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Facilitation in PBL - Espoused Theory versus Theory in use.
Reflections of a first time user.

AEJNE Volume 5 - No.2 March, 2000.

John Oliffe R.N. R.S.C.N. Grad Dip Adult Ed. M.Ed.
Deakin University, Victoria, Australia
2/6 Robert St.,
Elwood Victoria 3184
Email/Fax/Phone HYPERLINK mailto:oliffe@deakin.edu.au oliffe@deakin.edu.au Fax 613 92446159, Ph 613 9244-6122

Key Descriptors Problem-based learning, facilitation, espoused theory.

Abstract

The School of Nursing at Deakin University, Victoria, Australia, adopted a modified problem based learning curriculum within its undergraduate program in 1995. Level one students are introduced to principles of adult learning and processes of problem based learning. Second and third level students engage in problem based learning through problem situated scenarios. A broad range of teaching methods are used including: computer mediated communication, audio/video conferencing, computer assisted learning, audio/video materials, lectures, tutorials, interactive skill laboratories and supervised clinical practice.

As a first year associate lecturer, the author found facilitating third level undergraduate nursing students within the problem based learning curriculum a great challenge. In the need to establish credibility those first tutorials fell awkwardly between facilitation, and chalk and talk.

Through reflection, peer discussion and review of the literature the author sought to investigate and develop an understanding of facilitation, central to which were issues of espoused theory versus theory in use. Since facilitation is an uncommon skill amongst academic teaching, the success of the facilitation of problem based learning is dependent on staff understanding and appreciating their new role in such teaching. The assumption that those who teach, can, or will, choose to facilitate is naive. The author analyses the reflective, peer and literature review processes employed by staff at Deakin University. The findings illuminate teaching strategies and philosophies underpinning practice, which serve as a reminder to the experienced and as an introduction to the novice facilitator. What remains unresolved is whether the espoused theory of facilitation is a realistic recipe, or if the user can simply adopt ingredients that pleasure the palate

Background to PBL

Problem Based Learning (PBL) evolved from innovative health sciences curricula introduced in North America in the 1950's and Canada in the late 1960's ( Boud & Feletti 1997). Technological innovation and restructuring of health care services has led to rapidly changing needs in the preparation of nurses. The expanding knowledge base meant it was impossible to include all the knowledge required for the beginning practitioner in the undergraduate curriculum.

The principle idea behind PBL is that the starting point for learning should be a problem, a query that the learner wishes to solve. PBL is a way of constructing and teaching courses using problems as the stimulus and focus for student activity. PBL starts with the problem rather than the exposition of disciplinary knowledge. The move toward acquisition of knowledge and skills through a staged sequence of problems presented in context, together with associated learning materials and support from facilitators ( Engel 1997). The PBL approach values content and process equally. Acknowledging that learning takes place most effectively when students are actively involved and learn the context in which the knowledge can be used. PBL takes account of how students learn, and encourages students to learn how to think and act as beginning graduates.

The centrality of the PBL process is its ability to stimulate a questioning attitude and a search for meaning (Margetson, Cooke & Don 1995). After the introduction of the problem, the teacher becomes the guide on the side rather than the sage on the stage. The teacher becomes a facilitator. The essence of facilitation is to create an environment in which the participants are free to define and advance their own learning goals, using their own creative energy to acquire whatever resources are deemed necessary. Facilitated learning is student centred, and because it values equally process and content, emphasizes the development of self direction and inquiry skills.

The School of Nursing, Deakin University, Victoria, Australia, adopted a modified problem-based learning curriculum within its undergraduate program in 1995. Level one students are introduced to principles of adult learning and processes of problem based learning. Second and third level students engage in problem based learning through problem situated scenarios. Broad ranges of teaching methods are used including: computer-mediated communication, audio/video conferencing, computer-assisted learning, audio/video materials, lectures, tutorials, interactive skill laboratories and supervised clinical practice.

As a first year associate lecturer, I found facilitating third level undergraduate nursing students within a problem based learning curriculum an enormous challenge. I recall my first problem based learning tutorial, taking the 'stage' front and centre, alert, rehearsed, with processes defined, and thirty sets of eyes beginning their tutor dissection. The physiological response of tachycardia and tachypnea all consuming, I reminded myself of my clinical and teaching expertise. The need to establish credibility was overwhelming. So eager to teach, so eager to please, so eager to share, the tutorial fell awkwardly between facilitation, and chalk and talk.

This realisation prompted me to search for an espoused theory of facilitation that could be incorporated into practice. The consequent journey of self-discovery identified some blocks to facilitation and resulted in the implementation of strategies to overcome them. These findings serve as a reminder to the experienced, and as an introduction to the novice, facilitator.

After all, there is consensus that the effectiveness of the facilitator can exert tremendous influence on the success of the PBL learning process. (Creedy, Horsfall & Hand, 1992, Wilkerson & Hundert, 1997 Frost, 1996 Holmes & Kaufman, 1994). However, despite that influence, facilitation remains an uncommon skill amongst academic staff, and "a concept seldom considered when facilitators think about what they do". (Katz, 1995 p.70). When I was aware I was not facilitating, I explored the reasons why. Whilst not constituting a definitive list of the potential blocks, the following reasons were identified:

1. Nursing education history

Nurse education first moved to the higher education sector in Australia in 1977 (Russell 1988). However it was not until 1984 that the Federal Government announced its support for the full transfer of nurse education to the tertiary sector. Hence nursing has been in the higher education sector, only a relatively short time, and continues to evolve from a predominately didactic education system which disseminates information and identifies the content students need to know. Reed and Procter (1993) argue that students by definition cannot determine their own learning, because they do not know what they need to know, concluding that "the teacher must control and structure their learning" (p.31). Products and advocates of such education systems who are asked to facilitate, rather than teach, can be tempted to teach the way nurses were traditionally taught. The concepts of trusting students' metacognition, sense of self-direction, and ultimately, the relinquishing of teacher control, are new and demand a conscious shift in teaching practice for many schools of nursing, and nurse educators.

2. Individual's education philosophy.

Prior to embracing the practice of facilitation, there is a need to understand, accept and incorporate the philosophy that underpins PBL. Individual educators must ask themselves how adults learn, seek the answers in practice and in literature, examine their educational philosophy and evaluate its congruence with PBL. Belief in the benefits of active, student centered, constructivist learning is central to the success of PBL curriculum.

I find myself using the familiar behaviourist model of education on occasion rather than the humanist model to which I aspire. My values, education philosophy and teaching practice are continually challenged. The cognitive conflict created has resulted in an ongoing, meandering journey, through the underpinning philosophy of PBL and the practice of facilitation. Given their relative inexperience in the humanist model, PBL nurse educators must be willing to embark on such philosophical journeys.

3. Exposure to PBL

Given the relative newness of PBL itself, many educators have not experienced facilitated sessions. The ability to incorporate observed facilitation strategies, recall a gifted facilitator, or draw on PBL experiences is, at best, limited. I needed to re-define my definition of good teaching practice. Unfortunately there are few historical signposts that point to constructivist approaches in nursing education. Historically, teacher effectiveness was congruent with ability to explain content, in a way that students understood. Clearly, facilitation in PBL values process and content equally, a concept that is new for many nurse educators.

4. Lack of skills/experience

Wilkerson and Hundert (1997) state that once an educator is more aware of the diversity of learning processes, PBL facilitation will need a broad range of specific teaching skills to select responses that will maximize learning. Having investigated, accepted and incorporated the philosophy that underpins PBL, many facilitators are left stranded without the expertise and support to develop facilitation practice. Andrews and Jones' (1996) study of PBL in an undergraduate nursing program concluded that ìcolleges offering the PBL approach are few, expertise is lacking, leaving many teachers to learn experimentally or by trial and error' (p.363). The privacy of teaching can insulate staff from peer review; such practice along with a lack of reflection contributes to poor facilitation.

5. Ego

Ego is nurtured in the expert who shares experiences and disseminates information and knowledge. Facilitation in PBL provides little nourishment to the traditional teaching ego, as the facilitator is a vehicle for student learning not the driver or navigator. The need to camouflage clinical and theoretical expertise along with some sense of vulnerability in modeling problem-solving, processing and reflection further exacerbates the problem of ego.

6. Resistance to change

Innovations such as PBL can be perceived as prompting "creative destruction" within an organisation whereby the innovation challenges and destroys established practice (Morgan, 1997). PBL and facilitation demand change from many of its users. Restraining factors can include fear of failure, loss of status, inertia, and fear of the unknown (Wilson 1996). Loss of traditional teaching practice can also lead to grieving. Kubler-Ross (cited in Fossum, 1989) offers the grief cycle as an explanation of individual's reaction to loss, identifying the stages of denial, bargaining, anger and acceptance. The stages are not chronological, can co-exist and acceptance may not be the outcome. Nurse education in Australia has undergone many recent changes, an individual's commitment to which is premised on the ability to be successful with the innovation. Change in curriculum is a seemingly objective and appropriate task for managers, however for all the most human reasons, it is not unproblematic for individual staff.

From the preceding six points, it is obvious that nursing has a substantial cultural difficulty with the facilitation of PBL. In the face of these, I initiated the following strategies in an effort to overcome the difficulties.

1. Reflection / journalling

Schon (1987) describes reflection-in-action as thinking about what you are doing as you're doing it. He argues that every practitioner must be a researcher in the sense that they must research their own practice and make changes on the basis of this research. Such reflection is the first step toward identifying how we can facilitate learning more effectively. Some of the most important rules of facilitation cannot be followed in a simple mechanical way. Between the espoused theory of facilitation and the theory in use, there is often a gap of meaning. Educators' reflection and journalling is paramount to the development of an understanding of teaching practice and education philosophy. Such practice permits experimentation, and the basing of new trials on appreciation of earlier results. The author's ownership of thoughts and views fosters a sense of control whilst processing the multiple, often new, issues surrounding facilitation in PBL. A journal allows the facilitator to reflect on where they have come, and plan where they are going.

2. Literature review / journal club

Education articles that challenge, question, illuminate and validate help facilitators process issues embedded in teaching practice. I undertook a literature review in an effort to identify and establish realistic facilitation practice. Many useful concepts and strategies were identified and incorporated into my practice and shared with colleagues through the Deakin University, School of Nursing, Facilitators' Guide.

The Facilitators Guide provides a framework for facilitators on which they can base their practice. An understanding of facilitation and a familiarity with facilitation strategies are often assumed knowledge. The purpose of the Guide is to clarify concerns, validate practice, and prompt facilitators to seek further information. The content includes a list of strategies targeted to nursing students, and underpinned by suitable scholarship. In brief these are strategies which:

• encourage students to talk about their related experiences. (Diekelmann 1990) Nurse's stories reveal practical knowledge embedded in practice (Benner 1984). Recognition of adult experiences and prior learning is a characteristic of adult learning (Knowles 1984).
• tolerate silence (Silver & Wilkerson 1991) The facilitator who can tolerate silence is less likely to dominate or lead the tutorial.
• encourage the student to take on the role of the patient (Freitas, Lantz, & Reed, 1991) Promotes the development and integration of empathy to clinical practice.
• divide groups to debate important issues as the students see them (Thompson & Sheckley, 1997)Encourages students to arrive at their own conclusions. Such strategies focus on the process of arriving at a philosophical position, not on the position itself.
• ask students to elaborate Sends the message that the facilitator wants to know what the student thinks.
• are wary of the dreaded second question (Barrows 1988) A follow up question to a students reply usually sends the message that the answer is incorrect. The student then spends more time trying to figure out what the facilitator wants.
• probes student thinking, ask non directive, open ended, stimulating questions (Wilkerson,1995) Promotes group problem solving and critical thinking and allows students to move from molecular to community level.
• encourages active listening
• allows you to identify and synthesize multiple perspectives
• avoids sharing opinions or information with students (Barrows 1988) Implies that there is a correct answer and takes away student ownership of the problem
• creates student dissatisfaction with student's current ideas (Creedy, Horsfall & Hand 1992) In order to facilitate change in existing knowledge, students will need to experience cognitive conflict between their current knowledge and their inexplicable current problem situation. The conflict increases the likelihood of assimilation or accommodation of new explanatory knowledge.
• provides role model (Stepien and Gallagher 1993) Think aloud, reflect, practicing behavior you want students to use, including productive ways of giving feedback.
• allows students to identify and explore issues within an issue.(Thompson and Sheckley 1997) Promotes configurational learning, a natural process, involving rearranging, adding to, subtracting from, and re-evaluating previous configurations. It encourages an appreciation of the processes rather than attempting to force something that occurs anyway (Fossum 1989).

As well as the Guide, formal journal clubs foster sharing of articles, group discussion and encourage further contributions to the Facilitators Guide, whilst, informally, articles strategically positioned in the staff room also stimulate much thought and discussion.

It could be argued that much teaching practice remains hidden in the competitive world of academe. However, many useful facilitation strategies are recounted informally. Strategies employed by colleagues such as dividing large tutorial groups and the use of multiple scenarios with a single tutorial are amongst the staff room gems shared at Deakin University this year.

3. Facilitator workshop

In conjunction with the Facilitator Guide, a workshop for the facilitation team, prior to subject commencement, and supported by fortnightly meetings during the semester ensures continued formal peer support. Workshops and meetings opened by facilitators willing to present issues and problems encountered, encourage group input and solutions, modeling the PBL tutorial process. Such strategies encourage a sharing environment whilst avoiding didactic approaches to explain facilitation techniques. Facilitator meetings also promote the identification of common learning issues, and give guidance to content of exams. Team teaching also promotes a united and consistent facilitation practice that helps reduce student discontent, confusion and the seemingly inevitable tutorial group comparisons.

4. Peer review

Peer review of facilitation practice is offered at Deakin University. Whilst some institutions perceive the process as mandatory, the concept of offering the service minimizes anxiety often associated with such review. Given the increased profile of teaching portfolios, the concept of written peer review is becoming more popular amongst educators. Review criteria are negotiated and reflects the needs of the requesting facilitator and expertise of the reviewer. Common requests for review of facilitation style and strategies include the ability to interact on a metacognitive level, intervene and guide, and interjection of higher level questions. The review requests are congruent with the findings of Kaufman and Holmes (1996) who, in a survey of facilitators in PBL, identified three major areas of concern;

• Unsureness over when to intervene, guide, correct misinformation or explain course material.
• Difficult situations such as disruptive students.
• Ability to interpolate higher level questions.
• The peer review process allows the reviewer to observe varying facilitation styles which can also contribute to the reviewers' facilitation practice.

5. Program design and delivery

Authoring of scenarios allows facilitators to be involved from the beginning of the PBL process. The design of PBL scenarios is different from conventional program design in that they are based on real life problems and are ill-structured, open ended, or ambiguous (Fogarty 1997). As a scenario designer I find it is valuable to observe a student's interpretation of complex situations, which contain interrelated concerns, through the facilitator role. I design patient problem scenarios based on actual cases and collect resources from hospital case notes. Whilst I am aware of the patient outcome, documentation available to students provides cues only. Recently, I designed a scenario that should have facilitated the identification of many student learning issues, however the patient introduction paragraph was directive. The scenario suffered, not as a consequence of the information provided but because of the language used. Facilitation provides valuable information for the designer in developing scenarios that will engage, intrigue, promote inquiry, and allow students to learn from real life situations.

The actual subject delivery of problem situated scenarios is varied in an effort to keep students engaged and maximise learning. Mannequins in the nursing labs simulate clients in the problem-situated scenarios, and students are encouraged to cluster cues from the accompanying bedside documentation. Such strategies are supported by Schmidt (1998) who identified encoding specificity, stating that the closer the learning situations resemble the situation where acquired knowledge should be applied, the better the learners' performances and applications of knowledge.

Scenarios are also presented 'on line' and students meet to allocate learning needs for later presentation. This mode of presentation facilitates double-loop learning in that students not only analyse scenario content but also develop computer skills that are transferable to clinical practice. Some tutorials where students return to share information are set up as formal debates and students are encouraged to present their findings as structured arguments (e.g. quality of life versus quantity of life). Debates create a lively environment that avoids students reciting large amounts of text, and thereby promoting synthesis rather than reading skills.

In conclusion there is, and ought to be, considerable variation in the ways PBL is implemented, and facilitation practised. However, despite this, pragmatic facilitation practice must be identified and developed by institutions and individuals alike. The espoused theory of facilitation is evolving, as is nurse education facilitation practice. We need to identify the espoused formal theory of facilitation as well as focus on the informal theories-in-use of effective facilitators. We can clearly learn from both. My belief is that formal theories of facilitation will be increasingly built on the informal theories-in-use of reflective facilitators, and, because they speak directly to facilitators, these formal theories will increasingly influence the theories-in-use.

Individuals should be encouraged to adopt from the varied possibilities, some ingredients that pleasure the palate, and to seek new ingredients that may enhance the flavour of facilitation. The facilitator's journey should be nurtured, and should mirror the PBL philosophy of valuing both the educational process and the content equally.

Reference List

Andrews, M. & Jones, P. (1996). Problem-based learning in an undergraduate nursing program: a case study. Journal of Advanced Nursing. 23, p.357-365.

Barrows, H. (1988). The Tutorial Process. Springfield Illinois: Southern Illinois University School of Medicine.

Benner, P. (1984).From Novice to Expert: Excellence and power in clinical nursing practice. California: Addison-Wesley.

Boud, D. and Feletti,G. (1997). Changing problem-based learning. Introduction to second addition. The challenge of problem-based learning. London Kogan Page Ltd

Creedy, D. Horsfall, J. & Hand, B. (1992). Problem based learning in nurse education: an Australian view. Journal of Advanced Nursing.17, p.727-733.

Diekelmann, N.(1990). Nursing Education: Caring, dialogue, and practice. Journal of Nursing Education. 29 (7), p.300-305.

Engel, C.(1997). Not Just a Method But a Way of Learning in Boud, D.& Feletti, G. The Challenge of Problem-Based Learning. London: Kogan Page.

Fogarty, R. (1997). Problem-Based Learning and other Curriculum Models for the Multiple Intelligences Classroom. Melbourne: Hawker Brownlow Education.

Fossum, L. (1989) Understanding Organizational Change. Brisbane: Crop Publications.

Freitas, L. Lantz, J. & Reed, R. (1991). The Creative Teacher. Nurse Educator. 16 (1), p.5-7.

Frost, M. (1996). An analysis of the scope and value of problem-based learning in the education of health care professionals. Journal of Advanced Nursing. 24, p.1047-1053.

Holmes, D. & Kaufmann, D. (1994). Tutoring in problem-based learning: a teacher development process. Medical Education. 28, p.275-283.

Katz, G.(1995). Facilitation. In Christine Alavi, C Problem-based Learning in a Health Sciences Curriculum. London: Routledge.

Kaufmann, D. & Holmes, D. (1996). Tutoring in problem-based learning: perceptions of teachers and students. Medical Education. 30, p.371-377.

Knowles, M. (1984). The Adult Learner: A Neglected Species. Houston: Gulf Publishing Company.

Kubler-Ross, E. Grief Cycle cited by Fossum, L. (1989) Understanding Organizational Change. Brisbane: Crop Publications.

Margetson, D. Cooke, M. & Don, M. (1995). Beginning from where you are. Problem-based learning in a health sciences curriculum. London: Routledge.

Morgan, G. (1997). Images of Organization. London: Sage.

Reed, J., Procter, S. (1993). Nurse Education: a reflective approach. London: Edward Arnold.

Russell, R.L. (1988). Nursing education: a time for change 1960-1980. The Australian Journal of Advanced Nursing 5 (4) p.37-41

Schmidt, H. (1998). Problem-based learning: Does it prepare medical students to become better doctors? Medical Journal of Australia 168, p.429-430.

Schon, D. (1987). Educating the Reflective Practitioner. San Francisco: Jossey-Bass.

Silver, M. & Wilkerson, L. (1991). Effects of Tutors with Subject Expertise on the Problem-based Tutorial Process. Academic Medicine. 66, p.298-300.

Stepien, W. & Gallagher, S. (1993). Problem-Based Learning: As authentic as it gets. Educational Leadership. 4, p.25-28.

Thompson, C. & Sheckley, B. (1997). Differences in Classroom Teaching Preferences Between Traditional and Adult BSN Students. Journal of Nursing Education. 36 (4), p. 163-170.

Wilkerson, L. (1995). Identification of skills for the problem-based tutor: student and faculty perspectives. Instructional Science. 22, p.303-315.

Wilkerson, L. & Hundert, E. (1997). Becoming A Problem-Based Tutor: Increasing self awareness through faculty development. In Boud, D. & Feletti, G. The Challenge of Problem-Based Learning. London: Kogan Page.

Wilson, D. (1996). A Stategy of Change. Concepts and controversies in the Management of Change, New York USA: Routledge

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