Problem Based Learning - My experiences of being a student OT

Yesterday I had the pleasure of attending London South Bank University’s Learning & Teaching Conference. I was asked to speak about my experiences of the learning process and in particular how I found the teaching of research within the 2-year Post-Graduate Course. I wasn’t entirely sure how to tackle this subject but in the end I think it worked out OK, even though it turned into a discussion of Problem Based Learning & its Pro’s and Con’s rather than research per se. The following may be useful to those struggling to come to terms with the whole PBL concept as well as those who attended the conference. Find attached the original slideshow as a PDF and below a text version of the talk (with some extra content which I can add with hindsight). Hope its useful! Read on for the full article..

• Intro
• Weaving Baskets
• The Course
• The PBL ‘rules’
• Problem based Learning - a brief history
• Lectures Skills
• PBL Pros
• PBL Cons
• Written Work
• Practice Placements
• My Experience
• In conclusion: What does it give you?

Introduction

Over the next 20 minutes or so I hope to share my experiences of the OT course at London South Bank University. I hope it’s useful!

Weaving Baskets

So I have just finished the two year Post Graduate Course for Occupational Therapy at South Bank. Students on the course come from a varied range of backgrounds and with that, experiences. Similarly its worthwhile to point out that there are varying lengths of time between their last degree.

OT, if your not aware, is a allied health profession which works in pretty much all areas of healthcare. The image that OT’s commonly like to dispel is that we are a bunch of basket weavers, spending our days in workshops giving patients just something to fill their time. (This is something that I have to admit I was a bit disappointed with at first - I actually wish I did know how to weave a basket - it may have saved me some incredibly painful trips to Ikea searching for wicker chairs and the like..). The key role of an OT is one for debate, but for this presentation I shall explain it as “to get a client independent” - that is, allow people to do things for themselves in real life situations. If, for example, a person wants to get back to work then that is the therapeutic aim. If its to be independent looking after themselves and children then that is the aim. To achieve these aims a whole toolkit of options are available to a therapist - including the main one of activities that people find meaningful to themselves.

However the main question that has been more and more necessary to answer is how are these tools chosen? Which methods do we use as therapists to engage clients? and ultimately are they effective? It is these questions that research can answer and due to the urgency for research within OT the course here at South Bank drives this question from the students upwards to the profession.

The Course

So lets look at the course. The course is comprised of four main methods of teaching; Lectures to teach theoretical content, Skill sessions to teach practical skills, Practice Placements which consist of 4-8 week blocks out of the classroom in the field and Problem based learning groups. (Note that the time spent in each is pretty much 50% placements, 30% PBL, 15% Lectures & 15% Skills - ish)

While I was creating the detail for this presentation it struck me that these really aren’t four seperate items, but actually all part of the PBL process. Because of this importance of PBL I just want to spend a bit of time explaining the process.

PBL - ‘the rules’

Here are some of what I would call my ‘rules’ of PBL - i.e. what constituted the PBL process for me

• PBL is done in small groups - typically around 5-10 people.
• In the first year a tutor is present for nearly all of the sessions - and in the second year their presence rapidly declines. Perhaps the use of the word “tutor” is misleading in this context - the tutors role isn’t to teach but to act as a resource. It’s up to the students to use this resource - when and how is up to them. Which conveniently leads me on to the third rule -
• There is no third Rule! Yes that’s right - the third rule is there are no rules! What I mean by this is that each group develops their own strategy for learning the material. This really does lead to a whole new meaning of the term “democracy”.
• The fourth “rule” as such is that there is always some form of trigger material - this is the material that the students need to discuss. Note that this isn’t a question, or even a bunch of questions - this trigger material doesn’t define to the students what they need to learn - or how to learn it, it merely is a starting point. Now on reading this I can hear you saying “Whhhat?!, how’s that work?!” but realise that a set of aims always incorporates each module and often each trigger - the point is that even without a tutor the students should be able to grasp what they need to understand from these aims and pull it together with the trigger. Even without aims and objectives (I have to admit we actually looked at them at the end of each module more often not) your learning objectives are driven by YOU - that is, what is it you need to learn? You are the best person to decide this. Does it always work? Well, I’ll come onto that later..
• The last rule of thumb is that material/resources are provided for each module alongside the trigger. This isn’t usually directly associated with the trigger directly but usually on the same theme. For example a trigger may involve looking at single case study of a lady trying to bring up a family with Arthritis, and the course lectures at that stage are about “Pain”. Lectures are more often than not an “additional resource” to guide PBL rather than the guiding light. Students are encouraged to use many sources of information with this being just one of them.

Problem based learning - a brief history

• The history of Problem Based Learning began in the early 1970’s at McMaster University in Canada with its theoretical history going much further back.
• Basic premise of PBL is that Active Learning is better than Passive learning - that is being involved is far more effective than the sponge method of learning - just absorbing information thrown at you.
• Active learning is used elsewhere of course - many of you probably teach/have been taught with questions intended to “making them think” or just to wake them up, but the real problem comes in trying to teach vast amounts of complex material. This approach takes time - a lot of time using a passive approach. With PBL the idea is that material is continually revised and re-learnt alongside all parts of the curriculum. We were told to envisage this as a spiral - your learning improves as you go further up the spiral often seemingly covering the same material with the material becoming more and more relevant to your own experiences and clinical work.
• I actually prefer the analogy of painting a fence - you often go over the last bit of paint when your putting on the next stroke and at the end of the process you have a new fence! (But remember - the fence always needs a new lick of paint every now and again!)
• I will admit that going over old material in this way at first seems crazy (“Crikey, enough with Models already!” and “Why are we going over the role of an OT again?!” are just two quotes that come to mind) but it actually works; you will look the part when, in that first job, another OT states they use the Reed & Sanderson model and you can critically argue that, perhaps that model is outdated (and perhaps they should read a book that is more recent than 1991.. meeow!)

Lectures/Skills

In one view Lectures are a resource for PBL and nothing more. Another “pot” of knowledge that you can use. On another hand lectures provide you with key skills for unlocking the other resources. For example, there are the research orientated lectures that help you critically appraise articles, lectures that provide you with the anatomical knowledge to understand how a person’s disability impedes on their function.

Practical skills occur once (sometimes twice) a week. There aim is to provide you with some basic practical skills to go out into the world of work. I must admit that I kind of wish these skills were a bit more in-depth - for example why don’t we learn something like AMPS assessment training? Well on reflection, doing this would be a) costly b) perhaps pointless. Most OT’s get a post as a basic grade. Most posts are rotational. Most posts don’t need this level of experience for these posts (a lot of departments have just one person to do these assessments which are sadly often one-off’s). Now I actually think this is slightly wrong thinking - If all OT’s leaving college had more tools to choose from then this is a good thing surely? (I grant you - the choice of which particular tools to arm student’s with is a bit like the “how long is a piece of string” debate - where do you stop?)

Note, that unlike many courses of this level, there is no direct assessment of a students knowledege of the lectures and skill sessions. There is no written exam, no multiple choice - nowt. Please see my other mini-essay and thoughts on this here (Update: I understand this has now changed due to a point made by the QAA. Anatomy exams are now being brought in - and I am tempted to agree with this decision, although again, a huge point for debate. Anatomy is the one thing that is easily forgotten. With an exam, more students are motivated to learn and attend, the knowledge is then more “stuck in” when it needs to be revised on placement and in the workplace)

PBL Pro’s

So what’s the advantages of PBL then? It appears a pretty wacky approach at first so lets try and reflect on some of the positives:

• It fits really well with OT. Remember that PBL is all about engagement. Meaningful learning. Active participation. All things that are synonymous with OT (and many would say medicine, nursing etc.. But I think OT first and foremost!).
• Its this active participation which is essential for medical related courses and perhaps one of the reasons why PBL is being used across a large number of health courses. Its essential for getting people thinking and putting all the theory together - as a result I think its a far more motivational way to learn.
• Note that PBL rarely teaches lots of facts in one session. Not directly. If it teaches anything it’s how to learn and how to work within a group which brings me on to my last two points:
• Develops Group Skills. Before I started the course, I, as well as most of my peers, had worked in a number of organisations big and small and with a varying degree of team management and “team playing”. Heck, I even used to interview people and project manage. So I figured when I started the course “yeah, I can do that group thing already”. But doing PBL twice a week for going on 6 hours (and more if you include the debates that used to carry onto the pub) does really hone those skills. Its a comfortable environment to get things wrong, to discuss things that are slightly controversial and work out your own professional opinion and stance on matters. It evolves you!
• In this respect PBL is a much more people related way of learning. Compare it to traditional techniques where you would attend a lecture and you could theoretically get away with saying nothing and I think you will see what I mean. You learn how to present yourself professionally and interact professionally. (I’m sure my old PBL-ers would laugh at my terminology here and in particular my view of the term “professional”)

PBL Con’s

OK So this PBL malarky can’t be perfect right? Well lets see:

• The theory with PBL is great. Everybody pulls together to work out a set of aims for each trigger. Fantastic - but what if 10% of the group don’t do what was intended? Lets imagine a scenario: Member A identified a need to learn more about the brain at the start of the trigger. Various tasks were drawn up between the group and it turned out that because Member C also wanted to know about the brain he went off to do a quick presentation on the brain. The thing is Member C’s needs weren’t exactly the same as A’s and presented on something that A already knew about. A ended up not learning the thing he wanted to. Well one the optimists amongst you would say “Well that’s fine - it doesn’t hurt to revise something” - but what if you don’t actually learn the thing you needed too. Even worse - imagine that C couldn’t find anything - or simply forgot to do his bit so comes back with nothing? Well, my argument to this is thus: If you need to learn something that desperately the responsibility lies with one person: you. I have to say actually that psychology plays a big part in stopping this before it gets too far. If person C said he would do something in-front of the group then a large amount of guilt plays on that persons conscious. It generally does the trick for that person to pull something off the web at the last minute - it all helps! Secondly, the amount of time in PBL is so great that it does allow time for these mistakes to happen - you will learn everything that you want too in the time - you just need to have faith
• Just as the above example identifies, there is a tendency for PBL to be a battle ground for personal need and group need. At times you need to be altruistic - and then reflect on the process (All experiences are good experiences!) and then other times you need to be selfish. I have to say those times when you have presented something badly, not quite covered what anyone wanted are all good - you generally say to yourself “Blimey that was useless. Ill do it better next time.” And outwardly apologise for the poor effort (note: Usually after these incidents you can bet that everyone else in the group has put 200% of effort into providing stimulating, interesting information. It makes you squirm but its for the best!)
• Just as your own methods of presenting & learning take a while to hone, so do the particular group management styles. Do you have one leader throughout, a different person each module? Do you find resources for each PBL individually or as a group? Do you do a big spider diagram to work out your aims at the beginning? Does interactive presenting work? It all takes time. Compare this to traditional teaching however where your own personal ideal learning methods aren’t even investigated by yourself or others and I say this time spent is worth it.
• PBL needs excellent resources. Period. And remember when I mean “resources” I mean access to tutor support as well as physical resources such as library books, internet access etc..
• PBL is quite frankly odd. Its strange. Only while writing this talk have I started to get my head around it. I can remember only a few times where as a group we went away saying “yeah that was good - I feel like I have learnt a lot”. My suggestion is (and I really sound like a teachers pet now) is “REFLECT”. Think about what you have gained out of each PBL - discuss this with the other members and you will get somewhere..!
• One of the main reasons why all of the above examples occur (i.e. people not pulling their weight) is really due to a lack of motivation. With no exams testing your knowledge, it can at times feel like “Ill leave that PBL presentation to the last minute - its far more important I do my essay” - which is I have to say hard to disagree with. But if everybody does that you have to drag your bum out of bed early for a session at uni which is quite frankly pointless. Careful creative management of the PBL group is needed to get something out of those sessions around essay handing in time. Lack of motivation for PBL at certain times of a course is inevitable. Don’t fight it - go with it - just plan the sessions in advance.

Written Work

So although the course has no sit-down exams as such (NB: It didn’t at least!) there are some assessments to test your tacit knowledge. These assessments follow the following formats:

• One Essay format question. The starter essay of the course infact - useful to warm you up to the library
• Case studies. These are cases taken from placement that you anonymise. In my opinion these are far better than any exam - they pull it altogether (NB: If your reading this article while in the middle of writing one of these case studies, worse re-writing one, you probably disagree with this statement) and really question the evidence base of models, assessment and intervention. On each case study a reflective essay exists giving the student a unmarked “freestyle” area to reflect on the entire experience.
• Now, I realise this was a talk about research and I have hardly mentioned the word. That’s because I feel the whole PBL process is closely intertwined with the learning of research; how you manage your time, question evidence, research a topic etc. There are of course the lectures giving you the skills to understand the research process but there is a way where these skills are in-directly assessed. These are ultimately in the production of a unique research proposal as a final piece of work in the second year. To get there, a critical review of a qualitative and quantitative study is done, a literature review of a field of interest and finally the proposal. Its a very drawn out process but useful. My only sadness is it results to nothing. Their is no current intention that this study actually gets done - even though its written so, and this is kind of sad. 100’s of really good literature reviews are written each year which actually could be of use to the clinical field at large. But what happens to them? Not a lot - they go in a cabinet somewhere. Its one of the reasons why I have a call to peers to produce a précis of their literature reviews for meta-ot.

Practice Placement

• The placement is the best bit - well, if you enjoy it that is!
• It’s where you can put all your PBL knowledge gathering skills, group skills and theoretical skills to the test.
• If your reading this wondering whether to do a course at London rather than somewhere else, I would say “London!” every time if only because of the placement options. No staying over in nursing accommodation required, huge diverse range of placements (depending on availability of course) and specialities including of course some of the biggest (and I have found enthusiastic) teaching hospitals in the country.

My experience

Bear in mind that all of the above thoughts should be taken with a pinch of salt. I have had the luxury of having fantastic trouble free placements, a superb PBL group, a great tutor and some previous experiences which have given me a pretty good start. PBL and the learning process for any discipline is a subjective opinion. I am also writing this after the course. Ask me to tell you my thoughts on the process at the time and it would have been an entirely different presentation!

Conclusion: What it gives

So now I have left, do I think the process is all good? In short - yes . I have to admit the skills learnt within PBL and those directly related to writing a research proposal was quite a learning curve. However I know few who can’t speak passionately about their chosen research area given 5 minutes of airtime. The skills learnt make a far more confident practitioner - an all-round needed thing for a field which at times appears to be short of confident striving people. The majority of students, through the forum of PBL and a research based course, now question the evidence behind those “tools” which I mentioned in the first couple of slides. In the end this surely means that not only the course, but the profession has succeeded.