Problem-based learning in dentistry, implementation, and student perceptions

Jayashri Tamanna Nerali; Lahari Ajay Telang; Ajay Telang; Pishipati Vinayak Kalyan Chakravarthy

doi:10.4103/sjos.SJOralSci_15_20

ORIGINAL ARTICLE

Year : 2020 | Volume : 7 | Issue : 3 | Page : 194-198

Problem-based learning in dentistry, implementation, and student perceptions

Jayashri Tamanna Nerali¹, Lahari Ajay Telang², Ajay Telang³, Pishipati Vinayak Kalyan Chakravarthy⁴
¹ Department of General Dentistry, Penang International Dental College, Butterworth, Malaysia
² Department of Oral Medicine and Radiology, Penang International Dental College, Butterworth, Malaysia
³ Department of Oral Pathology, Penang International Dental College, Butterworth, Malaysia
⁴ Department of Conservative Dentistry and Endodontics, Penang International Dental College, Butterworth, Malaysia

Date of Submission	11-Mar-2020
Date of Decision	31-May-2020
Date of Acceptance	14-Aug-2020
Date of Web Publication	04-Nov-2020

Correspondence Address:
Dr. Jayashri Tamanna Nerali
Department of General Dentistry, Penang International Dental College, Level 18.21, NB Tower, 5050, Jalan Bagan Luar, Butterworth
Malaysia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/sjos.SJOralSci_15_20

Abstract

Introduction: Problem-based learning (PBL) is one of the most comprehensive and widely accepted student-centered tool for teaching and learning health professions education, wherein students define the problem, establish learning objectives, undergo self-directed learning and facilitate understanding of the problems. This study has been carried out with an aim of assessing 3^rd year dental student's perception of PBL as a teaching and learning method over a 5-year period based on problem-solving and self-directed learning, cooperative learning, role of facilitator and product discussion.
Methodology: The perception of 3^rd year students from year 2014 to 2018 was assessed at the end of PBL sessions using a self-administered, structured questionnaire. Their responses were recorded using a five point Likert scale and data collected retrospectively was analyzed. Students' open feedback regarding the PBL process was also recorded and analyzed.
Results: A total of 376 participants responded to the questionnaire (female = 250 [65%], male = 126 [35%]). Majority of students agreed that PBL improved problem-solving skill, self-directed learning and perceived that it had a positive impact on cooperative learning. Students also felt that PBL product discussion prepared them for future presentation and helped to clarify concepts.
Conclusion: The results suggested that students had a positive attitude toward PBL and it improved their problem-solving skills as well as motivated them to learn and participate actively. Some students felt that PBL was time consuming, yet it was a fun and interesting way to learn.

Keywords: Dental students, health professions, perception, problem-based learning

How to cite this article:
Nerali JT, Telang LA, Telang A, Chakravarthy PV. Problem-based learning in dentistry, implementation, and student perceptions. Saudi J Oral Sci 2020;7:194-8

How to cite this URL:
Nerali JT, Telang LA, Telang A, Chakravarthy PV. Problem-based learning in dentistry, implementation, and student perceptions. Saudi J Oral Sci [serial online] 2020 [cited 2021 Jan 16];7:194-8. Available from: https://www.saudijos.org/text.asp?2020/7/3/194/299962

Introduction

World Health Organization consultations on public health teaching and training recommended utilization of 40% time for skill-building in all public health courses by innovative learning methods. These methods should make training; student-centered, inquiry-driven, problem-oriented and evidence-based, with the role of the teacher as a facilitator to help students to acquire these competencies.^[1] As an alternative to the traditional pedagogical model, problem-based learning (PBL) was introduced into health professions education at McMaster University in 1969 and in dental education at the Faculty of Odontology in Malmo, Sweden in 1990.^[2] Malaysia was the first country in Asia to introduce PBL program in medical education at Univeristi Sains Malaysia in 1979. There after many other schools have adopted PBL in some form or other and more recently in other fields of study as well.^[3]

PBL is a student-centered approach in which a problem serves as the stimulus for active learning. Built on the learning principles of 3CS which stand for constructive, collaborative, contextual, and self-directed it helps the student define the problem and establish learning objectives required to develop their understanding of the problems.^[4] PBL promotes self-motivation and self-responsibility, facilitating a more enjoyable and effective learning environment. By integrating knowledge with practice, PBL trains students to analyze problems, identify and acquire knowledge and skills needed to deal with real-life situations and meanwhile helps cultivating teamwork, communication, and research skills.^[5]

PBL has been implemented in various types at various levels of curriculum, such as pure PBL curriculum with no lectures, PBL curriculum with few lectures, Hybrid PBL curriculum and PBL presented as a single course level.^{[2],[6],[7],[8],[9],[10],[11]} In dental curriculum, a well-planned hybrid PBL can foster development of knowledge, skills, and attributes that oral health professionals will need in the future.^[12] To achieve successful result in PBL pedagogy, three components – the PBL problems, small group learning, and the student-centered environment must all be present and addressed during the implementation of a PBL.^[13]

PBL was implemented as part of the institution curriculum at Penang International Dental College, Butterworth, Malaysia during its transition from traditional curriculum to Outcome-Based Education. Although this process has been in place since 2012, the quality assurance feedback collected for improving the PBL process was not collectively analyzed until later on. The PBL learning process overview is shown in [Figure 1].^[14] In PBL process students are divided into 4 groups of 8–10 per group and a facilitator is assigned to each group. The steps followed in implementation process are as follows:

Figure 1: Problem-based learning process overview

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Introductory lecture in beginning of the year 3 course
Three PBL problems with different themes and stated learning outcomes are conducted
PBL product discussion for each group and assessment
Evaluation of PBL process.

Aim and objectives

The aim of this study is to analyze dental students' perception of PBL based on the four domains; problem-solving and self-directed learning, cooperative learning, role of facilitator in PBL and product discussion.

Methodology

The perception of 3^rd year students during the year 2014–2018 was assessed at the end of the PBL session. A self-administered, structured questionnaire along with a written information sheet was distributed explaining the purpose and design of the study. At the end of the PBL product discussion, the students were asked to complete the questionnaire. The students were made aware that the participation was voluntary and answers were anonymous. Their responses were analyzed using IBM SPSS Statistics for Windows, version 19 (IBM Corp., Armonk, NY, USA). Students' open feedback regarding the PBL process was also recorded and analyzed.

This questionnaire was used to assess dental student's perception of PBL based on the following four domains:

Perception of students on problem-solving and self-directed learning
Perception on cooperative learning
Perception of students on role of facilitator in PBL
Perception of students on product discussion/presentation.

Each domain contained four to seven questions and the participants were expected to select a response according to Likert Scale (1 = Strongly disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, and 5 = Strongly agree).

Results

A total of 376 participants responded to the questionnaire, out of these, 250 students were females and 126 were males. Students of both genders responded positivelytoward PBL helping in improving problem-solving skills and self-directed learning. [Table 1] represents Mean and standard deviations of each questionnaire statement for domain 1: Perception of students on problem-solving and self-directed learning].

Table 1: Domain 1 - Perception of students on problem-solving and self-directed learning

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Majority perceived that PBL enhances cooperative learning, and the two statements that were found to be statistically significant were “I usually participate actively during PBL session” and “PBL allows opportunity for hearing different perspectives and learning from one another” [Table 2].

Table 2: Domain 2 -Perception on cooperative learning - Mean and standard deviations of each questionnaire statement

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Most of the students agree that the facilitator created a positive learning environment and effectively facilitated the PBL sessions [Table 3].

Table 3: Domain 3 -Perception of students on role of facilitator in problem-based learnin

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In [Table 4] the mean scores for all statements about perception of students regarding product discussion were above 4, indicating that the product discussion after PBL sessions promotes team work and competitive spirit as well as prepares them for future presentation.

Table 4: Domain 4 - Perception of students on product discussion/presentation

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The open feedback received from students was categorised into positive and negative comments. Overall positive comments-“PBL is a good way to learn,” “fun and interesting,” “Enhances knowledge sharing and teamwork,” “Improves self-confidence and self-esteem.”

Overall Negative comments – “time consuming,” “limited knowledge, “so difficult to solve problem” “PBL problems are too vague.”

Discussion

Higher educational curriculum has been deeply attached to traditional methods of teaching and learning based on didactic teaching and rote learning, which are nearly a century old. PBL was introduced as an alternative to traditional pedagogical models and since been implemented in many medical and dental school curricula. There is enough evidence that PBL is an effective teaching and learning method. However, from the Asian context most schools and students were positive about adapting to PBL, claiming that successful PBL implementation is enhanced by strong support from academic administrators and training for both faculty and students.^[15]

Studies evaluating the effectiveness of PBL are limited in dentistry as the focus of dental education is different from that of medical education. Clinical skills in dentistry involve mainly mechanical hand activities that rely on developing psychomotor skills and less of clinical reasoning and problem-solving in comparison to medical education.^[2]

The participants in this study were all 3^rd year students belonging to the same undergraduate program. Although all students went through the same number of PBL sessions, the problems used in PBL sessions were different yet revolved around the same themes. Three PBL problems were used in year 3, semester 1, over a period of 5 weeks followed by product discussion. The students' perception on four domains were discussed below.

Perception on problem-solving and self-directed learning

Regarding the perception of students on problem-solving and self-directed learning, 74% of students agreed that PBL improved problem-solving skills and self-directed learning. There is variation seen in responses which may be due to the variety of problems given and different facilitators assigned for different PBL sessions. Similarly, in another study PBL motivated the students to learn interesting and solving the triggers and scenarios.^[12] The medical and dental students reported that PBL helped them with in-depth understanding of certain topics and link their basic science knowledge to clinical classes as reported by Barman et al.^[16]

Perception on cooperative learning

Barman et al. reported that level of participation in discussion during the PBL session varied from student to student among both medical and dental students. Some of them worked hard to prepare themselves for discussion while others were relatively passive.^[16] In the present study a positive perception about cooperative learning was perceived by students with 80% of them agreeing that PBL promoted cooperative learning and an increasing trend was seen over the 5 years. This is similar to the study conducted by Alper in 2008, who concluded that most students have difficulty in evaluating the problems when they first encounter PBL; but proactive discussion and encouragement can help in improving overall learning experience.^[5] Even similar findings are reported among medical students showing positive attitudes toward cooperative learning.^[17]

Perception of students on role of facilitator in problem-based learning

Tutor training has been suggested as an important aspect of PBL. Dolmans and Ginns, in the year 2005, said the behaviour of tutors should stimulate self-directed learning by encouraging students to generate well defined learning objectives and motivating students to use the various resources.^[18] Our study results reported that most of the students agree that the facilitator created a positive learning environment and effectively facilitated the PBL session. The results are similar to the study conducted in Qassim University where in dental students' agreed that facilitator was helpful and encouraged active discussion during PBL process.^[19]

A study done to assess the change of correlation between the written test score and tutors' performance test scores in the assessment of medical students during a PBL course in Malaysia observed higher correlation coefficient in the group where tutors received PBL training. This reinforces the importance of tutor training before their participation in the PBL course.^[20] Barman et al. reported that medical and dental students felt that guidance from subject specialists and well-prepared facilitators of the sessions were beneficial and also briefing the students and facilitators about the philosophy and principles of PBL may make the PBL sessions more beneficial.^[16] Thus, it is important that the facilitators should be trained to effectively guide the students during the PBL process in order to achieve their learning goals.^[12]

Perception of students on product discussion/presentation

In the aspect of product discussion, the areas analyzed were teamwork, future preparation, communication skills improvement and usefulness of feedback. On average, 90% of the students had a positive attitude toward product discussion and they felt that feedback given by assessor helps students to clarify their concepts. Product discussion was conducted in the form of presentation so as to enhance students' presentation skills and this was assessed independently by a different set of assessors. Studies have found that a structured assessment pattern for PBL improved student participation, this could be because the students and the tutors knew what was expected from the session. This also helped to standardize the PBL assessment pattern.^[21]

Limitations

The principles of PBL and effectiveness in achieving its intended outcomes when implemented in the basic sciences years is more as compared to clinical years. The limitation of the study is that it only presents the students perception of PBL when conducted during clinical years. This is due to the uniqueness of twinning dental degree program offered.

Conclusion

The overall results of our study showed the students have a positive attitude toward the PBL process and it improved their problem-solving skills as well as motivated them to learn and participate actively. The role of good facilitation and active product discussion involving content expert is also a contributor to the positive attitude toward PBL. Although some students felt that PBL was time consuming, it was a fun and interesting way to learn. Further research should focus on the effectiveness of PBL in dental students' learning approaches and its role in clinical learning.

Acknowledgments

The authors wish to acknowledge Lee Tze Wen, Yeow Yee How and Cheng Yie Jing for their contribution. Special thanks to all the students who volunteered for the focus groups and participated in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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