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Dr.Rosaline Rachel

Principal ,MMM College of Nursing

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Outline of presentation

Role of effective problem in PBL

Characteristics of a good PBL

Guidelines for creating PBL problems

Two models

Writing a problem statement : Developing a PBL scenario

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Benjamin Franklin
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PBL learning is….

Contextual….constructive knowledge

Collaborative learning

Self directed and engaging work

Use authentic, complex, ill structured

tasks,Problem solvers, critical thinkers ,
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• Problem based learning is a

form of educational practice
whereby the student is
Problem presented with a problem
which then acts as a catalyst for
Based learning.
Learning • PBL is a popular approach to
learning in health care.
• It aims to develop problem-
solving skills and foster team-

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Problem • PBL differs from the lecture

or the “talk and chalk”
Based model in that the students
Learning themselves direct their
own learning and the tutor
acts as a facilitator or guide

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• The problem is real world
and ill-structured
• Highlights need for inquiry
PROBLEM • Attracts and sustains
AS A student interest
CURRICULAR • Connects the school
ORGANISER learning and the real world
• Enables meaningful

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Characteristics of a good Problem
• The problem must motivate students to
seek out deeper understanding of
• The problem should induce students to
make reasoned decisions and to defend
• The problem should incorporate the
content objectives in a way as to
connect to their previous acquired
• If used for a group project , it needs a
level of complexity to ensure that the
students must work together to solve
• If used for a multi stage project, the initial
steps of a problem should be open
ended and engage to draw students in
to the problem.

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Role of effectiveness problem in PBL
• The problems encountered by students
in a PBL curriculum provide both the
starting point for learning and forms the
key unit for structuring relevant
curriculum content which is well
(Barrows & Tamblyn, 1980; Davis & Harden,
1999; Dolmans, Snellen-Balen-dong, Wolhagen &
van der Vleuten, 1997).
• It is difficult to get the most out of
the PBL if the two essentials of
students’ learning are not factored in
the implementation namely: the role
of tutors and the format of the
- Albanese and Mitchell (1993)9

Problems are suggested • Lead to learning issues

to be one of the three
elements of PBL • Trigger interest
• Be of suitable format
The other elements are
tutors and students • Stimulate critical reasoning
• Promote self-directed
Balendong,Moiust and
Stalenhoef-Halling ,1990
• Be of suitable clarity

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• Be of appropriate difficulty
• Enable application related
to prior knowledge &
• Stimulate elaboration
• Promote teamwork

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• Learning objectives likely to be
defined by the students after
studying the scenario should
Guidelines be consistent with the faculty
for learning objectives
creating • Problems should be
PBL appropriate to the stage of the
curriculum and the level of the
problems students‘ understanding
• Scenarios should have
sufficient intrinsic interest for
the students 12
Content-oriented: subject
– Basic knowledge and
understanding of specific
concepts, techniques, etc. in the
Types of discipline
Learning Process-oriented: global skills
Objectives – Effective communication: oral
and written
– Acquiring and evaluating
– Working effectively with others
– Higher order, critical thinking

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 Think of a realistic
• Think of one or
more learning scenario from the
objectives in news, a
your course videotape, or
Two popular press
Schemes article
Writing  What learning
• Name a realistic
Problems objectives for
application of your course are
the concept(s). evident in the
Outline a scenario?

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Draft the problem
Outline the problem (create a ‘story board’) First consider, “What will be
on the first page?”

• Good PBL problem has multi-page, multi-stage
construction – progressive disclosure.
• Not all information disclosed - but students to
look for resources.
• Challenge students to come to consensus,
reach conclusions and make judgments.

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Problem Types

Explanation or Analysis Problems

‘What is going on here?’
Decision or Dilemma Problems
‘What would you do?’ ‘What do you think?’
Task-Oriented Problems
Doing an activity or carrying out a project - for
example, interviewing patients or designing a

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Problem Design
Two model
Problem-solving: Arriving at
Problem solving decisions based on prior
model knowledge and reasoning

Inquiry model originates with

an issue, problem, question,
Inquiry model exploration on a topic that
provides opportunities to
create or originate new
problems that contributes to
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Cognitive psychological model
in Problem-Based Learning

Professional competence development is a transition

from conceptually rich and rational knowledge base
to non analytical ability to handle situations
efficiently and effectively
• Activation of students prior knowledge
• Elaboration of content
• Restructuring of semantic network/schemata
• Development of an intellectual scaffold
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Hungs 3C3R model
Problem Design

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Assessing the Quality of Problems
in Problem-Based Learning

Problems are a set of descriptions of situations

or phenomena demanding solutions or
explanations, and are usually structured in
textual format, sometimes with illustrations,
pictures, videos, and simulations


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……approaches to measure
the quality of problems…. cont

• Evaluate whether students are able to

generate the same learning goals as intended
by the curriculum.
• The degree of congruence between the two is
considered to be reflective of problem
effectiveness (Dolmans, Meer, 1993;

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to measure the quality of problem

• Administration of a self-report rating scale to

evaluate the quality of a course at the general
program level

• Schmidt, Dolmans,Gijselaers, and Des Marchais (1995), developed and

validated a 58-item rating scale

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The extent to which the
Five problem leads to
formulation of intended
Factors learning objectives

 Clarity of the problem

 Elements of clue or key

Factor 1 words in problem

 Structured approach

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The extent to which the
Factor 2 problem is familiar to students

Factor 3 The extent to which the

problem interests students

The extent to which the

Factor 4 problem promotes collaborative
The extent to which the
Factor 5 problem stimulates critical

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Writing a problem statement
Start with a Story Start with the Concepts
Research Research

What concepts are Look for the story to use


Research the Problem

First Draft
(Point of view, focus, appropriateness for audience, staging, objectives nature of the
end-of-stage questions)

Research, Draft II (refine)


Draft III

From C. F. Herreid, SUNY Buffalo & W. Welty, Pace University

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Seven principles for effective problem design (after
Dolmans et al 1997)

Appropriate use of prior knowledge

Potential for elaboration through discussion

Content relevant to future profession

Requires integration of knowledge

Encourages self-directed learning

Intrinsically interesting subject matter

Contributes to the “discipline map”

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Ranking of criteria for problem construction
(Des Marchais, 1999)

Stimulating thinking, analysis and reasoning

Assuring self-directed learning

Using previous knowledge

Proposing a realistic context

Leading to the discovery of learning objectives

Choosing professionally relevant topics

Assuring contextual detail

Choosing an appropriate vocabulary

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Points to write effective problem

Student Instructors
Constructivism Authenticity centered as facilitator

Meta- Integrated Learning

knowledge in

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• Selection of a good problem

• Make them problem solvers, critical thinkers,
team players, effective communicators and
resourceful life long learners.
• Higher transfer and retention of knowledge
• Enhancement of self directed skills
• Better preparedness for independent learning

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Dr.Rosaline Rachel

Principal ,MMM College of Nursing

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Problem – student – tutor

• Problems used in PBL contextualize
real word problems, set of
Key descriptions of phenomena or
situations in need of explanations
Elements and resolution
• Presented in textual
– Explanation problems
– Description problems OR
– Strategy problems

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• From cognitive process and problem

solving skills module
• Ivan Pavlov - classical conditioning
• Causal modeling technique depends
Explanation on three distinct inter related
problems • Tutor’s content knowledge
• Tutor’s willingness to involve
with students in an authentic
• Tutor’s communication skills

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Description Problem or Strategy

It is an inter relationship between

Quality of a problem
Student’s prior
• Three foundation elements Tutor’s performance

Student's individual self

• Two process elements study activity
Group function

• Two outcome elements Student’s achievements

Student’s outcome

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The following are some questions that will guide this process

– What open ended questions can be asked ?

– What learning issues will be identified?
– How the problem will be structured?
– How long will the problem be ?
– How many sessions will be needed to complete ?
– Will students be given information in subsequent pages
as they work through the problem?
– What resources will the students need ?
– What end result will the students produce at the
completion of assessment of problem ?
• Write a instructors ’s guide detailing the instructional plan
• Identify key resources for students. The instructor to guide the
students to identify variety of learning resources. 36
Case study

• Ideal PBL case should

• Realistic based on real life
• Logical in approach and have smooth flow
• Student centered
• Able to stimulate integration of knowledge across disciplines
• Be challenging but in level with students knowledge and
• Stimulate student’s discussion at a higher cognitive level
• Set in a context aiming at student’s future career requirements
• Open ended or using gradual disclosure design
• Addressing the preset learning objective
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Developing a PBL scenario
• The problem must motivate students to
seek out deeper understanding of
• The problem should induce students to
make reasoned decisions and to defend
• The problem should incorporate the
Characteristics content objectives in a way as to
connect to their previous acquired
of a good PBL knowledge.
scenario • If used for a group project , it needs a
level of complexity to ensure that the
students must work together to solve
• If used for a multi stage project, the initial
steps of a problem should be open
ended and engage to draw students in
to the problem.

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Developing a PBL scenario

• Learning objectives likely to be defined

by the students after studying the
scenario should be consistent with the
How to faculty learning objectives

create • Problems should be appropriate to the

stage of the curriculum and the level of
PBL the students' understanding

scenarios • Scenarios should have sufficient

intrinsic interest for the students

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Developing a PBL scenario

• Designing a PBL scenario with an

embedded problem will emerge
through student brainstorming

Designing • Think of a real, complex issue related to

your course content
a good
• Scenarios should be motivating,
interesting, and generate good

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Developing a PBL scenario
• Basic science should be presented in the
context of a clinical scenario to encourage
integration of knowledge
• Scenarios should contain cues to
stimulate discussion and encourage
How to students to seek explanations for the
issues presented
create PBL • The problem should be sufficiently open,
scenarios -
so that discussion is not curtailed too
early in the process
*Adapted from Dolmans et al.
• Scenarios should promote participation
by the students in seeking information
from various learning resources
– *Adapted from Dolmans et al.

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Developing a PBL scenario
• Scenarios attempt to stimulate learning
in contexts that are similar to what
learners face in their real-life situations
• Scenarios allow students to generate
hypotheses for the problems and think
about approaches to make priorities
How to between their hypotheses
• Scenarios serve as a tool for
create PBL integrating knowledge and linking basic
sciences with clinical situations.
scenarios -
• Scenarios stimulate discussions
between students and allow to discuss
*Adapted from Dolmans et al.
moral and ethical issues that can be
raised that issue
• Scenarios allow students to provide
evidence and reasoning for their
• Scenarios enforce the retention of
information learnt in long-term
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Writing a problem statement
Flow of the problem should be
The problem statement
•Meet the problem
should •Need to know
•Define the problem
• Be developmentally statement
• Be grounded in student’s •Gather information
•Share information
experience •Generate possible
• Be curriculum based solutions
• Should accommodate a variety
•Determine Best Fit
of teaching and learning Solution
strategies and styles and well •Present the solution
structured •Debrief the problem

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• Mr. X, 60 years old, a man who is
new to the clinic. He is a driver. In
the last month, Mr.X was having his
blood pressure checked at the
pharmacy, and was found to be high

Example .
• You are the nurse interviewing Mr. X
at the clinic. He denies on any
medication for high blood pressure.
He is obese.

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• He also complaints of headache in
the previous week.

• On assessment, you found that Mr.

X’s vital sign was T0 : 36.8 0C, BP:
Example 170/95mmHg, P: 92 bpm and R: 20

• His tentative diagnosis is high blood


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• He was prescribed a list of
examinations and laboratory test, as
well as medications for relieving his
headache. Mrs. X accompanies her
Example husband to the clinic. She is worried
about him, as they have no children
and rely on each other’s company.

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Some Guiding questions
What is the meaning of high blood pressure?
What body system is involved?
What will be the possible physiological changes?

What is the meaning of obesity?

What kind of information do you seek for in order
to understand his present situation?

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Some Guiding questions

What are the appropriate health assessment skills

for this client?

What are the common patterns of reaction to


Why is the wife so worried?

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• Health history taking
• Physical examination

Some • Physiological changes

areas of • Body and nutritional assessment

discussion • Reactions to stress and coping

• Treatment and nursing care for client
with high blood pressure and

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• Reframe the situation as new
information emerge
the • Working on possible solutions
• Critically examine the various
possibilities with justifications

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• Make them problem solvers,
critical thinkers, team players,
effective communicators and
resourceful life long learners.
• Higher transfer and retention of
Conclusion • Enhancement of self directed skills
• Better preparedness for
independent learning
• Improve the interpersonal
relationship skill learning.
• Higher level of learner satisfaction

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Sample case scenario
• A 35-year-old primi mother is in her 5th month of
pregnancy complaints of exertional dyspnoea,
tiredness, fatigue, pedal odema (especially at the
end of the day).

• She has family history of diabetes and hypertension.

She also had complaints of cramp in the calf muscle
especially during night.
• What care and advice does this mother requires

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Lab investigations

• Hb: 9.3gm/dl, GCT: 99mgs% Urine R/E: No

evidence of infection. Urine albumin and
sugar: Nil
• Blood Pressure: 100/70 mm. Hg, GPLA score:
• USG: Liquor: Adequate, no anomalies seen.

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• You are a registered nurse (RN) working in a
Women’s Health Clinic.
• A patient , 38 years old, presents to the prenatal
clinic after missing her last 2 menstrual cycles. Her
home pregnancy test was positive.
• An ultrasound at the clinic confirms pregnancy.
Gestational age is calculated to be 10 weeks. An
initial assessment of the patient’s medical and
obstetrical history follows.
 Obstetric/Gynecologic (OB/GYN) history (hx):
Uncomplicated spontaneous vaginal delivery (SVD) at 38.2
weeks (5 years ago); Cesarean section (C/S) x 1 at 37.5
weeks for non-reassuring fetal heart tones (FHT) (3 years
ago); abnormal Papanicolaou (PAP) smear x 1, + human
papilloma virus (HPV), colposcopy within normal limits
(WNL); Chlamydia with treatment (7 years ago)
• Medical hx: Chronic hypertension (HTN) x 5 years; asthma
 no intubations or hospitalizations; hx of breast biopsy,
benign (2 years ago)
• Allergies: Penicillin

• Social hx:
(+) tobacco, “occasional” per patient (pt), <5 per/day
currently, has smoked “off and on” for 15 years
(+) cocaine use, states she has not used any cocaine/drugs
for > 1 year; (-) alcohol use
Abusive partner with first pregnancy, states she has a new
partner x 4 years
Depression, currently not taking meds for treatment (tx)
• Medications: Prenatal vitamins; Labetalol 200mg BID;
Albuterol inhaler as needed (prn)

• Family hx: Insulin-dependent diabetes mellitus (mother);

HTN and heart disease (father); lung cancer (CA) (maternal
grandmother, deceased)

What should the nurse
consider related to caring
for a patient with a
history of domestic
abuse, drug use, sexually
transmitted diseases and

Professional nurses should be
aware of attitudes, values and
beliefs that they hold related to
patients from different social
backgrounds so that care is not
affected negatively.

QSEN: KSA (next slide)


KNOWLEDGE: Review patient support system and resources

SKILL: Refer patient to appropriate resources r/t domestic abuse

and addiction as indicated

ATTITUDE: Recognize personally held attitudes about working with

patients from different ethnic, cultural and social backgrounds;
willingly support patient-centered care for individuals and groups
whose values differ from own

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Good bye

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JD, Brown AL, Cocking RR. 2000. How people learn: Brain, mind,
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• Coderre S, Woloschuk W, McLaughlin K. 2009. Twelve tips for blue
printing. Med Teach 31(4):322–324.
• Dolmans DHJM, Snellen-Balendong H. 1997. Seven principles of effective
case design for a problem-based curriculum. Med Teach 19(3):185–189.
• Weiss RE. 2003. Designing problems to promote higher-order thinking.
• In: Knowton DS, Sharp DC, editors. Problem-based learning in the
• information age. San Francisco, CA: Jossey-Bass. pp 25–31.
• Constructing PBL cases 367