Physiotherapy 98 (2012) 330–335

Problem Based Learning in physiotherapy education: a practice

perspective
Hilary Gunn ∗ , Heather Hunter, Bernhard Haas
University of Plymouth, Devon, UK

Abstract
Background Problem Based Learning (PBL) has been integrated into a range of health education curricula; however there is limited research
evaluating the application of skills developed through PBL in clinical practice.
Aim This study aimed to provide evidence of how skills gained through PBL are applied in practice by student physiotherapists, from the
perspective of their placement supervisors.
Method A qualitative one-to-one semi-structured interview methodology was used, purposively recruiting a sample of 10 qualified physio-
therapists with experience of placement supervision of students studying on a PBL physiotherapy undergraduate degree.
Results The supervisors felt that PBL offered positive benefits for both student education and clinical practice. There was evidence of the
application of skills and attributes associated with PBL, including positive learning behaviours and a high level of motivation and self-direction.
Supervisors felt that proactive students were able to apply transferable skills inherent in the PBL approach to clinical practice, including a
holistic, problem-solving approach and effective team-working but that there was considerable variation between students.
Conclusions There is evidence of variable application of skills associated with PBL in clinical practice in this study group. Further research
would be useful to explore the factors that enable students to successfully apply the attributes developed using a PBL approach into practice.
© 2011 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Keywords: Physiotherapy; Practice learning; Problem Based Learning; Student performance

Introduction practice [6]. However, there is currently a dearth of research

Problem Based Learning (PBL) represents a major and
widespread change in health professional education [1]. Pro-
ponents of PBL suggest that it is likely to foster improved
lifelong learning skills characterised by constructive, collab-
orative, self-directed and, contextual learning [2], and that it
stimulates a deeper approach to learning [3]. Others argue
that PBL does not prepare students in the core areas of basic
sciences such as anatomy [4]. However, a recent systematic
review has suggested that the approach is suited to develop-
ing student performance in interpersonal and social domains
whilst maintaining levels of knowledge, clinical skills and
reasoning [5]. This is attractive, particularly given the impor-
tance placed on these attributes in reviews of healthcare
∗ Corresponding author at: University of Plymouth, School of Health Pro-
fessions, SF23, PAHC Building, Derriford Rd, Plymouth PL6 8BH, UK.
E-mail address: hilary.gunn100@plymouth.ac.uk (H. Gunn).
which specifically evaluates the application of these skills in
practice [7,8].
The three year BSc (Hons) Physiotherapy course at the
University of Plymouth commenced in 2004. Mature students
over 21, comprise 50% of applicants. With the exception of
the first term, the programme utilises a hybrid PBL curricu-
lum which incorporates PBL scenarios supported by lectures
and practical skills classes. As students undertake place-
ments throughout the three years of their degree, the clinical
physiotherapists who supervise the students in practice are
uniquely placed to evaluate the performance of PBL educated
students. This study aimed to investigate the application of
skills gained through PBL in practice, and to explore how
the students are perceived by their placement supervisors.
The study was designed in two parts, the first consisting of
qualitative analysis of placement feedback documentation
provided by practice educators at the completion of each
practice placement. Part two consisted of semi-structured

0031-9406/$ – see front matter © 2011 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.physio.2011.05.005
 H. Gunn et al. / Physiotherapy 98 (2012) 330–335 331

Table 1
Characteristics of participants included within the study sample.
Participant no. 1 2 3 4 5 6 7 8 9
Years Supervision 4 >4 7 10 7 >4 10 6 >15
Supervised PBL Yes Yes Yes Yes Yes Yes Yes Yes Yes
Supervised non PBL Yes Yes Yes Yes Yes Yes Yes Yes Yes
Placement setting In patient In patient In patient Community Community In patient Community In patient Out patient

interviews carried out with individual supervisors to gain a
more in-depth insight and to enable further exploration of the
initial themes. This paper reports on the key findings of part
two of the study.
to reach consensus on initial themes. Coding of the other
transcriptions was subsequently undertaken by one member
of the team (HG); this was then reviewed (by HH and BH)
for reliability and further discussion and development of the
themes.

Method Findings and discussion

A qualitative methodology utilising a one-to-one semi- Three main themes relating to the study aims were devel-
structured interview approach was employed, using an oped from the interviews (Table 2).
interview schedule developed from the findings of part one of These were:
the study. The interview schedule contained prompts relating
to the participant’s work environment, supervision practice • Perceptions of PBL.
and experience, as well as, exploratory prompts relating to • Attributes of the students in practice (responsiveness,
their perception and understanding of PBL and the perfor- approach, self-management, actions and performance).
mance of the students they had supervised. • Factors affecting success.

Participants and procedure

Theme 1: perceptions of PBL
A sample of physiotherapists with experience of super-
The participants demonstrated a clear understanding of
vising our students was recruited from NHS trusts within the
both the ethos and process of PBL. They were able to discuss
South West peninsula of the UK. A purposive sample of 10
the main aspects of the PBL approach, and also to reflect on
participants was developed from the initial pool of respon-
how it differs from the traditional curriculum.
dents, aiming to include a spread of participants from across
There was a perception that a PBL approach offered a
geographical and practice speciality areas. The characteris-
range of benefits for both student education and clinical prac-
tics of the participants and their supervisory experience are
tice, although there was recognition of variability between
detailed in Table 1.
students. Participants suggested a variety of factors that may
Interviews were undertaken by lecturers (HG HH) who
be linked to the students’ ability to fully engage with the
were involved in the design and teaching of the programme.
process, including degree of maturity, learning approach and
Each interview was recorded and lasted approximately 45
motivation.
minutes.
“I think it works differently for different students and I think
Ethical consent certain ones really grab the idea and benefit a lot whereas I
think others find it a bit more of a challenge” Participant 2
Consent for the study was granted by Plymouth and Recognition of individual variations between students
Cornwall Research Ethics Committee, and the Research occurred on a number of occasions throughout the interviews,
and Development departments of each participating Trust. and will be further discussed within later themes.
Informed consent was gained prior to the commencement of
the interview and all contributions were anonymised.
Theme 2: attributes of the students in practice
Analysis
Responsiveness and flexibility
All interviews were fully transcribed and analysed using
thematic analysis techniques [9]. Two researchers (HG, HH) As with the findings of previous studies and reviews
undertook initial analysis and coding of four randomly [5] there was a strong perception that students with a PBL
selected transcriptions, and discussed their interpretations background demonstrated positive attributes in this area. Par-
 332
Table 2
Summary of themes/sub themes and participant views.
Theme/subthemes Participant Participant Participant Participant Participant Participant Participant Participant Participant

1 2 3 4 5 6 7 8 9
Responsiveness and flexibility
• Manage workload Yes Yes but Yes but
variable variable
• Integration with Identified as Identified as Identified as Identified as Identified as Identified as Identified as Identified as
team/reliability a strength a strength a strength a strength a strength strength a strength a strength
• Communication Yes Yes Yes Yes Yes Yes Yes Yes
skills
Approach Yes Yes Yes Yes Yes Yes Yes Yes
• Maximising
opportunities

H. Gunn et al. / Physiotherapy 98 (2012) 330–335

Self management Joint goal Yes Yes Joint goal Yes Yes Yes
• Openness setting setting
• Use of learning
strategies
Actions and Yes Yes Yes Yes
performance
• Holistic
• Reflec- Yes Yes Yes Identified as Yes Yes Yes
tive/evaluative/problem variable
solving
• Integration of Yes Yes Yes Yes Yes Yes Yes
EBP/ideas genera-
tion/reasoning
Factors affecting Issue which Issue which Issue which Issue which Issue which Issue which Issue which Issue which Identified as a
success determined determined determined determined determined determined determined determined strength
• Proactive in student student student student student student student student
learning/self performance performance performance performance performance performance performance performance
directedness
• Determination to
understand
• Knowledge of SWOT Yes Yes Yes Yes
strength and shared
weaknesses
• Variability of Yes Yes Yes Yes Yes Yes Yes Yes Improving
student
• Knowledge of Variable hands Deficiencies in Some Limited hands None Minor issues Initial issues Minor Patchy
sciences on skills anatomy deficiencies in on skills and with handling with anatomy deficiencies in anatomy
• Clinical skills anatomy and anatomy – but improved anatomy and knowledge
(handling) handling handling
 H. Gunn et al. / Physiotherapy 98 (2012) 330–335
ticularly identified was the ability to integrate into a team and
to draw on the strengths of all team members.
“they’re very aware of team working. -they’re used to the idea
that they’ll pull on other people’s knowledge and background
and make use of their expertise” Participant 4
The need to develop a problem solving approach to
practice has also been highlighted as key to developing prac-
titioners who are able to work effectively in the modern
healthcare environment [6]. In this study, there was recog-
nition that PBL based students were able to utilise and apply
existing skills and knowledge to new scenarios, and that this
was particularly relevant to the practice setting.
“I think they are better prepared because they understand
that they have to find out information if they don’t know
something and apply it to the clinical situation that they are
in” Participant 3
“They bring ideas to you that you can start talking about.
They’re very inquisitive, they’re not afraid to ask but they
engage well in clinical discussions. Participant 5
It has been theorised that PBL may be a particularly ben-
eficial approach to aid the development of these skills and
attributes [5]. Integral to the PBL process is the need for stu-
dents to review scenario data, to reflect on existing knowledge
and experience and to generate ideas and theories linking
problems with solutions which are then backed up by research
and acquisition of further knowledge [7]. Students there-
fore may tend to develop a more questioning and inquisitive
approach because of the need to seek out information rather
than for it simply to be provided. Within the literature there
has been debate as to whether this effect is more due to selec-
tion bias at admission than skill development during training,
although research by McManus et al. [10] suggests that selec-
tion bias cannot account for all of the variances seen in the
performances of students.
Approach to placement
Participants highlighted a number of aspects of student
behaviour associated with PBL related to this area. In agree-
ment with other studies [5], there was a perception that
students tended to approach their placement experiences with
a high degree of self motivation:
“(PBL) encourages them to be self-motivated learners, which
are what they have to be really throughout their career.
They’ve got to know what they don’t know and go and find
out about [it].” Participant 4
However, there was recognition that less successful stu-
dents tended to struggle with their approach to both learning
and placement experiences. Although there was recognition
that stronger students utilised their knowledge and experi-
ence proactively in novel situations, participants felt that less
successful students not only struggled to acquire knowledge
333
initially, but also found it challenging to apply theory to
practical situations.
“I might start them off (with a treatment) and I’ll give them
two or three things and then they’re stuck.. they do find it
a little bit difficult linking theory with the actual practice”
Participant 2
The successful application of theory to practice has been
highlighted as a key issue within health education curric-
ula, and also an area where it has been suggested that the
use of a PBL approach may be particularly effective to
facilitate improvements [11]. Whilst participants felt that
many students demonstrated strengths in this area, there was
recognition that this remained a challenge; their experiences
suggest that some students may need further help and input
to successfully integrate theory into practice.
Self management
The demonstration of effective learning strategies by stu-
dents on placement was one of the areas identified as a
particular strength of PBL educated students. Participants
highlighted a range of positive attributes in this area.
“generally they’re advanced, . . . they’re much more confi-
dent, they know where to go for stuff;” Participant 8
Although the development of positive learning behaviours
has been demonstrated in other studies evaluating perfor-
mance in the educational setting [5,7,13], the experiences
of our interviewees suggests that this is an attribute which
appears to be transferred from the learning context to the prac-
tice environment. Participants recognised that the students
implemented a range of positive learning behaviours includ-
ing reflection, self-evaluation and self-directedness, and felt
that these positively impacted on placement performance
[7]. It was interesting to note that in some circumstances,
participants reported that positive learning behaviour did
not necessarily lead to successful placements, suggesting
that it may be important not only to develop an appropri-
ate approach but also to ensure that the application of that
approach is successfully channelled into relevant learning
activities.
Actions and performance
In the areas related to actual physiotherapy practice, the
interviewees identified both strengths and weaknesses associ-
ated with the PBL approach. Particular strengths included the
ability to utilise a holistic approach to patient management,
and being able to problem-solve in unfamiliar situations.
“I think that the problem based learning enables the students
really to treat the patient as an individual and consider the
patient holistically, I think it works very well from that point
of view” Participant 1
334 H. Gunn et al. / Physiotherapy 98 (2012) 330–335
Areas where participants highlighted concerns centred on
the acquisition of fact based knowledge and hands-on prac-
tical skills through the course.
“I think that sometimes they don’t come with as many prac-
tical skills as we’d like. . . and maybe less knowledge of
anatomy” Participant 8
This concern about levels of ‘fact based’ learning within
a PBL environment is not new, and there has been much dis-
cussion of the relative merits of various approaches in terms
of performance in fact based tests within the literature [4].
However, the findings of review studies consistently suggest
that PBL students perform at least as well as their peers on
qualification [5], and that the level of performance in specific
areas (such as anatomy) is generally equivalent to that of their
non-PBL educated peers [12].
Theme 3: factors affecting success
Participants identified several key attributes that they felt
contributed to student success on placements: the overall atti-
tude of the student and the manner in which they approached
their learning was a key factor. Motivation, enthusiasm, and
willingness to ‘have a try’ were all considered to posi-
tively impact on student success. This raises the question
whether this style of learning is particularly facilitated by
the PBL approach, or is something inherent in these stu-
dents. According to Baeten et al. [13] and Richardson [14]
student centred approaches to learning such as PBL can pro-
mote an ‘active’ or deeper approach to learning. However
student centred variables such as personality, experience,
learning habits, and preferences to learning as well as the
context of the learning experience can also have an influence
[13,14]. Within these discussions the question was raised
as to whether the PBL approach was suited to all types of
students, and that possibly those individuals who found a col-
laborative activist approach more challenging may find this
approach less beneficial. The participants expressed concern
that mechanisms need to be in place to recognise and support
individuals who may be struggling, to facilitate their learning
and to enable them to develop appropriate strategies to ensure
success.
Conclusions
The practice educators generally demonstrated a good
awareness of the PBL approach and felt that it offered posi-
tive benefits for both student education and eventual clinical
practice. In this study, there appears to be some evidence
of the clinical application of skills and attributes which are
purported to be developed by the use of a PBL approach. Prac-
tice educators particularly identified that students tended to
demonstrate positive learning behaviours and a high level
of self direction during their placements. There was also
evidence of the application of other transferable skills inher-
ent in the PBL approach to the practice setting, including
good interpersonal skills, which were particularly evident
within the multidisciplinary team environment and a holis-
tic, problem-solving approach to their clinical practice. In
line with the findings of other research, the levels of factual
knowledge demonstrated by the students were not consid-
ered to be superior to those who have learnt using other
approaches.
Throughout this study there has been a recurring ques-
tion of whether the attributes displayed by students are the
result of inherent individual characteristics, or the use of a
PBL approach in their learning. The degree of resonance
between the positive attributes that participants felt were dis-
played by the students and those that are highlighted within
the literature may suggest at least some influence of the PBL
approach. However the variation that was highlighted within
students coming from the same approach would suggest that
individual characteristics are significant, and would raise the
question as to whether this approach is suited to all learners
or merely for those who may display an inherent preference
toward collaborative self-directed learning activities.
Further research would be particularly useful exploring the
particular characteristics that enable students to successfully
apply the attributes developed using a PBL approach into
practice.
Ethical approval
Plymouth and Cornwall NHS Research Ethics Committee.
Reference No: 08/H0203/15.
Declarations of interest
None.
Funding source
This project was funded by a grant from the University of
Plymouth CEPPL project.
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