Problem-based learning and simulation seem to be interchangeable terms at times and I have often heard both students and tutors define simulation as problem-based learning. However, the claim that problem-based learning is a student paramedic completing a simulation by being given a set of physiological parameters and then evaluating a diagnosis, is mostly incorrect. Although there is a problem to solve (the problem being what is wrong with the simulated patient) simulation is not problem-based learning in the true sense of the term and why this may be so is explored in this section of the chapter.
Problem-based learning (PBL) was first popularised by Barrows and Tamblyn (1980) who advocated its use for medical students. They suggested this strategy would allow learned skills to be applied to practice simultaneously. Small groups of medical students worked together to explore a set of symptoms that a patient might have, to determine what the deficiency was in their (the students’) knowledge. This would help the students decide what further information was needed to treat the patient. Since the 1980s, there seems to have been a plethora of perspectives and frameworks suggested on how PBL should be used. Savin-Baden and Howell Major (2004) have suggested that most texts agree that PBL is a student-centred approach to education, which allows freedom of student learning beyond that which is traditionally used. Conway, Little and McMillen (2002) proposed that PBL is a possible key to social reform in education. This is especially pertinent when considering the latter themes of this study and particularly those of control and power. Some
mention must be made of the term enquiry-based learning and some texts and evidence do not seem to differentiate between the concepts of enquiry-based and problem-based learning and simulation. Price (2003) argued that enquiry-based and problem-based learning are completely separate approaches, that to enquire does not require a problem or more importantly, a problem to solve.
2.4.1 Problem-based learning frameworks
Margetson (1998) argued that there are two separate but linked frameworks in PBL, the convenient peg theory and the growing web theory. These theories approach the issue from two very different perspectives. The convenient peg theory allows the student to build on a foundation of knowledge to allow them to highlight where the knowledge gaps are and to use existing skills and information to solve problems. The peg metaphor is generated by the idea that the student can ‘hang’ their knowledge on the problem. The growing web concept of PBL suggests that the student generates knowledge from the problem itself; it allows the student to acquire the knowledge whilst the problem is being worked through. The growing web approach allows the student to add on to their knowledge, allowing their web of knowledge to grow as they work through the problem itself. An outline is shown in table 2.2.
Table 2.2 – Margetson’s (1998) theories of PBL.
CONVENIENT PEG THEORY
GROWING WEB THEORY
This theory suggests that:
PBL is a two-stage process. First the student acquires knowledge and then applies this knowledge to a professional problem.
Each PBL event should be small and broken down to component parts.
This PBL does not truly involve a ‘problem’. This PBL may be used for fixed fields of knowledge.
This theory suggests that:
PBL is a one-stage process, acquiring and applying knowledge should happen simultaneously.
Problem and context are inseparable. There is not always a solution to the problem.
This PBL may be used for more esoteric, flowing fields of knowledge.
2.4.2 Simulation related to problem-based learning
Using this framework, it becomes clear that the simulation learning used in paramedicine is part of the convenient peg theory of PBL. As discussed in chapter four of this study, the student acquires their knowledge prior to starting simulation learning. The course of study that the student undertakes is theory-heavy in the initial weeks and subsequently the student uses their learned knowledge to assess the patient and formulate a care plan. There may not always be a diagnosis but there is always a framework within which a student must stay. Sometimes the student will have a session on a particular skill or knowledge and then later in the same session will apply the learned knowledge to a practical application. To use a very basic example, the student may learn how to apply a bandage either by a PowerPoint session or a tutor showing how to apply on another student, the students then practise this skill on each other. This is clearly the convenient peg theory and according to Margetson (1998), does not meet the general ethos of PBL. I would suggest that most PBL situations are in fact project based learning rather than in keeping with true PBL. Savin-Baden (2010) argued that when engaging a student with a problem, the problem itself should be recognised as having three dimensions: the context, the content and the schema. However, it is the transferring the context, or the problem to different situations, which makes PBL worthwhile. To use the same author’s example, the problem of a patient with chest pain can be better solved on a subsequent simulated patient’s chest pain but only if the context is changed.