at the university in Canada due to the dissatisfaction of tradition lecture- based teaching (Matheson & Haas 2010). Nowadays, PBL has been actively and globally encouraged to be implemented into the medicine and nursing as well as the allied health professions (Achike & Nain 2005, Chung & Chow 2004, McGarry et al. 2011, Martyn et al.
2014, Kim & Shin 2016).
Problem-based learning is defined as an approach for students’ learning, which is related to a process for structuring and promoting learning based on problem solving (Poikela & Poikela 2006). In PBL, the students, organized into small groups, will not only acquire the knowledge but also develop the communication skills, team skills and lifelong learning skills (Matheson
& Haas 2010).
The aim of PBL is to build an effective connection between the education and working life.
The PBL is considered as a learning method related to solving the problems under the clinical situations. (Poikela & Poikela 2006.) The PBL is seen as valuable for enhancing problem- solving skills, communication and critical-response skills (Gabr et al. 2011). PBL is beneficial for learners to gain the necessary knowledge and forms the foundation of professional practice (Matheson & Haas 2010).
In Finland, PBL’s first application in medicine presented in the University of Tampere at the beginning of 1990 (Poikela & Nummenmaa 2006). Since 1995, the PBL has been introduced into the nursing degree programme, for example, teaching of nursing ethics has applied the principles of PBL (Tuomi 2010). Since the year 2000, a national meeting named ProBell has been organized in order to develop, explore and evaluate theories of PBL and related fundamentals of pedagogical theory as well as its application in various levels of education and job training (Barrett et al. 2005). In 2004, University of Tampere started to implement PBL into the kindergarten education and primary teachers’ curriculum (Poikela &
Nummenmaa 2006).
With the rapid increase of biomedical information and knowledge, it has been more and more necessary to utilize PBL approach in the health and social care education. By the opinions from Ehrenberg and Haggblom (2007), the connection between clinical part of nursing
education and theoretical nursing seemed still to be separated instead of being as a whole, which showed the ‘theory-practice gap’ among the nurses. According to the study from Ehrenberg and Haggblom (2007) in Sweden, since the background of the nursing programme united into university in 1993, the majority of nurses with older education have been related to limited nursing research skills. It becomes a problem that nursing students have not been inspired to find and use new knowledge based on researches or make critical analysis of nursing skills and procedures (Ehrenberg & Haggblom 2007). The purpose of education for nursing students has been considered to develop the nursing skills, the ability of critical thinking and problem solving in order to promote the successful transition roles from students to professionals (Hall-Lord et al. 2013). Modern health and social care has required the health care workforce to cope with challenges and uncertainty, settling problems and making reasonable decisions (Matheson & Haas 2010).
By the research results from Uys et al. (2004), the ability of problem-solving of PBL nursing graduates showed better level than those graduated from non-PBL programme, which was evidenced by the graduates’ and supervisors’ narratives. Problem-based learning has played an important role in the education of health and social care professionals. PBL has provided chances for the participants to be a self-directed learner by exploring knowledge and evaluating themselves. It should be noticeable that PBL is beneficial for the students to become a practitioner lifelong learner within the health and social care working context.
(Delport & Squire 2010.)
However, Cooper and Carver (2012) mentioned that student experiences as one of research areas in PBL have been studied insufficiently in the mental health nursing programme.
Furthermore, there are not enough research evidence to show that PBL students produce better examination results than the students with non-PBL (Matheson & Haas 2010). There are still unclear fields and limitations related to PBL’s application for nursing students.
Moreover, it has been difficult to find certain studies related to the experiences and conceptions from the international nursing students’ viewpoints on the PBL in Finland.
The application of PBL in the nursing education may bring out meaningful influence on the nursing students’ development in the future clinical practice. Although there are several studies related to explore the PBL’s application in nursing students, it is still unconclusive to reflect the international nursing students’ perspectives and learning experience in Finland.
The purpose of this study was to describe the experiences and perceptions of international nursing students regarding PBL as learning method and to explore the effective application of PBL for the international nursing students in one university of applied sciences in Finland.
2 PROBLEM-BASED LEARNING IN THE CONTEXT OF NURSING EDUCATION 2.1 Searching process for literature review
The search for authorized academic articles and books in the study was conducted with the assistance of electronic searching system. Based on the data resources of Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier, Scopus and PubMed, these data sources could provide peer reviewed English journal academic articles in the field of nursing education and clinical healthcare. The time limitation for searching system included from the beginning of the year 2003 to February of 2016. The researcher applied two periods for searching articles that were at the beginning of the year of 2014 and 2016. The key words were set to limit the amount of articles. These key words were intensively connected to the research topic, “nursing education,” “problem-based learning,”
“nursing students’ attitudes,” “perspectives”, “advantage”, “benefit”, “disadvantage” and
“difficulty”. Simultaneously, these key words were arranged into different phrases with connection words, such as, AND and OR. According to the various setting systems of the different database resources, the criteria for setting limitations in selection of articles was specialized. The Appendix 1 includes the details for the process of searching and selecting articles with the limitations.
The inclusion and exclusion criteria for searching and selecting academic articles were listed in the Appendix 1. The articles were selected through the assessment of articles’ titles, abstracts and full texts. There were 25 studies selected as final articles for literature review.
The research methods in these articles included qualitative, quantitative, and mixed method.
The table of literature review is attached as Appendix 2.
These research articles had several characteristics as the following mentioned. The language for articles was limited to English. All of the selected articles were published in the authorized journals, such as Nurse Education in Practice, Nurse Education Today, Journal of Clinical Nursing, Journal of Advanced Nursing and so on. The published articles were written by the authors coming around the world including Australia, Canada, China, Finland, Jordan, Thailand, Turkey, UK as well as USA.
In addition, there were several professional books related to PBL used in this study for advanced comprehensive understanding the PBL, for example, Problem-Based Learning in Health and Social Care published in 2010 by Clouston et al., Problem-Based Learning in Clinical Education published in 2012 by Bridges et al., and Understanding Problem-Based Learning published in 2006 by Poikela and Nummenmaa. In addition, there was one electronic book chosen into this study, which is named Foundations of Problem-based Learning published in 2004 by Savin-Baden and Howell. In addition, one report concerned with PBL published by Tuomi in 2010 was referred to this study.
2.2 General principles and concepts of PBL 2.2.1 Basic principles of PBL
Based on the context of PBL, the students’ objectives include both knowledge memorization as the main purpose of traditional curriculum and the usage of PBL for observation, analysis and creation. In addition, the acquisition of knowledge has been found on the independent individual learning and shared knowledge from the reflective discussion among the group members. (Poikela & Poikela 2006.) The nature of discipline and goals of PBL have shown the differences from other learning approaches. The most important point should be that the students are focused in PBL.
Several characteristics of PBL can be illustrated as the followings. The learners can acknowledge their own base of knowledge. The responsibilities of learning are emphasized on the students themselves. It is the opportunity for combining the theory and practice. PBL strengthens the skills for interaction and communication. (Savin-Baden & Howell 2004.) The role of tutor in PBL is changed from the traditional supplier to facilitator (Savin-Baden
& Howell 2004). The PBL group will function well with the facilitation of tutors. The qualities of tutor can be concluded from three aspects, such as, the suitable knowledge base, a willingness to engage with students and good skills for expression (Harendza et al. 2012).
2.2.2 Group dynamics in PBL
The individuals participating into the PBL are divided into groups. The group members need to cooperate with each other and take the individual responsibility from the group. The group
dynamics is the process of understanding how groups work. Namely, it can be also considered as the individual interaction between group members. Each group is specialized in the various ways depending on the individual members and the events occurred in the group.
(Seymour 2010.) In the whole process of PBL, the tutor will lead the trend of group dynamics in order to facilitate the participation and satisfaction of the students and achievement of learning goals. (Öystilä 2006.)
There are five stages in group dynamics. The initial stage can be called as dependency and inclusion, which means that the group members communicate in a polite way and the tutor tends to supply the direction and personal safety in the group. The second stage is counter- dependency and fight that is characterized by the conflicts among the group members or with leader, which is helpful to form the trust and cohesion in the PBL group. Trust and structure as the third stage will indicated by the students with more mature negotiation on group goals and task-oriented communication, which can be considered as the starting preparation for work. In the fourth stage named work, group members will concentrate on doing the job well through seeking out the resources and analyzing them for performing the group tasks successfully. The termination as the last stage means that leader should facilitate a positive end for the group, such as, encouraging the members to discuss the achievements, avoiding the increase of stress and anxiety. (Seymour 2010.)
2.2.3 Phases of PBL
Poikela and Poikela (2006.) mention that tutors in tutorials are purposed to facilitate the process of problem solving. During the whole study module, the tutorials are held by group members one time in one or two weeks. Besides this, the students conduct self-directed study by using various information sources, for instance, libraries, scientific websites, and interviewing the experts. (Poikela & Poikela 2006.)
The implementation of PBL will be carried out according to eight phases. In the first phase, the students need to understand the situation and background of the problem, based on which, the second phase will be started by the brainstorm. The second phase is necessary for the group members to explore the previous knowledge related to the problem phenomena. The third step is to collect and classify the similar ideas into categories with different names.
Based on previous steps, the forth step is mainly to facilitate selection of the most important
area for asking the questions. In the fifth phase, the students need to determine their tasks and learning goals. After that, it is time for the students to collect and seek the professional knowledge and current information as the process of self-study in the sixth phase. In the seventh phase is a period for constructing the knowledge. During the eighth phase, the students need to compare the different learning results among groups according to the questions discovered in the starting point. (Poikela & Poikela 2006, Tuomi 2010.)
Figure 1. Eight phases of Problem-Based Learning cycle. (see Poikela & Poikela 2006.) 2.3 Learners’ experiences and perceptions on PBL
The learners’ experiences on PBL are mainly divided into positive experiences and negative experiences. Various learners’ perceptions on the tutors’ roles are illustrated in the literature review.
1. Understanding in background of problem
2. Brainstorming
3. Categorization of ideas
4. Question synthesis
5. Determinination of tasks and learning
goals 6. Self-study
7. Construction of knowledge 8. Comparison of
learning results
PBL Cycle
2.3.1 Positive experiences on PBL
The characteristics of PBL as a learning method are active, interactive and student-centered, which was mentioned in Tiwari’s study related to the effect of PBL on students clinical nursing education (Tiwari 2006). The nursing students were given the opportunity for learning about real patient problems in a more interesting and meaning manner, which made the students feel pleased on the questions relevant with the learned knowledge and real nursing experience (Tiwari et al. 2006, Mete & Sari 2008). As the study by Chan (2014) pertaining to teaching innovation for developing nursing students’ corresponding competence in providing health care services, the nursing students learning with PBL enjoyed the nursing problem-based learning class related to writing poems, composing songs and using role playing.
Increased possibilities of self-direction appeared during the process of PBL by Cooper and Carver (2012). The students developed many characteristics regarding self- directed learners, such as, sharing and summarizing information, being able to respond to questions and being confident to identify learning needs (Williams 2004). The students admitted that PBL had the effects in promoting them to have the skill for searching information (Rowan et al. 2009). As the research by Williams in 2004 mentioned, baccalaureate nursing students expanded the range of searching information from textbook to books and journals (Williams 2004). The third year nursing students used the libraries more often to study independently (AI-Kloub et al. 2014).
Asking questions and sharing different opinions on individual learning results with other group members were facilitated by applying the PBL as learning method for baccalaureate students in nursing (Williams 2004). Based on the research concerned students’ views on PBL between the students in Shanghai and Macao, Shanghai students responded PBL as the manner to foster them to analyze situations in different ways and encourage to share the opinions as well as consider more possibilities for resolving problems (Yuan et al. 2011).
The confidence of nursing students was mentioned in the study of Poskiparta et al. (2013) about Finish nursing students’ experiences of PBL in health promotion education. The results showed that the students needed more guidance due to their less confidence on the learning abilities (Poskiparta et al. 2013). The confidence of learners was enhanced by encouraging
them to share correct or wrong opinions within PBL (Anderson & Reid 2012). Furthermore, baccalaureate nursing students reflected that they had the abilities for summarizing and sharing searched information confidently, which was reflected by the study of Williams’
study about self direction in PBL nursing program (Williams 2004). In addition, it was reported that undergraduate nursing students increased the confidence in resolving problems appearing in the PBL case (Tiwari 2006). The study concerning mental health student nurses’
experience in PBL from Cooper and Carver in 2012 showed that post-graduate mental health nurses considered PBL as learning method increasing the confidence related to their practice (Cooper & Carver 2012).
The PBL generated high level of motivation for the third year nursing students in maternity nursing course (Alkasawneh et al. 2008). PBL motivated learning and encouraged teamwork (Chikotas 2009). The second year nursing students in PBL group had higher learning motivation compared with the students in traditional group (Hwang & Kim 2006). The students experiencing traditional teaching methods reflected that PBL was more effective method to encourage them to assume the learning responsibility for own learning, which was provided by the Yuan et al. (2011). The similar results found in the study by Lin et al. (2010) that nursing students educated by PBL had more satisfaction in the parts of self-motivated learning. According to Chan (2014), the motivation to learn and empathy to patient was enhanced for the nursing students in PBL courses.
PBL was helpful to promote the open communication and mutual trust with group members, which was evidenced by Eccott et al. (2012) in the study regarding the attitudes and perceptions of 24 students from medicine, pharmacy, nursing, physical therapy and occupational therapy in the PBL module. The post-graduate mental health nurses under second-year educational course with PBL agreed that limited group size might enhance the opportunity for offering mutual support and sharing knowledge (Cooper & Carver 2012, Poskiparta et al. 2013). Both students and teachers illustrated that PBL could connect the individuals to work together and overcome barriers and resolve the problems in a more flexible manner (Poskiparta et al. 2013). The results from Yuan et al. (2011) indicated that PBL was moderately effective from the students’ opinion for fostering communication skills.
The students mentioned their group work skills required in the contemporary health and social care system were enhanced by the influence of PBL, such as dealing with value
diversity and ambiguity (Smith & Coleman 2008, Cooper & Carver 2012, Poskiparta et al.
2013).
The ability of critical thinking and use of evidence in practice could be supported by PBL’ s application in nursing, which was suggested by Martyn et al. (2014) in the study to explore the relationship between teaching, approaches to learning and critical thinking in a PBL nurse course. PBL could cultivate the critical thinking for the nurses to receive the required competencies in clinical practice (Smith & Coleman 2008, Applin et al. 2011). Yuan et al.
(2009) mentioned that the students were encouraged to analyze the situation critically and frame the issued in different way, which would assist them to compare different potential results and critically apply what they found in the clinical practice. As a result of critical thinking and creativity developed by PBL, nursing students had the sensitivity and ability of reconstruction knowledge (Chan 2013). Thai nursing students agreed that their abilities for solving problems and critical thinking increased in the PBL (Klunklin et al. 2011). The critical thinking skills could be affected by classroom learning environment, characterized by personal relevance, uncertainty and critical voice (Martyn et al. 2014). The research results by Chan (2013) suggested that several classroom activities had the possibilities to arouse the students’ awareness to critical thinking, such as, composing songs, writing poems and role plays.
2.3.2 Negative experiences on PBL
Time-wasting in PBL was noted from the students in the research by Yuan et al. (2009). The process of PBL was considered as time-consuming and stressful process by half of Macao students and approximately 20 percent of Shanghai students (Yuan et al. 2011). Much personal time was applied by undergraduate nursing students so as to search for large amount of information (Tiwari 2006). Some students and teachers still need more time to accept learning outcomes of PBL in the health promotion issues (Poskiparta et al. 2013). In the study from Jones (2006), the time required for PBL can be problematic especially for the students with crowd curriculum. It was suggested by AI-Kloub et al. (2014) that adequate learning resources and sufficient time could be supplied for students in the PBL.
Besides the negative aspect of time-consuming, the large workload from the PBL was also considered as one of concerns for the students (Yuan et al. 2010). Although the students were
expected to search for the professional knowledge by themselves instead of receiving expert knowledge directly from the teachers, apparently, a larger course workload increased up, such as, proceeding critical thinking and related cognitive activities. (Smith & Coleman 2008).
Uncertainty stress and worry during the adaptation to PBL were also mentioned in the study by Klunklin et al. (2011), especially at the beginning of the programme (Rowan et al. 2008).
At the same time, the students had anxieties and concerns about the absence of teaching-led sessions (Cooper & Carver 2012). The feelings of uncertainty and anxiety were stimulated by the nursing students’ doubts of learning range in the PBL when they compared with previous conventional learning style (Smith & Coleman 2008, Yuan et al. 2011). The students concerned about the insecurity about what they learn rather than how the PBL process enable them to learn (Smith & Coleman 2008). Even if after owing the skills of retrieving and criticizing the information and worried about receiving incorrect information, the students still felt unprepared for the practice (Rowan et al. 2008). The students admitted that it was hard in the starting of PBL without previous knowledge or direction (Mete et al. 2008, Cooper & Carver 2012). Especially for the first year students, it could lead to uncomfortable learning experience because of tutors’ professional specialized questions and details with many new terms (Mete & Sari 2008).
Unclear instructions for topics of assignment and grading rubrics were viewed by the students as lack of consistency. Besides this, the students used to teacher-oriented learning felt confused with PBL’s self-directed learning. (Landeen et al. 2013.) Cooper and Carver (2102) described that mental health nursing students still had tendency to require the reassurances whether they proceeded correctly during the whole process when adapting to PBL. The lack of feedback and less reassurance about own studies could also result in the low level of dental nurses’ confidence in the self-directed learning process of PBL (Anderson & Reid 2012). The student expected the tutor to provide the relevant information when the problem could not be resolved by students themselves (Mete & Sari 2008). In addition, the students suffered uneasy when the tutors pointed out their insufficiencies in public, meanwhile, positive feedback was required by the students to afford from the tutors (Mete & Sari 2008).
Anderson and Reid also suggested in their study on dental nurse students’ participation in
PBL that students will be motivated by tutors’ encouragement and enthusiasm (Anderson &
Reid 2012).
2.3.3 Perceptions on tutors’ roles in PBL
According to Harendza et al. (2012), the role of tutor in the PBL was considered as a critical factor in leading to the success of students’ individual study and group work, such as, providing assistance and directions when students being short of previous knowledge, encouraging student learning by creating an open atmosphere. The facilitators were considered as resource of encouragement for relieving students’ anxiety and creating a collaborative learning atmosphere (Yang & Yang 2013). especially the active and inspirational facilitators were preferred by post graduate mental health nurse students (Cooper & Carver 2012). Cooper & Carver (2012) mentioned that facilitator’s enthusiasm for the subject could increase the motivation for the effective function in the PBL groups.
Besides character of tutors, the effectiveness of PBL also relies on the support of faculties by developing students’ understanding on PBL and strategies for coping PBL process (Yuan et al. 2011). The students indicated that learning motivation and success in PBL were influenced by the behaviors and clinical experience of tutors, such as, giving concrete example for promoting understanding, and activating students’ interests to explore (Mete &
Sari 2008). The students preferred the facilitator’s comments on the group presentation as the reference for progressing the next presentation (Yang & Yang 2013). Meanwhile, asking questions with high quality as one of the tutor’s abilities was required during the process of PBL, which would be helpful to the students to focus on the subject matter and make the connection between theoretical knowledge and clinical situation (Mete & Sari 2008).
In addition, the students had good feeling to the facilitators who could differentiate the students with more active contribution to the group discussion (Yang & Yang 2013). as well as the some students need special attention due to the individuals’ particular learning preference (Alkasawneh et al. 2008). The tutors also encouraged the silent students to participate discussion actively. The eye contact with tutors promoted the students’ self- esteem and positive group dynamics. (Mete & Sari 2008.)
The students have disappointed feeling on the lack of facilitator’s support in the discussion part (Poskiparta et al. 2013). The researched results indicated facilitator’s rigid critical evaluation could easily lead to the neglect on the students’ hard effort in PBL, which would not be beneficial for the students to build the trust with other members (Yang & Yang 2013).
In addition, boring tutorials and instructors had less contribution to the process of PBL (AI- Kloub et al. 2014).
The need for more guidance from facilitators was required by Finnish nursing students as a result of their less confidence on the personal abilities (Poskiparta et al. 2013). The nursing students tended to expect tutors to trigger them to find out the resolutions for correcting the wrong information instead of receiving the correct one directly from the tutor. The tutors were suggested to maintain the balance on different nursing field rather than relying on their own specialized professional fields. (Mete & Sari 2008.) The study of Yuan et al. (2011) suggested that PBL tutors for nursing students should play the role of assisting students to understand PBL, developing strategies in promoting students to cope and engage actively in participation and consultation in the process of PBL.
2.4 Summary for research perspectives
The learning process of PBL was described by the participants as enjoyable, active and student-centered learning manner, as well as the different activities in the PBL (Tiwari 2006, Mete & Sari. 2008, Chan 2014). The PBL can provide the opportunities and conditions for the students to interact actively with other group members and exchange the comments and opinions on individual learning results (Williams 2004, Smith & Coleman 2008, Yuan et al.
2011, AI-Kloub et al. 2014).
The motivation for active learning was enhanced by applying the PBL according to several researchers’ opinions, which could be resulted from skill of information search and PBL’s inspiriting atmosphere (Hwang & Kim 2006, Alkasawneh et al. 2008, Chikotas 2009, Lin et al. 2010, Yuan et al. 2011, Chan 2014). The advancement of the skills for working as a group in the PBL are also noticed by several articles, such as, communication skills, mutual trust and skills for overcoming barriers (Ecott et al. 2012, Poskipart et al. 2013).
Another important characteristic of PBL was to facilitate the capacity of self-directed learning through providing chances for students’ independent information searching and awareness of own responsibility in continuous learning as well as increase of self-confidence in the construction of personal learning goals (Williams 2004, Yuan et al. 2010).
Critical thinking as the required skills in the clinical practice was developed on the participants during the application of PBL (Smith & Coleman 2008, Applin et al. 2011).
Several articles showed the students’ opinions relevant to several factors of cultivating the ability of critical thinking in the PBL as well as the teachers’ advices for promotion of critical thinking (Ozturk et al. 2008, Klunklin et al. 2011, Chan 2013). The effect of PBL was also influenced by time-consuming, unclear objectives, overall design structure of PBL, increasing workload, large group size and facilitator issues as well as poor interaction among the group members (Wells 2009, Yuan et al. 2009, AI-Kloub et al. 2014). Different reasons for causing students’ stress and worries and related negative results were also mentioned in some researches (Mete et al. 2008, Anderson & Reid 2012, Landeen et al. 2013). In addition, unclear instructions for assignments and grading rubrics confused the students and made the difficulties on evaluating the learning effectiveness of PBL for the participants (Smith &
Coleman 2008, Landeen et al. 2013). The students admitted the tutors with positive attitude would help them to decrease the anxiety and facilitate the formulation of opened learning environment as well as motivate students’ to be the effective participant in the PBL learning groups (Cooper & Carver 2012, Yang & Yang 2013).
It was the phenomena that students required the tendency of the reassurance of searched knowledge by the tutor during the process of PBL and tutors’ further information on the unresolved problems as well as the manner of giving feedback (Mete & Sari 2008, Anderson
& Reid 2012). The tutors’ supports and related strategies for applying PBL could affect the students’ effective understanding on the utilized learning method, so that it would be helpful for the students’ to adjust the learning attitude and cope the challenges by applying this learning method (Yuan et al. 2011). The students’ learning motivation was enhanced with the tutors’ teaching behaviors and own clinical experiences through sharing the clinical examples stimulating the students to make further exploration (Mete & Sari 2008). Tutors’ appropriate comments and questions were regarded as the factors for promoting participants combining the theoretical knowledge with the concrete situations (Mete & Sari 2008, Yang & Yang
2013). The tutors with the ability of differentiating the students’ abilities had more possibilities to be welcomed by students, because students individually had the particular learning manner (Alkasawned et al. 2008, Yang & Yang 2013).
The students using PBL to study pediatric clinical course mentioned PBL with boring tutorials (AI-Kloub et al. 2014). Lack of sufficient supports from tutors resulted to the students’ negative emotion, such as, disappointed feeling (Poskiparta et al. 2013). Strict critical evaluation for the students could also interrupt the formulation of trust among the group members (Yang & Yang 2013).
The PBL students provided various suggestions and expectations for the tutors due to individuals’ needs for advancing their learning efficiency within the PBL. The tutors were recommended to trigger the students’ motivation of self study and active participation as well as provide the students with abroad professional knowledge in each nursing field (Mete &
Sari 2007, Mete & Sari 2008). Teaching strategies in the PBL should be also developed to promote students to understand the principles of PBL and then to engage into the process actively (Yuan et al. 2011).
3 PURPOSE, AIMS AND RESEARCH QUESTIONS
The purpose of this study was to describe the experiences and perceptions of international nursing students regarding PBL as learning method and to explore better application of PBL for the international nursing students in a university of applied sciences in Finland.
The aim of this study was to increase the understanding from students’ experiences and students’ perceptions related to the roles of tutors and to use the results to further development of PBL in the international nursing education in Finland.
This study included the following questions:
(1) What are the 2nd year international nursing students’ experiences on PBL as learning method in a university of applied sciences?
(2) What are the 2nd year international nursing students’ perceptions on the tutors’ roles in the PBL process in a university of applied sciences?
4 RESEARCH DATA AND METHODS 4.1 Sampling
The second year international students with PBL as purposive sampling were considered as the sources of providing the data for achieving the purpose of this study (see Grove et al.
2013). The opinions related to PBL were gathered from the second academic year international nursing students in a university of applied sciences in 2014.
Regarding the international nursing students in a university of applied sciences, PBL is implemented as one of learning method other than the learning style in traditional lectures for these students. The purpose of PBL is to cultivate students’ learning ability of solving real- life problems. PBL based studies has been implemented on international nursing students in the second academic year. The potential participants (N=45) was divided into two groups (Group 1 and Group 2). The students in Group 1 started applying PBL in the course named Medical & Surgical during the autumn semester of 2013. The students in Group 2 also used PBL to start the same course from the spring semester of 2014.
4.2 Data collection
Questionnaire was applied as the method for collecting data from the purposive sampling in this study. Questionnaire is a self-report form designed to extract the information from participants directly in the written manner. The second year international nursing students could write down individual answers to each question in the questionnaire. The written information from these participants can be considered as the data for this study. (see Grove et al. 2013.)
There were 14 questions set in the questionnaire composed of three dimensions (background of participants, experiences of PBL and perceptions on tutors’ roles). In this study, questionnaire was composed of two types of questions: closed-ended questions and open- ended questions. The closed-ended questions were purposed to collect the background of the participants. (see Grove et al. 2013.) In order to collect data more efficiently in this study, using open-ended questions was regarded as appropriate way for receiving the students’
perceptions and experiences concerned with PBL in small samples. The questionnaire consisted of eight closed-ended questions for acquiring background and five open-ended
questions related to students’ experiences and perceptions as well as one general open-ended question was targeted for participants to share opinions and suggestions freely. The content of questions was formulated based on the results from the studies in the literature review.
The pilot test was executed for identifying the appropriate level for the participants in understanding and language fluency to the questionnaire. The content validity of questions in the questionnaires were evaluated through proceeding pilot test on three second-year international nursing students with previous learning experience related to PBL in the same university of applied sciences, which was useful for evaluating the understanding level of questionnaire’s content. In the pilot test, three participants were also asked to fill in the feedback chart for assessing the time-using and degree of acceptance. In addition, content of questionnaires was evaluated and identified with the assistance of the specialists of nursing PBL method in the same university of applied sciences.
The questionnaires were collected from May to October in the year of 2014. Besides 15 pieces of questionnaires answered by the second academic year students, three questionnaires from pilot test were also included. Altogether 18 questionnaires (n=18) were selected to continue data analysis.
4.3 Data analysis
The qualitative content analysis was used in data analysis. Firstly, the researcher reviewed all texts line-by-line answered by all the participants to understand the context of these nursing students’ responses on PBL, which is beneficial for the researcher to look for the repeated ideas in the whole manner. (see Grove et al. 2013.)
Secondly, according to Grove et al. (2013), it was necessary for the researcher to convert the data into smaller and more manageable units by taking certain part of the participants’
original phase or words. The answers from the participants were broken down into smaller segments for careful combination of similarities and comparison between differences. The participants had their own opinions for answering the questions in the questionnaire. All of the opinions were reorganized into different groups according to key meanings in the students’ responses.
Thirdly, the reorganized data groups were labeled with new titles. In addition, further coding level continued for relabeling the codes into the level of abstraction and formulating the common theme. The researcher extracted more concentrated themes from the labeled data groups. (see Grove et al. 2013.) The related tables in the attachments were applied by the researcher to illustrate how to form the coding and themes in order to show the process of content analysis (see Pilot & Beck 2014).
5 RESULTS
5.1 Students’ background
All the female and male participants included into this study were the second year nursing students in the international nursing program from a university of applied sciences.
According to the requirements of participants' compulsory curriculum, problem-based learning (PBL) courses were conducted both in the semester of 2013 Autumn and 2014 Spring respectively for two groups of participants, which meant that each participant was required to take the application of PBL method in one semester in same academic year. The age of participants ranged from 20 to 35 years old in the study. Quite few participants mentioned previous learning experiences pertaining to PBL in the previous education organizations before their admission into this university of applied sciences. Each participant was required to have three PBL cycles in the course of surgical operation in two months either in 2013 autumn or 2014 spring. Each participant was required to finish three essays pertaining to peri-operative nursing care based on three PBL cycles in one semester.
5.2 Students’ experiences on PBL
The students’ answers regarding learning experiences on PBL were made up of three portions that were students’ experiences of knowledge and skills development, students’ experiences of individual interaction and students’ experiences in the mechanism of PBL.
5.2.1 Students’ experiences of knowledge and skills development
The students’ experiences of knowledge and skills development consisted of three categories:
1) PBL case, 2) problem and information, and 3) skills in PBL tasks (Figure 2). PBL case was divided into two parts named contents of PBL case and limits of PBL case. Problem and information mainly described students’ experiences related to question synthesis, benefits of information search and difficulties within the process of information search. The third category named for skills in PBL tasks included advanced attention and motivation, advanced comprehension, and skills development.
PBL case included contents of PBL case and limits of PBL case. Based on the description of the participant, contents of PBL case were easy for the students to understand and helpful to
explore furthermore which were related to the clinical care of patients, diagnoses and diseases, and medications as well as the patient education including surgical procedures, and treatments and monitor for patients during the peri-operation.
“Personally I learned a lot because we broke down the surgical procedure. In the pre-operation, I learned about the gallstones disease and the feelings that nurses need to know before and during operating. Also about patient educating about the surgery and what illnesses or medication … what to monitor during the procedure”
Participant 1
At the same time, contents of PBL was considered as the connection between theoretical knowledge and practical aspects for stimulating students to discover the problems and make appropriate nursing care plans to patients. Meanwhile, content of different PBL cases provided the connection among each other to support students’ learning efficiently and comprehensively.
“PBL gets me much closer to the practical aspects while learning, allowing me to learn more effectively.” Participant 5
“Students feel proud that they were actively involved in solving an operating theater problem.” Participant 7
“When we have PBL, the different topics were supporting each other.” Participant 6 Case problem being divided into smaller parts really helped the students to decline their stress on the formulation of huge PBL problem. PBL assignments should be designed into an appropriate size and level of difficulty instead of large project or lots of small piece of tasks.
“It made learning easier in a way that one did not need to concentrate and stress about huge problems but focus on few clear questions at the time.” Participant 8
In contrast to the earlier mentioned results, the participants also pointed the limitations in the contents of PBL. The limited PBL contents restricted the students’ learning range regarding advanced exploration to other diseases and treatments. Lack of opportunity to know about other cases was considered as another factor resulting in the limited learning field for students. The participants concerned that the supplied case with specific disease and related
treatments could not represent other cases coming from various fields of practical nursing care, which were regarded as weak points by the participants. The participants thought this weak point might hinder the learning opportunities of developing and advancing other professional knowledge with forward movement. In addition, it was required to provide more clear and sufficient case content related to patients’ objective information for improving the exploration of the students’ learning range.
“Based on the problem case we maybe don’t get to explore other areas of relevance and subject matter. We learn specific diseases and treatment, while we lose out of other cases.” Participant 10
“The case should be clear and factors affecting vital signs should be clear.”
Participant 1
Problem and information consisted of question synthesis, benefits of information search and difficulties of information search. PBL supplied the possibilities for the students to synthesize their own questions based on the content of PBL. In the process of formulating appropriate group question, students intended to consider together and discuss within own group through inspecting the various aspects of PBL case and sharing individual opinions under the environment filling with the humanity value of equality. The participant also recognized, in some groups, that voting round implemented as a democratic-like policy took place for encouraging and triggering each member among the group to maintain their own rights and roles for expressing opinions, which influenced the decisions on the formulation of group question.
“Problem-based learning is giving everyone the chance to formulate their own questions, be deliberated by whole team and voting according to what is best for the whole team.” Participant 16
The democratic voting was one of the manners for students to select the appropriate group’s PBL question from different choices, but it was considered as one obstacle for expanding the learning scope. The participants hold the view that there was a potential tendency among the group members towards avoiding selection of the learning topic with more time use.
Important questions might be extracted out of the question list by democratic voting. It was
also possible to lead the students to lose the opportunities to identify high-quality questions for exploring more professional knowledge.
“Some students voted only to study easy aspects of the case rather that study relevant aspects.” Participant 10
“With PBL one is limited to the case and should not focus on other feeling affecting the problem. We focused only on the pre-operative, intra-operative and post- operative procedures and not on the genesis or the causes behind gallstones formation.” Participant 1
Besides the formulation of problem, dealing with the information within PBL process was another considerable part for students. The students mentioned several benefits of information searching within the PBL. The participant added that skills of searching information were developed with advancement of the ability to filter the effective and sufficient information within the learning tasks. The participants also mentioned the strengthened capacity of using internet information portals as the academic assistant tools of information search. Meanwhile, interesting and vivid learning process had been experienced by the participants when playing the active role in the information searching regarded as one of necessary phases of PBL cycle. Furthermore, the process of information collection was also the progressive manner of learning knowledge in the process to become one specialist commanding the ability of dealing with clinical situations.
“Learning how to search for information and understanding what information is relevant. I have learnt to use information portals to search for specific information in a timely manner.” Participant 17
“I am involved myself in finding out information rather than listening lectures all the time, I am more active and feel more free to learn which never let me fell boring.”
Participant 18
“When knowing the problem or in this case the disease it helps you to find out information and when gathering information you learn as well. During the PBL process one becomes a master of the certain problem.” Participant 15
As one of the characteristics of PBL case content, the students also mentioned that PBL case enhanced the learning efficiency in the information search. The PBL learning method was useful to cultivate the ability of exploring knowledge in the process of searching information in order to think about and deal with the synthesized tasks in the PBL. Meanwhile, it could influence the student to arrange the extensive information for resolving the formulated question in the PBL. In addition, it was meaningful to encourage each student to participate into the group work actively by sharing self-explored knowledge with other group members.
“It widens your knowledge in the process of information searching and encourages everyone’s participation in a group.” Participant 11
Simultaneously, difficulties in information selection emerged also in the participants’
answering. Searching adequate and efficient resources was considered by some participants as challenge in the PBL period, especially the searching keywords in the conjunction with unfamiliar medical terms, which increased the difficulties for them to select appropriate resources for resolving problems. To some extent, experienced students noticed that each individual report referred to different sorts of academic resources, and these resources might formulate the conflicts among the knowledge pertaining to nursing practice. Additionally, insufficient knowledge background on the discussed PBL topic was regarded by the student as an obstacle of exploring the related information in the beginning period of PBL.
Inadequate information resources were also relevant to being less acquainted with professional terms emerged in the PBL.
“Students using different sorts of references: some are using national recommendations and others single research papers that might contradict. Difficult for the mentor to correct false or outdated information when the group was already
‘processed’ it.” Participant 12
“In the beginning it felt a bit difficult since I don’t have any background information about the topic.” Participant 4
“Sometimes it was difficult to find adequate resources to some strange medical words.” Participant 2
The third category named for skills in PBL tasks contained several parts, including enhancement of attention and motivation, advanced and abroad understanding, as well as skills development. The PBL supplied opportunities of incorporating the new learning rules into the nursing courses for the students with first time to come across PBL. The students were encouraged to face the challenges in the competence for responding new learning method and building thinking process in knowledge analysis. As the participant mentioned, group members were motivated to actively participate in learning process independently and cooperatively to adapt to this kind of learning method.
“PBL is a relatively new learning experience for me. I have never come across it before until we used it to study operative nursing. It makes every student active member of the group and for that matter, the class.” Participant 7
Regarding PBL’s large amount of information, this learning method made the students to be accustomed to face larger amount of various type of reading materials, which was considered as difference from traditional learning method requiring relatively smaller range for reading.
“It was good to familiarize yourself in different texts and I read more than I would probably here to different kinds of methods (f.ex. normal lesson).” Participant 2 Additionally, the PBL supplied the chances for promoting learning skills how to deal with knowledge, such as, making knowledge accumulation, building linkages among the professional knowledge and making judgments on group members’ obtained knowledge.
Furthermore, PBL method provided the opportunity for the participant to utilize the received PBL knowledge into developing more extensive comprehension in other learning fields.
“I have increased my knowledge on the task and I was able to discuss with group members what I have learnt. I was also able to relate the new knowledge to other courses.” Participant 17
Besides the fair opportunity provided in the PBL’s learning atmosphere, the students could also facilitate social interaction skills to improve effective communication with other group members, which could be considered as the skills serving throughout the whole life, for example, keeping higher quality of presentation and delivering more clear and pervasive presentation in the next PBL cycle.
“It will also boost your public presentation skills in a way bolstering your communication skills in future presentation.” Participant 16
Besides the advancement of social interaction skills, several required skills for learning also emerged in the PBL, such as, critical thinking skills, time-management skills and ability for group dynamics adjustment. The participant admitted PBL provided the opportunity to practice and reinforce these skills and capacities especially when facing conflicts among the different viewpoints in the group discussions.
“It felt challenging as it will hone your critical thinking skills, time-management skills and group dynamics and see how ideas clash and become one without compromising the main thought of the discussion.” Participant 16
Figure 2. Students’ experiences of knowledge and skills development
Class Subcategory
Main category
Student’s experiences of knowledge and skills
development
PBL case
Contents of PBL case Limits of PBL
case
Problem and information
Question synthesis Benefits of information
search Difficulties of
information search
Skills in PBL tasks
Skills development Enhanced attetion
and motivation Advanced comprehension
5.2.2 Students’ experiences of individual interaction
The students’ experiences of individual interaction consisted of two types of working manner for the students, which were divided into 1) independence and cooperation and 2) roles and characters (Figure 2). Independence and cooperation included two parts named respectively independent work and group work. Roles and characteristics was composed of roles playing and characters of group members
Independence and cooperation consisted of individual work and group work. PBL contained the independent study for students. The student indicated it was a preference to hold on independent work at first before the further group discussion pertaining to making decisions on the answers of questions. The part of PBL learning cycle was also regarded as an independent learning phase contributed by group supports, which could offer the students a unique learning manner of comparing and combining the learning results from individual independent study and various answers from other group members.
“Independent studies. I realized that PBL gave me the chance to study on my own and then compare with my group members what I have.” Participant 14
Group work in PBL allowed the students to know how to incorporate with the rest of group members. The students shared the multiple concepts and knowledge and evaluated the searched information associated with the identified PBL problem. The group members hold the group’s own final meeting for collecting the individually searched information, incorporating comments and making decisions based on the most recurrent or noticeable knowledge and proposals. The final meeting was purposed to find out and refine the appropriate and useful resolutions to be implemented in patients’ nursing care. All of the mentioned tasks were required to complete under the group working atmosphere.
“The group finally meets and members collect their answers and select the most recurrent or salient points as the correct answers or solution to the problem.”
Participant 7
The PBL assisted the participants to be used to learning and working under a group working atmosphere. In the final phase of PBL, when addressing group presentation, the students considered it was the opportunity to learn how to cooperate with group members effectively
by achieving the group goals and presenting the group tasks. Meanwhile, with the purpose of completing the group tasks successfully, group members had the intentions to supply own personal ideas and make the efforts. It was emphasized by the participant it was fair chance for each member to participate into the final presentation as part of group work by sharing transparently searched knowledge within the group.
“Learning to work as a team. Teamwork was important especially when we had to prepare the final presentation. All group members contributed their ideas and inputs and we were able to successfully complete our task.” Participant 17
Based on students’ acknowledge to PBL’s study manner, the independence and cooperation were actually twisted together to strengthen the efficiency of group working in PBL. Within the whole process of PBL, the question formulation based on the case required the group members to work together. After that, information search was processed individually for answering the formulated question and construct the individual knowledge system. In order to obtain the final results of group work, group members need to discuss and integrate the individually received knowledge into the final combined report.
“Formulating questions that we as a group have to solve based on the case, writing its answers personally by researching and then discussing those individual answers in a group.” Participant 18
Roles and characteristics could be described by the following two subcategories that were role playing and group members. At the beginning period of PBL cycle, the students were arranged with different roles in each group. As the participant described, the role of chairman as the leader guiding in the group meetings was beneficial to make the students to be familiar with the abilities of organization, coordination and leading skills in the group activities.
Simultaneously, each member had the opportunity respectively to be the chairman, secretary and observer in the different session of PBL. The skill of leadership and arrangement were practiced and strengthened by applying the rotation of roles on each group member within a group. No other rules were mentioned in the participants’ answers.
