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This article was downloaded by: [Northeastern University] On: 10 November 2014, At: 23:44 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Innovations in Education and Teaching International Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/riie20 Problem design in problem-based learning: evaluating students' learning and self-directed learning practice Ella Yeung a , Stephanie Au-Yeung a , Thomas Chiu a , Nicola Mok a & Patrick Lai a a The Hong Kong Polytechnic University, Hong Kong Published online: 04 Jun 2010. To cite this article: Ella Yeung , Stephanie Au-Yeung , Thomas Chiu , Nicola Mok & Patrick Lai (2003) Problem design in problem-based learning: evaluating students' learning and self-directed learning practice, Innovations in Education and Teaching International, 40:3, 237-244, DOI: 10.1080/1470329032000103762 To link to this article: http://dx.doi.org/10.1080/1470329032000103762 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions

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Page 1: Problem design in problem-based learning: evaluating students' learning and self-directed learning practice

This article was downloaded by: [Northeastern University]On: 10 November 2014, At: 23:44Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registered office: MortimerHouse, 37-41 Mortimer Street, London W1T 3JH, UK

Innovations in Education and Teaching InternationalPublication details, including instructions for authors and subscription information:http://www.tandfonline.com/loi/riie20

Problem design in problem-based learning:evaluating students' learning and self-directedlearning practiceElla Yeung a , Stephanie Au-Yeung a , Thomas Chiu a , Nicola Mok a & Patrick Lai aa The Hong Kong Polytechnic University, Hong KongPublished online: 04 Jun 2010.

To cite this article: Ella Yeung , Stephanie Au-Yeung , Thomas Chiu , Nicola Mok & Patrick Lai (2003) Problem design inproblem-based learning: evaluating students' learning and self-directed learning practice, Innovations in Education andTeaching International, 40:3, 237-244, DOI: 10.1080/1470329032000103762

To link to this article: http://dx.doi.org/10.1080/1470329032000103762

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) containedin the publications on our platform. However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose ofthe Content. Any opinions and views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be reliedupon and should be independently verified with primary sources of information. Taylor and Francis shallnot be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and otherliabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to orarising out of the use of the Content.

This article may be used for research, teaching, and private study purposes. Any substantial or systematicreproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in anyform to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

Page 2: Problem design in problem-based learning: evaluating students' learning and self-directed learning practice

INTRODUCTION

Problem-based learning (PBL) has been gaining con-siderable momentum in both Occidental and Orientalcountries. Debates have been focused on whetherPBL in interactive small groups should replace sys-tematic lectures, and, if such a reform would enhancethe learning outcome of students. Barrows (1986) hasidentified the primary educational objectives that canbe addressed by PBL as being: (a) the developmentof an effective clinical reasoning process; (b) theorganization of a knowledge base for use in clinicalcontexts; (c) the development of effective self-directedlearning skills; and (d) an increased motivation forlearning.

Several studies have provided evidence of the desiredeffects of PBL in terms of improving students’learning outcome. Rankin (1992) and Marshall et al.(1993) showed that medical students in a PBL pro-gramme utilized library resources more frequentlythan those in a conventional curriculum, suggestingthat the former teaching methodology promotesactive, independent learning. Research by Stokeset al. (1997) showed a shift of the students’ attitudestowards more independent learning subsequent toPBL instruction. There is also evidence to suggest

that learning in a PBL format can lead to long-termretention of knowledge, enhance the integration ofbasic science concepts into clinical problems andresult in an increase in intrinsic interest in the subject(Norman and Schmidt, 1992).

The shift from traditional didactic lectures to small-group PBL tutorial sessions involves a change of students’ learning from passive to active. Profoundadjustment is therefore needed by academic staff interms of philosophy of teaching and ability to entrustthe students’ capacity to learn and worries that thestudents will not learn all the ‘necessary’ content(Saarinen-Rahiika and Binkley, 1998).

In a PBL tutorial session, students have to examinea meaningful problem in detail, followed by explo-ration of their own learning issues and discovery ofhow to work towards the goals involved in solving aproblem. Learning of basic and clinical sciences alltakes place using problems and academic staffbecome the facilitators during the teaching/learningprocess. As the learning issues derived in the tutorialsguide the students’ self-directed study activities, thecontent of the problems thus becomes an important

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Innovations in Education and Teaching InternationalISSN 1470-3297 print ISSN 1470-3300 online © 2003 Taylor & Francis Ltd

http://www.tandf.co.uk/journalsDOI: 10.1080/1470329032000103762

Problem Design in Problem-based Learning: EvaluatingStudents’ Learning and Self-directed Learning PracticeElla Yeung, Stephanie Au-Yeung, Thomas Chiu, Nicola Mok and Patrick Lai, The Hong KongPolytechnic University, Hong Kong

SUMMARY

The design of the problems that are used in problem-based learning plays an important part in achievingthe intended learning objectives set by teaching staff. To a large extent, the learning issues generatedby students during tutorials determine their learning activities and form the framework for the directionof self-directed study. The relevance of these learning issues will drive and stimulate students to becomemore competent self-directed learners. The work described in this paper explores the match betweenstudents’ learning issues and the learning objectives that have been set by teaching staff. The findingsindicate that students recognize (on average) 79.9% of the learning objectives with a significantimprovement as the semester progresses ( p � 0.01). There is also evidence to suggest that studentsmove towards independent learning as a result of problem-based learning.

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vehicle towards achieving targeted learning objectives.It could be argued that problems used in PBL canbe effective enough to reflect the intended courseobjectives. Therefore, the work described in thepresent study has two aims. The first aim is to com-pare learning issues generated by students with theobjectives set by teaching staff. The second is toexplore students’ self-directed learning practice andthe ability to search for information in meeting thelearning objectives.

METHOD

This section of the paper describes the study thathas been undertaken in terms of the subjects, the aca-demic course involved and the evaluation proceduresthat were employed.

Subject

A total of 148 students (84 males and 64 females) atthe Hong Kong Polytechnic University were enrolledinto the Bachelor’s Honours Degree of Physiotherapyfor the academic year 1998/9. All students hadfulfilled the minimum requirement for admission tothe programme. Of the 148 students accepted, 137students had completed the secondary Form 7 in thelocal schools participating in the Advanced LevelPublic Examination and the admissions were basedon the strength of the examination results. Elevenstudents were non-local or mature applicants reach-ing the age of 25 in the year of admission.

Course context

The degree is a three-year full-time programme, com-prising of 108 credits for the academic componentsin the Hong Kong Polytechnic University and 27credits for clinical education conducted in majorclinical settings in Hong Kong.

In semester one of first year the focus is on the basicsciences such as anatomy and physiology. In thesecond semester, the students’ role is recognized toprogress to that of ‘student therapist’ for preparationof the first clinical placement by the end of the semes-ter. The emphasis of the second semester is on theapplication of a clinical decision-making process tothe design and implementation of physiotherapyinterventions for specific problems of the differentbody systems (Course Documentation, 1998). Theassessment, diagnosis and management issues are

discussed using commonly observed conditions toillustrate main principles underlying a given inter-vention. The PBL module ‘Physiotherapy Diagnosisand Management of Musculoskeletal Dysfunction’amounts to five credits. The module is the very firstin a series ‘Physiotherapy Diagnosis and Manage-ment’ and is embedded within a traditional curricu-lum. For PBL teaching it is recommended to haveless than 10 students in one tutorial group (Woods,1996). Due to the level of resource available,students were divided into six groups with an averageof 25 in each group. To accommodate this difficulty,it was decided to divide the 25 students into threesubgroups. The teaching staff had to create an envi-ronment to ensure that facilitation of problem-basedlearning occurred by other means. Initially, in a two-hour tutorial session, the faculty member rotatedamong the three subgroups to facilitate the process.In the following sessions, students in each subgroupneeded to be empowered to do this while the facultymember monitored the progress. It is obvious thatthe success relies on the active participation of thestudents, making suggestions and developing learn-ing issues. It has been suggested that setting up PBLgroups provides students with the opportunity todevelop skills but in itself does not develop theirproblem-solving skills, group skills and self-directedlearning skills (Norman and Schmidt, 1992). It isthrough the learning cycle of practice and feedbackthat one develops these desired target skills.

Biggs (1989) suggested that the teaching processassociated with a deep approach to learning shouldinclude at least one of the following: (a) an appropri-ate motivational context; (b) a high degree of learneractivity; (c) interaction with others, both peers andteachers; and (d) a well-structured knowledge base.We have attempted to apply these principles withinthe design of problems. Problem design is minimallystructured to allow for free inquiry. Students have totap into their prior knowledge base in order to find theknowledge gap and then design an inquiry strategyfor self-directed learning.

During the tutorials, the learning issues generatedby the six groups of students were collected by theteaching staff for the purpose of exploring these learn-ing issues from the students’ perspective. This wascompared with the course objectives as set by theteaching staff (an example is presented in Appendix 1).The teaching staff then had to judge whether students’learning issues reflected the intended learning objec-tives. There were a total of five problems.

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Problem Design in Problem-based Learning 239

Evaluation

The evaluation consisted of two parts. The first partrelates to the learning issues set within studentgroups. In order to evaluate if the students were ableto identify the learning objectives associated with thecourse, the learning issues generated were collectedfrom the different student groups (n � 18 groups)and then compared with the learning objectives set bythe teaching staff. The staff who designed the prob-lem then assessed whether these issues were relevantor whether they matched with the set objectives. Thesecond part of the quantitative evaluation related toindividual students (n � 148). At the completion ofeach problem, every student was asked to complete aquestionnaire. This process sought to identify if thestudents felt that they were able to achieve the learn-ing objectives that were set. This evaluationaddresses the students’ learning experiences in PBLand reflected upon how much they had learnt. Theitems in the questionnaire consisted of the learningobjectives for that particular problem (an example isgiven in Appendix 2). Students were asked to ratehow much they thought they had learnt about each ofthe objectives from any source (e.g. individual learn-ing, group members, group discussion, resourcepersonnel etc.) on a five-point Likert scale, rangingfrom ‘nothing’ to ‘good grasp’ of knowledge. For aproblem, the scores for each objective were firstsummed up and then divided by the number of objec-tives. For example, in problem 1 (see Appendix 2), atotal score for the seven objectives was calculatedand then divided by seven to get the composite scorefor this individual problem.

Statistical analysis was conducted using the SPSSsoftware (version 9.0). The numbers of objectivesidentified by the student groups were expressedas percentages. An ANOVA (Repeated Measures)was employed to evaulate whether an individual’sperception of fulfilling the knowledge objectives (asspecified by the teaching staff) improved over thesemester. The significance level was set at � � 0.05.

Individual semi-structured interviews, at the begin-ning and the middle of the semester (week 7), wereconducted with eight students. The time taken foreach interview was approximately 30–45 minutes.The interviews attempted to explore students’self-directed learning practice and their competencyin searching for relevant resources. Analyses werecarried out on the verbatim transcripts and wereexamined independently by two staff members forconstructs related to the two main themes.

RESULTS

Quantitative analysis

Of the five problems that were set over the semester,a total of 66 learning objectives were identified by theteaching staff. The students, on average, were able torecognize 79.9% of the issues as their learning objec-tives (Table 1). Closer examination of the objectivesthat were not identified revealed that they were allrelated to broad issues on the sociological andpsychological aspects of patient management. Usingthe example given in Appendix 1, the learning issuesnot being identified by most students were:

• Waiting list – medical system in Hong Kong.• Anxiety of Wong Sam Mui to have an operation.• Role of relatives (daughter in this case) in the

health care of elderly people.• Discharge criteria for a patient after hip surgery.• Concept of health in relation to outcome measure.

There were 31 additional issues being identified bystudents. Although these were not intended learningobjectives, they were rated as relevant by the teach-ing staff involved with the course.

Table 2 summarizes the mean score of the question-naire for each individual problem. An ANOVA(Repeated Measures) was used to evaluate whether

Table 1 Learning objectives identified by student groups(n = 18 groups) over five problems

Learning objectives identified (%)

Mean SD

Problem 1 78.8 4.5Problem 2 76.7 8.6Problem 3 75.0 2.3Problem 4 81.4 5.6Problem 5 83.3 1.4

Table 2 Learning objectives achieved by individualstudents after completion of each problem (n = 148)

Mean

Problem 1 2.49Problem 2 3.17Problem 3 2.78Problem 4 3.13Problem 5 3.42

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students felt that they achieved the set objectivesafter completion of a problem. The analysis showed asignificant difference (F � 4.22, df � 4, MS � 7.84,p � 0.001), suggesting that there was improvementin the students’ ability to pursue their learning activ-ities guided by the learning issues generated duringtutorials over the 14-week semester.

Qualitative analysis

In the process of analysing data from the interviews,exploratory analysis was employed to identify themain themes in the transcripts. These were substanti-ated with quotations from the interview transcripts.

Definition of self-directed learning practice

When asked about their perception of what self-directed learning means and how best to achievethis practice, students seemed to have a good under-standing:

For example, there is a problem. Firstly, I would find outwhat I should learn, and then try to find relevant infor-mation such as reading books, or reading journals, andthen perhaps discuss with some classmates. (WYK)

Self searching for references and answers … (WWF)

Students have to be very initiative and very hardworking,and should acquire the skills in searching for informa-tion … (CCP)

Students should actively find information or to solvesomething or to learn new things … (WHL)

Students should be active, persistent, an eagerness forknowledge and have good organization power … (WWF)

Everyone should be responsible for his/her own learning.(HOL)

Perceived benefits and problems to self-directedlearning practice

Some students expressed benefits about developinggood self-directed learning skills, while others haddoubts about the benefits. Most of the comments weregenerally related to workload, increase in time tosearch for information and lack of library resources.

I know how to search information now and I readmore … (LWH)

I know how to study more effectively…Now I will go tothe library to borrow relevant books, then read them, and

jot down notes … not just memorizing as in thepast … (WYK)

… limited resources in the library. (CCP)

For the aspects of workload, I think it is higher, becausemost of the time we need to search information our-selves … (LML)

Increase in confidence in searching for information and a wider resource base

The active learning in PBL promotes self-directedlearning skills such that students can develop moredesirable learning habits. The transcripts show thatstudents were able to identify their deficit in knowl-edge and target their learning needs to relevantsources of information. In addition, students weremotivated in that they used a wider variety of knowl-edge resources rather than just textbooks.

In the past, I seldom went to the library to borrow books,now I go often … I read more things, not just reading onebook. When we present our material in a tutorial, itwould refresh the knowledge that we have already readbefore. (WWF)

… for example to find some other information useful tome on the Internet … In the first semester I never triedto search for information on the Internet, while in thesecond semester, I started to have this habit. I did notknow I could find so much information on the Internet.And I also go to the library more to look for informa-tion … Although others have borrowed most of thebooks, I would try to find in the reserve collection in thelibrary. (WHL)

In secondary school, it was not like this, we all sat thereand listened to the teacher talking, now it is really differ-ent…for example, I would take the initiative to go to thelibrary to find books, and in the past I would just sit thereand study what the teacher had given us. (LOY)

Now I always have to look at keywords and find outrelevant information on that part … I must get the mainidea … (HOL)

Of the eight students interviewed, all realized thatthis method of teaching would only be effective ifthey became active in their learning. The followingquotations illustrate this.

I do not really like PBL, I don’t think it is effective espe-cially for lazy students. I prefer the traditional method, atleast I know what I should learn, whereas PBL requiresstudents’ initiative. It turns out that learning can becomevery ‘messy’ as a result of my laziness. (CCP)

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This style of teaching is good but there must be enoughtime to allow me to search for information, otherwise Idid not learn a single thing, I had experienced that … forone or two tutorials, I did not prepare and found that I didnot understand anything. (LWH)

DISCUSSION AND CONCLUSION

In order for students to become active learners, thelearning activities that they undertake have to beapplicable to their future career and they must see a rea-son for learning something. The educational theory inPBL captures this most important philosophy (Woods,1996). The problem and the interactive approach usedin PBL tutorials serve as an effective learning mecha-nism in clinical and scientific education.

In order to enhance the quality of teaching, it isnecessary to consider carefully how we approach ourteaching since this directly affects how our studentsconstruct knowledge – and this, in turn, affects theirlearning outcomes. In PBL, the content of a problemserves as a major vehicle that influences each stu-dent’s direction and motivation for learning. It hasbeen suggested that if students are to learn desiredoutcomes (e.g. self-directed learning practice) in areasonably effective manner, they should be engagedin learning activities that are likely to achieve theseoutcomes (Biggs, 1999).

From the analysis of the quantitative data, studentswere able to identify most of the learning objectivesthat were set by the teaching staff, and there was a sig-nificant improvement in the achievement of the learn-ing objectives over the 14 weeks of learning. Based onthe qualitative data, there is evidence to suggest thatstudents show a shift towards independent learning byestablishing more regular self-directed learning prac-tices and by increasing confidence in searching forinformation relevant to learning using PBL.

Bearing in mind the complex nature in students’learning processes, further research utilizing a longi-tudinal design to compare between PBL and non-PBLinstruction is needed to confirm these results.

ACKNOWLEDGEMENTS

This research was supported by a grant from the PBLconsortium fund for Teaching Development Grants.

REFERENCES

Barrows, H S (1986) A taxonomy of problem-based learn-ing methods, Medical Education, 20, 481–6.

Biggs, J B (1989) Approaches to the enhancement oftertiary teaching, Higher Education Research and Devel-opment, 8, 1, 7–25.

Biggs, J B (1999) The power of problem-based learning inan aligned teaching system, Research and Developmentin Problem-based Learning, 5, 14–24.

Course Documentation (1998) Bachelor of Science(Honours) Degree in Physiotherapy, The Hong KongPolytechnic University, 15–22.

Marshall, J G, Fitzgerald, D, Busby, L and Heaton, G(1993) A study of library use in problem-based andtraditional medical curricula, Bulletin of the MedicalLibrary Association, 81, 299–305.

Norman, G R and Schmidt, H G (1992) The psychologybasis of problem-based learning: a review of theevidence, Academic Medicine, 67, 557–65.

Rankin, J A (1992) Problem-based medical education:effect on library use, Bulletin of the Medical LibraryAssociation, 80, 36–43.

Saarinen-Rahiika, H and Binkley, J M (1998) Problem-basedlearning in physical therapy: a review of the literatureand overview of the McMaster University experience,Physical Therapy, 78, 195–207.

Stokes, S F, Mackinnon, M M and Whitehill T L (1997)Students’ experiences of PBL: journal and questionnaireanalysis, Zeitschrift für Hochschuldidaktik, Specialissue ‘Problem-based Learning: Theory, Practice andResearch’, 21, 161–79.

Woods, D R (1996) Problem-based Learning: Resources to Gain the Most from PBL, Waterdown, Ontario,Canada.

BIOGRAPHICAL NOTES

Ella Yeung is an Assistant Professor in Physiotherapyin the Department of Rehabilitation Sciences, theHong Kong Polytechnic University. Her particularinterest is in the development of clinical reasoning inphysiotherapy education.

Stephanie Au-Yeung is an Assistant Professor of theDepartment of Rehabilitation Sciences, the HongKong Polytechnic University. She has a backgroundof physiotherapy and is interested in approaches todevelop students’ critical thinking and self-directedlearning ability.

Thomas Chiu is an Assistant Professor in Physiother-apy in the Department of Rehabilitation Sciences, theHong Kong Polytechnic University. He has clinicalexperience in the management of musculoskeletalproblems for more than 20 years. He has a verystrong interest in problem-based learning and haspresented a paper at the 5th Biennial InternationalPBL Conference, Montreal, Canada in 1999.

Problem Design in Problem-based Learning 241

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Nicola Mok was the research associate for the pro-ject. She was responsible for collecting and analysingthe quantitative and qualitative data obtained fromthe interviews. Nicola is currently a PhD candidateat the University of Queensland in Australia.

Patrick Lai is the Senior Educational DevelopmentOfficer of the Hong Kong Polytechnic University.His current research interest is web-based enhanced

problem-based learning and the promotion and eval-uation problem-solving and critical thinking skills ofstudents.

Address for correspondence: Ella Yeung,Department of Rehabilitation Sciences, The HongKong Polytechnic University, Hung Hom, Kowloon,Hong Kong.e-mail: [email protected]

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APPENDIX 1

Problem 1: Wong Sam Mui

Presentation I

Wong Sam Mui, a 65-year-old Chinese woman comes to your hospital’s outpatient physiotherapy departmentaccompanied by her daughter. She was told by the doctor two years ago that she has osteoarthritis in her righthip. Her doctor says it is like the head of the thigh bone rubbing against the socket of the pelvic bone.

Lately pain has become so severe and her movement has got limited. She was being examined by anorthopaedic surgeon last week with a view to hip replacement with an artificial joint. The surgeon told her thatthe X-ray of her hip looks ‘all worn out’.

Possible learning issues:

• Osteoarthritis associated with a particular age group or gender.• Possible causes of the condition and progressive nature of the disease.• The associated clinical features of osteoarthritis.• Additional information the students may identify include details of the current condition, previous history,

medical and X-ray reports, medication.• How pain and limitation of movement affect her activities of daily living (think of examples).• The indication of total hip replacement and what is involved (video sessions organized to watch the

operation).• Medical management of osteoarthritis.• Plan for physical examination of the hip.• Spend time on discussion of their prior knowledge gained in other subjects that is relevant to the problem.

Presentation II

From the examination of Mrs Wong in a standing position, it is evident that there is some deformity in herhip. Her leg is turned out and flexed up. Her hip movements are very restricted and painful. She is put on awaiting list for surgery but she wants to delay the operation as much as possible. Apart from physiotherapy,the doctor has given her some painkillers and anti-inflammatory tablets.

Mrs Wong continues with four weeks of physiotherapy treatment of exercises and heat treatment with mini-mal improvement. She finally agreed to proceed to a cemented total hip replacement.

Possible learning issues:

• Reason for the hip deformity – what structures are likely to be involved?• Physical examination of the hip – what structures need to be examined? • How much physical examination is necessary?• Reinforce with the initial presentation.

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Problem Design in Problem-based Learning 243

• Medication, namely medical management of osteoarthritis.• Waiting list – medical system in Hong Kong.• Anxiety of Wong Sam Mui to have an operation.• Role of relatives (daughter in this case) in the health care of elderly people.

Presentation III

Six months later, you see Mrs Wong in the orthopaedic ward. The medical notes say that she has had a totalhip replacement postero-lateral approach one week ago. You are asked to ‘mobilize’ Mrs Wong and to giveher exercises to do. She is told by the doctor not to bend her hip more than 90º.

Possible learning issues:

• Patient inquiry at a different hospital setting (inpatient versus outpatient setting).• Appropriate examination and tests after surgery.• Surgical intervention and how it affects post-operative physiotherapy management.• Rehabilitation goals and aims of treatment.

Presentation IV

You are asked by the surgeon to work with the occupational therapist regarding Mrs Wong’s discharge. MrsWong is now able to walk with a walking frame herself. You need to give her a checklist of do’s and don’tsbefore she leaves the hospital.

Possible learning issues:

• Precautions after hip surgery.• Role of physiotherapy prior to hospital discharge.• Role of professional team members related to patient care.• Discharge criteria for a patient after hip surgery.

Presentation V

You met Mrs Wong in the street taking her grandson to kindergarten. She said that for the first three months,the immobility after the operation was difficult to cope with. Activities like getting on and off the bus andusing the toilet were difficult for the first three months. Walking made her very tired also. It was almost a fullyear before she began to feel the real benefits of the operation and all her pain had gone. She joked and saidthat she would not need a ‘re-do’ of the operation like her neighbour does!

Possible learning issues:

• Change of walking aids from frame to a stick.• Community physiotherapy involvement.• Patient’s level of functional limitation and disability.• Concept of health in relation to outcome measure.• Revision of total hip replacement.

APPENDIX 2: STUDENT LEARNING EVALUATION

Problem 1: Wong Sam Mui

Please circle the appropriate score on how much you have learnt about each of the objectives from anysource (i.e. individual learning, other group members, group discussion, lectures, associated sessions, resourcepersonnel etc.).

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Questions and answers

1. What other learning objectives, in addition to our knowledge objectives, were important in your individuallearning? Please specify clearly.

2. If you had difficulties with any of the listed learning objectives, please indicate reasons for the difficulty.3. Do you have any other comments on this problem and its associated sessions and resources which may

assist us in revising the problem for the future?

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Learning objectives Nothing Basic understanding Good grasp

1. Describe the pathological conditions of 1 2 3 4 5osteoarthritis and the clinical featuresassociated with it.

2. Explain the medical and surgical 1 2 3 4 5intervention utilized in the managementof osteoarthritis.

3. Perform a basic subjective and physical 1 2 3 4 5examination pertaining to the hip.

4. Describe the selection of specific tests 1 2 3 4 5and measurements based on the patient’scondition.

5. Describe the basic principles of 1 2 3 4 5physiotherapy care in the rehabilitation of an orthopaedic patient with hipdysfunction.

6. Outline the broad plan of care to meet 1 2 3 4 5the patient’s health demands.

7. Perform some basic manual therapy 1 2 3 4 5techniques and exercise therapy pertainingto the hip.

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