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PBL improves retention of exercise physiology.

Abstract

Performance on exam questions at the end of the course and one year later was compared in an exercise physiology course where students were taught using lecture or problem-based learning (PBL) approaches. Student perceptions were also assessed about the use of PBL. Application of knowledge scores were higher in the PBL group at the end of the term and one year later (18% and 65% respectively). Student perceptions about the use of PBL were positive. Compared to a traditional lecture format, using PBL in an undergraduate exercise physiology course improved students' responses on exam questions where they were asked to apply course material in both the short- and long-term.

Introduction

Several educators and researchers in a variety of disciplines have integrated problem-based learning (PBL) into traditional lecture-based undergraduate courses (Cliff & Wright, 1996; Edwards, Hugo, Gragg, & Peterson, 1999; Finch, 1999; Huang & Carroll, 1997; Kinkade, 2005; Lim & Chen, 1999; Niederman & Badovinac, 1999; Purdy, Benstead, Holmes, & Kaufman, 1999; Stern, 1997; Sullivan, Hitchcock, & Dunnington, 1999). The use of PBL changes the focus to a student-centered approach and is believed to develop problem-solving skills (Dalton, 1999; Lim & Chen, 1999). An underlying assumption to the problem-based approach is that students become responsible for their own learning while heightening motivation and integration of prior knowledge (Saarinen-Rahiika & Binkley, 1998).

Bloom's (1956) taxonomy of educational objectives domain identifies six aspects of learning, the first three being knowledge, comprehension and application. Because application requires the use of general principles to solve a problem, problem-based learning exercises can help students to apply their knowledge and comprehension to new situations (Carroll, 1998). Developing these skills are often objectives in upper level undergraduate courses, thus the use of PBL as an active learning strategy could foster skill development and student growth.

According to the cognitive learning theory model, the learner incorporates the new information into already existing networks of association (Svinicki, 1998). Students who engage in PBL could therefore strengthen knowledge structures through integration into the learner's long-term memory. There is limited information on the short and long-term benefits of the use of PBL to teach exercise physiology, as well as on student perceptions of the teaching strategy. Therefore, the purpose of this study was to compare student scores on exam questions aimed at assessing a) knowledge and comprehension and b) application of exercise physiology course content as well as to evaluate short- and long-term retention of concepts taught using PBL or traditional lectures. We also reviewed anonymous student comments on their perceptions of the use of PBL exercises in an undergraduate exercise physiology course.

Methods

All procedures were approved by the institution's Research Ethics Board and were in accordance with the tri-council policy for research involving human subjects. During the registration period, undergraduate students enrolled in a four-year kinesiology program randomly selected one of the two sections of a required third year exercise physiology course and one of four sections of the accompanying lab. The instruction methods for each course section were not disclosed. The content of the labs was identical for each section. One group of students was taught using traditional lectures only while the other received a mixture of lectures and problem-based learning (PBL) activities with on-line discussions on a course web page. At the beginning of the semester, the study was outlined to all prospective participants and all students agreed to participate (i.e. allow use of course and exam marks as well as GPA in reporting group data and allow the use of anonymous comments from course evaluations to be used).

To ensure that both groups were similar, grades in two prerequisite courses, as well as overall GPA, were compared. Data related to student knowledge and comprehension, as well as application of course material, was collected using identical exam questions in both course sections at the end of the semester. Retention over time was assessed using a "surprise" test (identical to the questions used at the end of the semester) administered one year after the end of the courses. To this end, students enrolled in a required senior class were asked to volunteer for this part of the study. They were not told about the test and therefore could not review or prepare for the one year follow up assessment. The questions used to evaluate knowledge and comprehension of key concepts as well as ability to apply course material to specific situations were: 1) "Name and describe the different methods by which body heat is lost during exercise in a hot environment. Identify the major heat loss mechanism and the physiological problems that the prolonged use of this mechanism imposes." and 2) "Your grandparents are leaving for the hot and humid climate of the Caribbean islands for the Christmas break. They would like to exercise during their trip and ask you, an expert in exercise physiology, what they should do before, during and after the exercise sessions in warm environment. Explain why you recommend these procedures." The first question was designed to assess knowledge and comprehension--the first two learning objectives in Bloom's taxonomy, while the second provided an opportunity for students to apply that knowledge to a specific problem--the next step in Bloom's taxonomy.

Data on perceptions of the use of PBL was collected from open-ended questions on course evaluations. Students were instructed to comment on PBL and laboratories when answering the following four questions: "1) What were the weaknesses of this course and why?", "2) What were the strengths of this course and why?", "3) How would you improve this course?" and "4) Any other comments?". Data were analyzed using a content analysis following the methods of Spradley (1980) and responses were grouped into three categories: positive, negative or no response. Frequencies were then tabulated.

Data are presented as frequencies and percentages or as group means and standard deviations. An independent t-test was used to compare group means. Significant differences were accepted at p<0.05.

Results

Students randomly selected a course and laboratory section during the registration period and were blinded to the teaching method used in each section. However, to ensure that the groups were similar, grades in two prerequisite courses, second year Anatomy and Physiology courses, as well as overall grade point average were compared. No significant differences were found on any of these variables between the group taught with PBL and the group taught with lectures (Table 1). See issue website http://rapidintellect.com/AEQweb/win2006.htm

At the end of the semester, to compare student knowledge and comprehension of course material and to assess the student's ability to apply course content, class average on two open-ended exam questions were compared. Furthermore, final course grades were compared. The two teaching methods resulted in similar grades on exam questions and final course grades (73.3 [+ or -] 13.1% 70.0 [+ or -] 15.5% in PBL and lecture groups respectively) with only one significant difference, that being an 18% higher score (6.43 vs 5.43) for the PBL group's answer to a question of application of knowledge (Table 2). See issue website http://rapidintellect.com/AEQweb/win2006.htm

One year later, students were asked to retake the test. Some students had graduated and were no longer available to be retested, some students were absent on the surprise follow-up test date and two students refused to take part. Some students (i.e. teaching assistants and students that had previously failed and redone the course) had also recently reviewed the material and were excluded from the analysis. Therefore, data from 15 students in the lecture group and 18 students in the PBL group were included in this analysis. Again, scores on knowledge and comprehension were similar, however score on the application of knowledge question was significantly higher in the PBL group (Table 3). See issue website http://rapidintellect.com/AEQweb/win2006.htm

Finally, student perceptions about using PBL to teach exercise physiology, collected on anonymous course evaluations were assessed. Overall, they were very positive. 95% of students (i.e. 21 out of 22) who commented on PBL had favourable remarks (Table 4). For example, student comments included: "Not only does the incorporation [of PBL] help to add to my learning, I feel like without it I am being cheated" and "PBL assignment. Retain info better with direct involvement". Students who participated in the PBL exercises suggested that it made the material "more relevant and meaningful" and "problem based learning were effective and interesting ways to learn course material". Seventy five percent of all students enjoyed and appreciated this teaching style and were positive about its use in undergraduate curriculum. See issue website http://rapidintellect.com/AEQweb/win2006.htm

Discussion

Our main findings indicate that students who were taught exercise physiology using a combination of PBL exercises with web-based discussion, lectures and laboratory exercises performed as well as students taught using a more traditional teaching strategy (i.e. lectures and labs only). The use of PBL also allowed students to retain as much as the group taught solely with lectures and laboratory exercises over a one year period. Moreover, the students who participated in PBL exercises scored significantly higher on questions of application of knowledge at the end of the course and one year later.

Bloom's taxonomy of learning stages progresses through knowledge, comprehension/ understanding, application of knowledge, analysis, synthesis and evaluation. The fact that undergraduate students taught with PBL exercises performed as well as their counterparts on the knowledge and understanding components and were significantly better in applying the course content suggests that including PBL activities in the delivery of the course content does not hinder learning and may enhance the students' abilities to solve problems. Similar evidence has been reported in other disciplines when PBL was used as a teaching strategy (Miller, 2003; Prince, van Eijs, Boshuizen, van der Vleuten, & Scherpbier, 2005).

Retention after one year was similar for both groups on the knowledge and understanding question however, students taught with PBL exercises continued to do significantly better on the application of knowledge question. These data are consistent with others who concluded that students retained significantly more 7 months later when taught using problem-oriented learning (Them, Schulc, Roner, & Behrens, 2003). This is possibly due to the fact that the problems used in the PBL exercises in this exercise physiology course were designed to encourage students to apply the basic concepts they had learned or were learning to real life situations. Moreover, critical thinking and the ability to solve problems are objectives of the undergraduate curriculum in kinesiology. The significantly higher scores on the application of knowledge questions, both at the end of the course and one year later, demonstrates that the students taught using PBL achieved these objectives and that they maintain these skills at least for one year.

Overall, the students who participated in the PBL class were better at answering a question which was designed to evaluate their ability to apply their new knowledge to a specific situation. Several previous studies have concluded that knowledge acquisition and reasoning skills are greater for students taught using PBL than students taught using conventional methods (Doucet, Purdy, Kaufman, & Langille, 1998; Finch, 1999; Kaufman & Mann, 1998; White, Amos, & Kouzekanani, 1999) although Finucane, Johnson and Prideaux argue that there is insufficient evidence to conclude that PBL enhances problem solving skills (1998). At any rate, students involved in the present study commented that PBL made the information more pertinent. This may contribute to why some students believed this approach to teaching was more relevant to their needs.

Several studies have indicated that students find problem-based learning beneficial (Birgegard & Lindquist, 1998; Cliff & Wright, 1996; Doucet et al., 1998; Kuhnigk & Schauenburg, 1999; Lancaster et al., 1997; Stern, 1997; White et al., 1999). Specifically, students explain that such an experience enhances reasoning, integration of content and professional behaviours (Stern, 1997). PBL has also been reported to reduce dropout and improve academic performance (Iputo & Kwizera, 2005). Others have reported that students did feel however, that PBL was less effective if they did not feel confident that they were learning the content their instructor had intended them to learn (Huang & Carroll, 1997). In the present study, the use of the web-site discussion provided the instructor and tutors opportunities to give feedback and minimize the likelihood of this being a major problem. Feedback could be provided promptly, individually or to the group and ensured that the students were studying the correct material.

Evaluating the effectiveness of PBL is very difficult (Finucane et al., 1998). One problem that remains to be resolved is the choice of appropriate outcome assessment measures to evaluate the effectiveness of PBL as a mode of learning in undergraduate courses (Lim & Chen, 1999). In the present study and in another (Them et al., 2003), exam grades were used. Long-term retention of course material was also assessed using an unannounced test one year later. Our results are similar to those of Them et al. (2003) who reported that 7 months after completing a "nursing neurological patients" course, students taught using problem-oriented learning retained content better than those taught using frontal teaching. Although assessing the merit of a teaching strategy and student retention by comparing exam answers and grades may not be the best method, these promising data provide a suitable framework to continue to develop the use of and evaluation of this active learning style in parts of an undergraduate exercise physiology course.

Conclusion

In summary, the use of PBL activities can be a useful asset in teaching undergraduate exercise physiology. The integration of PBL exercises to teach exercise physiology was associated with significantly higher scores on exam questions assessing the students' ability to apply knowledge without any negative effect on scores on questions assessing knowledge and understanding. This significant improvement was also observed one year later suggesting that student retained the material longer. These students also rated the use of PBL in this course very positively on their course evaluations. This teaching strategy clearly improves short-term and long-term student performance with regard to application of knowledge. These results demonstrated the viability and merit of PBL and its acceptance by undergraduate students in kinesiology.

Acknowledgements

The technical assistance and financial support of the Acadia Institute for Teaching and Technology is gratefully acknowledged. The authors also would like to thank all the students who participated in this project.

References

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Joanne Y. Pelletier, Acadia University, Wolfville, NS

Gary W. Ness, Acadia University, Wolfville, NS

Rene J.L. Murphy, Acadia University, Wolfville, NS

Dr. Pelletier is an Assistant Professor in the School of Education at Acadia University. Dr. Ness is a Full Professor and Director and Dr. Murphy is an Associate Professor in the School of Recreation Management and Kinesiology at Acadia University.
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Author:Murphy, Rene J.L.
Publication:Academic Exchange Quarterly
Date:Dec 22, 2006
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