Running head: DOES PROBLEM-BASED LEARNING

Does Problem-Based Learning Meet Student

Expectations of Effective Teaching?

Susan L. Copp

Illinois State University

Does Problem-Based Learning Meet Student

Expectations of Effective Teaching?

Barr and Tagg (1995) state that a paradigm shift is occurring in higher education in America. "In its briefest form, the paradigm that has governed our colleges is this: A college is an institution that exists to provide instruction. Subtly but profoundly we are shifting to a new paradigm: A college is an institution that exists to produce learning" (p. 13). Behavioral pedagogy, Tyler’s model, has dominated nursing education (Diekelmann, 1993; Middlemiss & Van Neste-Kenny, 1994). Diekelmann (1993) describes this approach to education as emphasizing cognitive gain. Teachers spend a great deal of time preparing lectures while students spend a great deal of time reading and taking notes. Cognitive gain as an educational goal emphasizes content without relation to any kind of situation or context. The teacher gives information and learning is purported to occur by transfer of the information from the teacher to the student. Learning is defined as retention and application of facts. Diekelmann goes on to say that rules and content are important for students to learn because they serve as a guide for the students as they enter practice. However, these rules should only be used as a guide; what is important is that students are able to think through certain situations. Consequently, the "danger of behavioral pedagogy is that it emphasizes learning content and the acontextual application of content; thinking is de-emphasized and/or defined as merely applying content to specific situations" (Diekelmann, 1993, p. 247).

Nursing education has emphasized the learning of factual information and procedures. This traditional style of teaching provides a highly structured environment for the student and fosters student dependency in both the classroom and clinical setting. As we move into the 21st century, faculty must encourage students to actively participate in the learning process, individually and in groups. Teaching strategies should be implemented that encourage students to actively think, explore situations, and open their minds to new ideas and different viewpoints. Students come from diverse backgrounds and experiences; faculty need to build on these differences. By having students take an active role in determining their learning needs as well as in learning, students will begin to share their knowledge with one another. The role of a faculty member will change from one who disseminates knowledge to one who facilitates learning (Manuel & Sorensen, 1995).

As faculty members move towards utilizing more active teaching/learning strategies in the classroom the question arises about quality of instruction. This paper will discuss the evaluation of instruction in classrooms utilizing problem-based learning (PBL). This teaching/learning methodology moves beyond the traditional teacher and student roles requiring active student involvement in the learning process. Teacher-centered techniques of education are replaced by student-centered techniques. This paper attempts to answer the following questions: Does the implementation of PBL, a student-centered teaching/learning strategy, meet student expectations of effective teaching? Can students learn the essential content needed to successfully complete licensure examinations? The premise of this paper is the use of problem-based learning will meet student expectations of effective teaching. The use of PBL will also lead to better student outcomes such as an increased ability to critically think, problem solve, and work as a team member. The first sections of this paper will describe teacher-centered learning strategies and problem-based learning. Research related to problem-based learning and evaluation of instruction in the healthcare field will be discussed followed by a discussion of its implications for nursing education.

Teacher-Centered Strategies

Traditional nursing programs have been teacher-centered and have typically been structured around different subject areas related to clinical phases of nursing practice, such as pediatric nursing, medical-surgical nursing, and obstetric nursing. These types of educational programs have helped the student nurse develop analytical skills, but have not helped the student integrate information and develop problem-solving skills (Biley & Smith, 1998; Frost, 1996). In these traditional nursing programs, lecture is the primary method of teaching in which nursing faculty presumably transfer information and knowledge to the student nurses who passively absorb the information. There is so much knowledge to be absorbed that the curriculum is overloaded. The teacher decides what information is important for the students to learn and how and when that information will be learned. Often the teacher does not take into account the various learning styles of the students (Barrows & Tamblyn, 1980). Students are tested on their retention of the information, not on their ability to use the information in a real setting. Centra (1993) states that the lecture format is effective when measuring knowledge, but inferior when measuring the following: transfer of knowledge to new situations, attitude changes, and problem-solving or critical thinking abilities. Students are often able to pass tests related to the material being tested but are unable to transfer the knowledge gained in the classroom setting to the clinical setting so that they may become competent practitioners (Frost, 1996; Heliker, 1994).

Problem-based Learning

Problem-based learning is an instructional strategy that is student-centered and promotes active learning (Barrows & Tamblyn, 1980; Brandon & Majumdar, 1997; Heliker, 1994). PBL is defined as "the learning that results from the process of working toward the understanding or resolution of a problem. The problem is encountered first in the learning process" (Barrows & Tamblyn, 1980, p. 1). Problem-based learning was introduced in the United States during the 1950’s at Case Western University Medical School. McMaster University in Canada incorporated PBL into its curriculum in the late 1960s (Boud & Feletti, 1991). PBL evolved in the medical school curriculum because the earlier curriculum was criticized as not being relevant to the practitioner. The faculty was concerned about the students’ inability to function as valuable team members, their poor inquiry skills, their inability to recall knowledge learned in previous years, and a gap between theory and practice (Barrows & Tamblyn, 1980; Boud & Feletti, 1991). Since its inception in medical schools, PBL has been used throughout the world in the education of other professionals including professional nurses. Problem-based learning has been integrated widely into Australia’s nursing education programs and has now been adopted by nursing schools in Wales, Canada, and Sweden (Biley & Smith, 1998; Heliker, 1994). Nursing schools in the United States are beginning to incorporate PBL into their curriculum as well. The problems identified in medical schools have also been identified in nursing education programs. Student nurses lack problem-solving skills, positive attitudes toward life-long learning, and the ability to retain and transfer knowledge from the classroom setting to the clinical setting (Biley & Smith, 1998; Heliker, 1994).

The assumption of PBL is all students have some pre-existing knowledge and that knowledge is valued. The underlying theory of PBL is knowledge is actively constructed, not given (Biley & Smith, 1998; Gijselaers, 1996). Each student constructs his or her own way of interpreting the world and its meaning in order to understand. Once this knowledge has been constructed according to a person’s experiences and understanding, it is impossible to transfer it to another person (Biley & Smith, 1998).

Problem-based learning is implemented in the classroom setting by presenting a realistic practice situation by a variety of means including videotape, audiotape, case notes, and written scenarios. Students discuss the problem relating it to their previous knowledge and experiences. The teacher’s role (termed tutor in this method) changes from expert to facilitator, encouraging the students to explore the situation and reflect on past experiences. The tutor assists the students to identify issues that need to be addressed. The students are encouraged to brainstorm ideas concerning the nature of the problem and the possible underlying causes. Discussion takes place and the students analyze the situation, identifying gaps in their knowledge. From this analysis, questions arise which help the students identify their learning needs. The students research the answers to their questions and share new information with their peers in subsequent classes. This new information is applied to the situation and the students’ hypotheses may be modified or rejected. A plan of action is developed and then presented to the entire group (Barrows, 1996; Frost, 1996).

There are many benefits to PBL. The classroom becomes student-centered rather than teacher-centered. Students are challenged to become self-directed learners and develop problem-solving skills in order to develop a deeper understanding of the situation presented in the classroom. Because the students are actively involved in learning new material and concepts to solve the problem, they become motivated to seek knowledge leading to better comprehension and long-term memory. Students learn to work as a team and collaborate with one another; consequently, they develop listening, critical thinking, and teaching skills. PBL aids the integration of theory and practice; by dealing with real life situations in the classroom, students are able to reflect on prior experiences and knowledge and apply these to the new situation. Clinical performance skills are also enhanced because they take the knowledge from the classroom to the clinical area (Frost, 1996; Heliker, 1994).

Teachers, on the other hand, do not like giving up their power and authority in the classroom and may have a difficult time learning to use questioning and probing to guide students in their acts of discovery (Frost, 1996). Changing the teacher’s style of teaching can also produce anxiety for the teacher. The teacher also becomes a co-learner in this method of instruction. "This way of teaching as ‘being with’ the student describes the tutorial role in PBL in which both tutor and student come to view the whole picture in a more effective way, both learning in the process" (Heliker, 1994, p. 46). The workload of the teacher can increase significantly when PBL is implemented because of the need to develop cases. The first several cases presented in class take longer for the students to solve because they may not be confident in their abilities to solve problems. As students become more confident in their skills, teacher contact hours decrease (Cooke & Donovan, 1998; Frost, 1996; Heliker, 1994). It has also been noted that it takes approximately 20% more time to cover course content using PBL rather than the traditional lecture method (Frost, 1996). Testing is another concern – doubts have been raised as to whether multiple choice tests are appropriate for this type of learning because with this form of testing memorization is encouraged versus critical thinking (Brandon & Majumdar, 1997; Frost, 1996). Although tests can be developed which assess knowledge to solve a problem, national tests for registered nurse licensure continue to use the multiple-choice method.

Instructional Evaluation

Evaluation of faculty members falls into three categories: teaching, research, and service (Centra, 1993). Of the three, teaching and research are usually looked at more critically for promotion and tenure decisions. This section will focus primarily on student evaluation of teaching in the PBL classroom.

Student participation in the evaluation of effective teaching has been a time-honored tradition (Kirschling et al., 1995; McKeachie, 1996). McKeachie (1996) identified three uses of student evaluation: (a) to assist students in choosing courses, (b) to improve teaching, and (c) to evaluate teaching for use in personnel decisions such as tenure and merit increases. Since its inception, the notion of students rating the teacher has been a controversial subject (McKeachie, 1996). Most students, when asked to identify good teaching, do so by thinking about what teachers do most - lecture. McKeachie (1997) points out that most student evaluation forms focus on traditional classroom teaching methods. He argues that most learning occurs outside the classroom and student evaluation forms must clue students to consider these aspects of teaching when evaluating their teachers.

There are a variety of ways to define effective teaching and there has been ongoing disagreement over the content of student evaluations (Dennis, 1990). Evaluation systems should be designed to reflect the varieties of successful teaching (Centra, 1993). Centra, Froh, Gray, and Lambert (1987) defined effective teaching, "Effective teaching produces beneficial and purposeful student learning through the use of appropriate procedures" (as cited in Centra, 1993, p. 42). This definition of effective teaching identifies both the outcomes of effective teaching (student learning) and the process of teaching as important in the evaluation process. These authors identified six qualities that characterize effective teaching: (a) good organization of the subject and course material, (b) effective communication, (c) knowledge of and enthusiasm for the subject matter and teaching, (d) positive attitude toward students, (e) fairness in grading, and (f) flexible approaches to teaching. The first five qualities relate to traditional teaching methods, the sixth quality encourages teachers to use a variety of teaching methodologies. Centra (1993) reported that a seventh quality was added at a later date – "Appropriate student learning outcomes" (p. 43). Dolmans, Wolfhagen, Schmidt and van der Vleuten (1994) developed an evaluation tool to assess tutor performance in problem-based learning groups. This tool is a three-factor model that contains 13 statements reflecting the tutor’s behavior. The three factors are: (a) guiding students through the learning process, (b) content knowledge, and (c) commitment to the group’s learning. The researchers determined this tool is a valid and reliable instrument for evaluating tutor effectiveness in the PBL classroom and can be used to improve teaching behavior.

The remainder of this paper examines student attitudes, classroom structure, tutor attributes, and learning outcomes associated with problem-based learning. These four items will be examined to determine if they meet the criteria for effective teaching.

Student Attitudes Toward the PBL Learning Environment

The majority of research involving PBL has occurred in the medical field. Vernon and Blake (1993) performed a meta-analysis of evaluative research on problem-based learning. These researchers found that student attitudes favored PBL over the traditional classroom. They found that student evaluation was more positive when evaluating the PBL program. Student attitudes, classroom attendance, and student moods were more positive in the PBL classroom versus the traditional classroom. Albanese and Mitchell (1993) performed a review of the literature on PBL outcomes and implementation issues and found evaluation of the learning environment revealed students perceived the PBL environment more positively. There were high levels of student satisfaction with PBL. Kingsland (1996) found that students rated PBL courses at the top for clear goals, standards, and overall satisfaction. Edwards et al. (1998); Kingsland (1996); and Hammel et al. (1999) found that students were very satisfied with the PBL format, but felt overwhelmed with the workload. The students found that it took a great deal of time to find relevant information to solve problems.

Kaufmann and Mann (1996) compared students’ attitudes in PBL and a conventional curriculum. The authors found students in the PBL curriculum had a more positive attitude towards the curriculum than students in the traditional curriculum. The students in the PBL curriculum also had a more positive attitude toward faculty members and felt faculty in the PBL curriculum had the ability to excite their curiosity for learning. These students also felt the learning environment was more democratic than the traditional classroom environment.

Classroom Structure

The PBL format varies at the different colleges and universities that utilize this teaching/learning methodology. However, all formats of PBL encourage self-directed learning. Most students are accustomed to being directed by the teacher on what is important to learn. In PBL students decide their own learning needs and then actively pursue them. The teacher guides and facilitates the process. Because the teaching format in PBL calls for self-directed learning and the teacher usually does not lecture, there is less structure in the classroom. Students who are more comfortable with structure can have difficulty with the ambiguity that can be present in this type of classroom, leading to anxiety and frustration. Students who are unsure of their role will remain passive and may have difficulty discussing important details in complex situations (Brandon & Majumdar, 1997; Edwards et al., 1998; Frost, 1996; Hammel et al., 1999).

Students are usually placed in groups of six to eight students to work cooperatively on the assigned problem. This group work occurs both inside and outside the classroom. Hammel et al. (1999) reported students found group work frustrating. Some students felt others in the group were holding back relevant information; other students had difficulty trusting the accuracy of information brought back to the group by fellow classmates. However, Albanese and Mitchell (1993) found that students enjoyed the small group interaction. Brandon and Majumdar (1997) reported students confirmed group work increased interaction with others in the class and led to a greater appreciation for others opinions.

MacKinnon (1999) reported on four core elements that should be present in the PBL classroom: (a) community, (b) ownership, (c) relevance, and (d) empowerment. These core elements contribute to the student’s desire to learn and to work with the other group members. Community includes both teacher-student relationships and student-student relationships. Both types of relationships contribute to the students’ sense of belonging suggesting that the social dimension of learning is a critical component of the PBL experience. Ownership relates to students’ autonomy and personal control over their learning. The students liked the challenge and the responsibility to solve problems, yet appreciated when the tutor provided direct assistance only when necessary. Students in this study described their tutors as friendly, concerned, and supportive. Problem relevance is considered the most important factor for motivation and for the development of clinical reasoning skills. When relevance was not apparent to the students, they expressed frustration with the course. Empowerment was the fourth core element identified in this study. Fifty-four percent of the students in this study described gains in confidence, attitudes, knowledge, and skills. This gave the students a sense of achievement and improved their ability to work as a team. The author felt that the core elements are synergetic. If one element is missing, then it will impact the remaining elements leading to a decrease in student motivation.

Tutor Attributes

The tutor plays a key role in problem-based learning. The way the tutor guides the small group can directly influence how the student group functions, the students’ interest in the subject being studied, and can indirectly influence student achievement (Dolmans, Wolfhagen, Schmidt, & van der Vleuten, 1994). Barrows and Tamblyn (1980) state that the tutor should be an expert in the subject matter being studied. Expert tutors know when to let students struggle to solve the problem, know when to guide the students back on track when they are heading in the wrong direction, and can serve as a resource when questions arise.

Edwards et al. (1998) conducted a study of registered nurse (RN) students participating in a community health PBL course and found they preferred expert tutors to facilitate learning. The authors of this study also felt expert tutors are essential especially if the students are new to the PBL format. Albanese and Mitchell (1993) reported that students preferred to be tutored by experts. The researchers found that expert tutors can augment the students’ ability to learn by helping them identify relevant learning issues and by assisting to correct gaps in knowledge and errors in processing information. These studies support Barrows’ and Tamblyn’s concept of the expert tutor. But, as Albanese and Mitchell allude to, an expert tutor can decrease the student’s attempts at self-directed learning because the expert tends to be more directive during the problem-solving process.

In an effort to evaluate a new PBL curriculum White, Amos, and Kouzekanani (1999) performed a qualitative analysis on focus groups participating in PBL courses at the University of Texas-Houston Health Science Center School of Nursing. The RN students were asked open-ended questions about the teachers’ behaviors and how they facilitated the learning process. The students reported that the teachers were flexible, encouraged independence, made them responsible for learning, and encouraged them to learn. The students felt the PBL strategy was more helpful in aiding their learning. The authors also compared mean course evaluation scores from three adult health classes, one obstetric nursing class, and one psychiatric nursing class before and after implementing PBL. Scores for one of the adult health classes and both the obstetric and psychiatric nursing classes were statistically significant and indicated that the students were more satisfied with the PBL strategy of teaching.

Wilkerson (1995) discussed ratings from first year medical students attending Harvard Medical School who described the attributes of tutors who were the most helpful in promoting learning. Those receiving the highest overall ratings engaged in four distinct behaviors. Students described effective tutors as those who were able to balance student direction with assistance, intervening only when necessary to assist students to focus on the problem and to enhance learning; they did not control the group. These tutors also contributed their knowledge and experience to the group by recommending extra readings and citing their own research and clinical experiences, thus enhancing student learning. A third behavior exhibited by these tutors was their ability to create a pleasant learning environment by responding appropriately to the students. Lastly, these tutors stimulated critical evaluation of ideas by encouraging the students to think beyond the obvious and to look at the problem from a different perspective to enhance their learning.

Schmidt and Moust (1995) used end-of-course questionnaires completed by students from 524 different tutorial groups to evaluate an effective tutor. They found students rated PBL as effective if the tutors exhibited a caring attitude towards the students and if they showed an interest in them. They also rated the knowledge base of the tutor as being important and felt the tutor’s knowledge should be relevant to the learning objectives of the course. These students felt the tutor should be an expert in the subject area being studied and that he/she should be able to translate knowledge into terms easily understood by the students.

Brandon and Majumdar (1997) reported on the implementation of PBL in an interdisciplinary, public health course at New Mexico State University. Student evaluations indicated that faculty were effective when they facilitated the learning process and were patient with the students. Other attributes of effective faculty were identified as: communicating expectations with the students, encouraging student participation and rewarding students for asking questions, keeping the discussion on track, and being willing to guide and direct students to available resources.

Learning Outcomes

Dolmans, Gijselaers, and Schmidt (1993) identified three components that are used to assess instructional quality: (a) student performance on achievement tests, (b) student ratings of the quality of instruction, and (c) course content coverage. This study was conducted at the medical school at the University of Limburg in the Netherlands. Ninety-eight students participated in the study by completing a Topic Checklist (TOC). The TOC included topics that reflected intended course content and yielded information about student learning activities during the course of study. The TOC provided information about what content was studied by the students, how much time the students spent studying it, and the degree to which the students mastered it. The students studied 12 problems associated with normal pregnancy, delivery, and child development. They were asked to indicate whether they mastered each of the 12 problems and the amount of time they spent studying. Student completion of the TOC indicated problem areas related to the psychological well being of the mother and to the social development of children. The researchers found that the TOC is a reliable procedure to yield information about the weaknesses of a course and to provide the feedback necessary for the teacher to make improvements in the course.

PBL was piloted during the 1995 - 1996 academic year at the University of Texas-Houston Health Science Center School of Nursing with a group of 24 RN students (Amos & White, 1998). Students were asked to evaluate the course and identify outcomes of PBL as well as compare their PBL experience with the traditional lecture format. They reported that PBL was more challenging and was oriented to the adult learner’s previous experiences and knowledge. They confirmed that the PBL format was more realistic than the lecture format and applied directly to their professional practice. Students most frequently reported improved critical thinking skills as a positive outcome of PBL. "Identifying learning issues and exploring alternatives and solutions that were applicable to the case encouraged the students’ critical thinking" (Amos & White, 1998, p. 12). Students also identified the following outcomes: (a) Students learned how to learn; (b) They learned to work as team members; (c) They learned to access information from creative sources such as talking to experts, visiting community sites, and accessing information via the Internet; (d) Their research skills improved; and (e) Their self-esteem and professionalism were enhanced.

Performance on licensure examinations is an outcome measure of effective teaching. Both educational institutions and faculty members are evaluated on the passage rate of students taking licensure examinations by accrediting agencies. A major problem identified in the medical profession is that medical students who have participated in PBL do not perform as well on the National Board of Medical Examiners Part 1 (NBME 1), which tests basic science knowledge, as compared to those students who participate in the traditional curriculum (Albanese & Mitchell, 1993; Vernon & Blake, 1993). Mennin, Friedman, Skipper, Kalishman, and Synder (1993) found that students who participated in a more structured traditional program performed better on the NBME I, while students in a PBL program performed better on the NBME III. However, one study conducted by Richards et al. (1996) found no significant difference in student scores on the NBME.

Finch (1999) investigated the effect of PBL on academic performance of students studying podiatry. He found no significant difference between students in a traditional classroom and those in a PBL classroom in regards to testing of factual knowledge on the Chiropody Registration Examinations in Ontario. However, the PBL students demonstrated a deeper level of understanding and improved cognitive skills associated with patient management on the essay section of the registration examination. He suggested students participating in PBL are more knowledgeable and posses superior patient management skills than traditional students.

Hammel et al. (1999) performed a qualitative program evaluation to describe the effects and to explore the strengths and weaknesses of PBL at the Shenandoah University Program in Occupational Therapy. One hundred fifty-four students participated in the study. These students exceeded the pass rate average on the national certification examination. However, the authors emphasize that the results may be skewed because the examination has increasingly incorporated cases and clinically based questions rather than testing rote memorization skills.

Studies have indicated that students who participated in PBL were rated more highly in the clinical setting during years three and four in medical school versus those students who participated in lecture-based learning (Albanese & Mitchell, 1993; Richards et al., 1996). This is presumed to occur because students participating in PBL courses have daily contact with patient problems through written case studies, simulated patients, and earlier contact with "real patients" as opposed to those students participating in lecture-based learning. Frost (1996) and Heliker (1994) indicated that nursing students’ clinical skills were enhanced when they were engaged in problem-based learning in the classroom. These students were able to transfer knowledge from the classroom to the clinical setting.

No studies have been found that discuss passage rate on the national council of state boards licensing examination for registered nurses (NCLEX-RN). A review of PBL programs offered in the United States indicates most nursing programs that offer PBL incorporate it into courses for returning RN students, incorporate it into a graduate program, or introduce it in one or two undergraduate courses. No nursing program in the United States has organized its entire undergraduate curriculum on a problem-based learning format ("Undergraduate Institutions with Faculty Members Using PBL," 1999). Nursing schools in Canada and Australia have incorporated PBL into the entire nursing curriculum; however, no literature has been found that discusses passage rates on these countries’ licensure examinations.

Discussion

Does the implementation of PBL, a student-centered teaching/learning strategy, meet student expectations of effective teaching? According to some of the sources cited in this paper PBL does meet student expectations of effective teaching as suggested by Centra et al. (as cited in Centra, 1993).

Centra et al. (as cited in Centra, 1993) describe an attribute of an effective teacher as someone who exhibits a positive attitude toward students. Students in the various studies discussed in this paper perceived a positive learning environment. They also identified other effective characteristics of teachers such as allowing flexibility, displaying a caring attitude, and showing interest in the students. These characteristics not only show support for the students, but also serve to motivate them to take responsibility for their own learning. These characteristics also fit the three-factor tutor evaluation scale developed by Dolmans et al. (1994). The attributes described apply to factor one – guiding students through the learning process and factor three – commitment to the group’s learning.

Another effective teaching attribute identified by students in these studies was the knowledge of the teacher. Both Centra et al. (as cited in Centra, 1993) and Dolmans et al. (1994) identified knowledge of the teacher as an essential characteristic for effective instruction. Studies supported this belief; students wanted the tutor to be knowledgeable in the subject matter so that he/she could guide them in the right direction. A characteristic of the tutor’s knowledge is the ability to identify when to be directive with the students and when to let the students explore the issue on their own with little or no direction. Problem-based learning allows for flexibility in approaches to teaching and learning. Each student is able to identify his/her own learning needs and develops goals based upon them. The student engages in self-directed learning and the teacher guides and facilitates the process.

There are many benefits to PBL, but some negative aspects were identified and include an increased student workload, ambiguity in the classroom, and group work. Faculty members can turn this into a positive outcome by providing an orientation to the PBL process (Barrows & Tamblyn, 1980; Brandon & Majumdar, 1997; Hammel et al., 1999). It is imperative that students enter a PBL course or curriculum knowing the expectations of this teaching/learning methodology. Students must understand that PBL involves self-directed learning, so the teacher does not assume the traditional teaching role. They must also understand that PBL occurs in small groups; students determine learning needs and take an active role in researching the answers to the problems presented, then share this information with their group. Faculty members also need to teach students time management skills and allow them time for research and development of their library skills.

Amos and White (1998) suggest teachers begin the PBL process by teaching students about group dynamics. This will help the students deal with peer problems and group conflict. The authors also suggest the learning styles of the students should be evaluated so tutors can help guide the students appropriately. These techniques will help decrease student dissatisfaction with group work and the ambiguity associated with this type of learning.

Most teachers have been exposed to the traditional style of instruction during their own education. Because of past experience, many teachers perpetuate traditional practices of content delivery through lectures, demonstrations, and reading assignments. Excellence in teaching has routinely been recognized as good lectures and this is what has been rewarded. Developing new teaching skills has not been highly looked upon by educators (Barrows & Tamblyn, 1980). This way of thinking will have to change in order for new teaching/learning methodologies to be accepted by both teachers and students. Faculty development programs will need to be offered so teachers can make the transition to problem-based learning. These programs should be ongoing based on student, peer, and faculty evaluations to improve teaching in this environment. And, there should be continued research on the effectiveness of using PBL in the classroom. Administrators will need to be supportive of faculty members who bring these new teaching styles into the classroom. Faculty must also see that these teaching strategies are looked upon favorably by administration during review for promotion and tenure (Brandon & Majumdar, 1997; Urbina, Hess, Andrews, Hammond & Hansbarger, 1997).

The second question posed for this study was related to learning outcomes. Can students learn the essential content needed to successfully complete licensure examinations? The ultimate goal of nursing education is to produce graduates who have the knowledge, skills, and critical thinking abilities to enter practice as professional nurses. The research cited in this paper indicates that problem-based learning has many positive learning outcomes, which can help students meet these goals. Students learn to become self-directed, life-long learners. They learn to work through problems as a team and how to research. They take these new skills into the clinical area, where they provide patient care. They learn to critically evaluate problems and to use previous knowledge to solve new ones. However, these same graduates must be able to pass the licensure examination in order to begin to practice. Research results vary on the success rates of PBL graduates completing licensure examinations in the medical profession. Unfortunately, there is no research available regarding PBL and NCLEX-RN performance. Therefore, research needs to be continued in this area.

Conclusion

Problem-based learning is a teaching/learning methodology that offers a promising future to the education of nursing professionals. The research suggests PBL is a suitable alternative to teacher-centered courses. Students in this study have reported a positive response to this type of strategy. Research has indicated that students develop skills to be self-directed, life-long learners. It has also indicated information learned in the PBL environment is retained longer which enables students to adapt to a changing healthcare environment (Brandon & Majumdar, 1997; Frost, 1996).

The ultimate goal of evaluation of teaching is to improve the quality of instruction and learning. In order to meet this goal, more research is needed to gain insight into how to improve teaching and learning when incorporating PBL into the nursing classroom. The answer to understanding what is effective and what is not requires continued collection of both quantitative and qualitative data during each PBL course. This data should come from multiple sources including students, faculty, tutors, and administrators.

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