Problem based learning for continuing professional education: an exploration of the method and its effectiveness.

Introduction -
Problem Based Learning is an approach to teaching and learning that has been designed using theory and research evidence about the nature of learning and of professional expertise and has been widely adopted. The advocates of Problem Based Learning claim many advantages for the approach. However it is often unclear what is meant by the term, and claims appear to be based on anecdotal evidence or small scale evaluative studies. There appear to be few reports of the use of Problem Based Learning in continuing professional education.
Methods -
This thesis analyses a Problem Based Learning curriculum and evaluates its effectiveness in a continuing education programme for nurses in England. Using a randomised experimental design the learning outcomes of students who followed a 'traditional' curriculum were compared with the students who followed a Problem Based Learning curriculum in the same educational programme. The programme lasted one academic year and was undertaken on a part time basis. Five `teachers' participated in the study all of whom were volunteers. The two teachers who facilitated the experimental Problem Based Learning groups undertook various staff development activities to prepare for their role as facilitators. The students were qualified nurses from five NHS hospitals who applied to take the programme during the study period. Thirty five students were allocated to the experimental (PBL) curriculum of whom 20 subsequently completed. Thirty four students were allocated to the control (SGL) curriculum of whom 31 subsequently completed. The students had no previous experience of Problem Based Learning.
Data Collection and analysis -
A wide range of student outcomes were investigated using a variety of existing and new research instruments. Data on the process of curriculum development, programme delivery, students and teacher response were collected using non participant observation, teacher diaries, and researcher field notes. Qualitative data were analysed using the Framework method. Descriptive and Inferential Statistical analysis was carried out using SPSS. Analysis followed an estimation approach. Standardised effect sizes (a) with 95°-o confidence intervals were calculated to estimate the difference in outcomes between students in the experimental (PBL) and control (SGL) curricula.
Results -
Students and teachers found it difficult to adapt and come to terms with the Problem Based Learning approach. It was apparent that Problem Based Learning did not meet the students normative expectations of `teaching and learning'. Problem Based Learning appeared to cause the students great anxiety which lead to tensions between the teachers and students in the experimental (PBL) curriculum. This is reflected in the differences in student satisfaction indicaitors between the two curricula which all favoured the control (SGL) curriculum. Other results showed that students in the control (SGL) curriculum were more likely to perceive that the educational programme had changed their practice. A greater proportion of students in the experimental (PBL) curriculum did not meet the threshold score indicating readiness for selfdirected learning after completing the programme. The results exclude important statistically significant differences in impact between the two programmes on changes in approaches to learning, managers rating of performance, changes outside work, likelihood of taking on a teaching task in the workplace and on changing jobs.
Discussion and conclusion -
The mixed results from this study appear to contradict those obtained in some other studies of Problem Based Learning. The results are consistent with other studies using experimental designs. Different forms of Problem Based Learning may produce different results, and quality iof implementation may also be an important factor. However, if such `local' factors are important then it suggests that the context and culture in which Problem Based Learning is implemented is at least as important as the approach itself. The study found strong evidence of student dissatisfaction and of a disjunction between Professional, Student expectations and Problem Based Learning practice. It is argued that Problem Based Learning theory and practice lacks an adequate conceptualisation of the relationship between the different conceptions of teaching and learning held by different stakeholder groups in continuing professional education. Within the discourse of Problem Based Learning it appears to be taken for granted that everyone shares the principles, aims and values that underpin the approach i. e. there is a lack of
recognition that pedagogy is a site for struggle between a number of competing discourses.

Submitted in partial fulfilment of the requirements for the award of Doctor of Philosophy (PhD) in Education.